Summary
Since the minimal effective dosage for radiosynovectomy is not known, we have performed a doubleblind controlled trial of 1 mCi vs. 5 mCi198 Au in 60 knees of 46 patients with persistent rheumatoid synovitis. The therapeutic effect was assessed with a clinical score,99mTc pertechnetate uptake measurements and plain X-rays. With regard to clinical parameters no statistical differences between the two groups were found, but results indicate a trend towards a better outcome in patients treated with 5 mCi.99mTc uptake improved significantly in patients treated with the higher dose and not in the low dose group. Weighing ease of treatment and risk of side effects against the small difference in effectiveness, we conclude that the use of less than 5 mCi of198Au may be justified. During the study the injection technique was changed, enabling a comparison of two methods. Leakage to lymph nodes and liver decreased when the needle was flushed with normal saline after administration of the radiocolloid.
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References
Ansell, B.M., Crook, A., Mallard, J.R., Bywaters, E.G.L. Evaluation of intra-articular colloidal Gold198Au in the treatment of persistent knee effusions. Ann Rheum Dis 1963, 22, 435–439.
Menkes, C.J., Aignan, M., Galmiche, B., Le Go, A. Le traitment des rheumatismes par les synoviortheses. Rhumatol (Paris) 1972, 2 (suppl. 1), 61–80.
Delbarre, F., Menkes, C.J., Aignan, M., Roucayrol, J.C., Ingrand, J., Sanchez, A. Une nouvelle preparation radioactive pour la synoviorthese: le rhenium 186 colloidal. Advantages par rapport au colloide d'or 198. Nouv Presse Med 1973, 2, 1372.
Gumpel, J.M. Radiation synovectomy. 111. Clinical application and investigation. Review of published and personal results. Ann Rheum Dis 1973, 32 (suppl.), 29–33.
Oka, M., Hypen, M. Radiation synovectomy. Results in rheumatoid knee effusions treated with radioactive Yttrium. Scand J Rheumatol 1974, 3, 33–38.
Winfield, J., Gumpel, J.M. An evaluation of repeat intra-articular injections of90Yttrium colloids in persistent synovitis of the knee. Ann Rheum Dis 1979, 38, 145–7.
Sledge, C.B., Zuckerman, J.D., Zalutsky, M.R. et al. Treatment of rheumatoid synovitis of the knee with intra-articular injection of dysprosium 165-ferric hydroxide macroaggregates. Arthritis Rheum 1986, 29, 153–9.
Gumpel, J.M., Roles, N.C. A controlled trial of intra-articular colloids versus surgical synovectomy in persistent synovitis. Lancet 1975, 1, 488–9.
Menkes, C.J., Le Go, A., Verrier, P. Delbarre, F. A controlled trial of intra-articular90Yttrium, osmic acid and triamcinolone hexacetonide in rheumatoid arthritis. Proc Int Congr Rheumatology 1977, Abstract nr 614.
Menkes, G.J., Le Go, A., Verrier, P., Aignan, M., Delbarre, F. Double-blind study of169Erbium injection (synoviorthesis) in rheumatoid digital joints. Ann Rheum Dis 1977, 36, 254–6.
Ruotsi, A., Hypen, M., Rekonen, A., Oka, M.169Erbium versus triamcinolone hexacetonide in the treatment of rheumatoid finger joints. Ann Rheum Dis 1979, 38, 45–7.
Sheppeard, H., Alden, A., Ward, D.J. Osmic acid vs Yttrium-90 in rheumatoid synovitis of the knee. Scand J Rheumatol 1981, 10, 234–6.
Bridgman, J.F., Bruckner, F., Eisen, V., Tucker, A., Bleehen, N.M. Irradiation of the synovium in the treatment of rheumatoid arthritis. Q J Med 1973, 42, 357–67.
Yates, D.B., Scott, J.T., Ramsey, N. Double-blind trial of Yttrium-90 for chronic inflammatory synovitis of the knee. Ann Rheum Dis 1977, 36 481.
Gumpel, J.M., Matthews, S.A., Fisher, M. Synoviorthesis with169Erbium: a double-blind comparison of169Erbium with corticosteroid. Ann Rheum Dis 1979, 38, 341–3.
Arthritis and rheumatism council multicentre radiosynoviorthesis trial group: Intra-articular radioactive Yttrium and triamcinolone hexacetomide: an inconclusive trial. Ann Rheum Dis 1984, 43, 620–3.
Williams, E.D., Caughey, D.E., Hurley, P.J., John, M.B. Distribution of Yttrium 90 ferric hydroxide colloid and gold 198 colloid after injection into the knee. Ann Rheum Dis 1976, 35, 516–520.
De la Chapelle, A., Oka, M., Rekonen, A., Ruotsi, A. Chromosome damage after intra-articular injections of radioactive Yttrium. Ann Rheum Dis 1972, 31, 508–12.
Stevenson, A.C., Bedford, J., Dolphin, G.W., et al. Cytogenetic and scanning study of patients receiving intra-articular injections of198Au and90Yttrium. Ann Rheum Dis 1973, 32, 112–23.
Nelson, B.M., Andrews, G.A., Watson, E.E. Histopathologic studies of the liver following intravenous colloidal198Au therapy. Radiology 1978, 127, 239–47.
Boerbooms, A.M.Th., Buys, W.C.A.M. Rapid assessment of99mTc-pertechnetate uptake in the kneejoints as a parameter of inflammatory activity. Arthritis Rheum 1978, 21, 348–52.
Kyle, V., Hazleman, B.L., Wraight, E.P. Yttrium-90 therapy and99mTc pertechnetate knee uptake measurements in the management of rheumatoid arthritis. Ann Rheum Dis 1983, 42, 132–7.
Winfield, J., Crawley, J.C.W., Hudson, E.A., Fisher, M., Gumpel, J.M. Evaluation of two regimens to immobilise the knee after injections of Yttrium-90. Br Med J 1979, i, 986–7.
Ingrand, J. Characteristics of radio-isotopes for intra-articular therapy. Ann Rheum Dis, 1973, 32(suppl), 3–9.
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Van Soesbergen, R.M., Hoefnagel, C.A., Marcuse, H.R. et al. Radiosynoviorthesis of the knee: A doubleblind trial of 1 versus 5 mCi Gold-198. Clin Rheumatol 7, 224–230 (1988). https://doi.org/10.1007/BF02204459
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DOI: https://doi.org/10.1007/BF02204459