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Effectiveness of radiation synovectomy with Yttrium-90 and Samarium-153 particulate hydroxyapatite in rheumatoid arthritis patients with knee synovitis: a controlled, randomized, double-blinded trial

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Abstract

The aim of the present study was to investigate the long-term effectiveness of and tolerance to Yttrium-90 and Samarium-153-particulate hydroxyapatite radiation synovectomy in patients with rheumatoid arthritis (RA) and chronic knee synovitis. Eight-four patients (90 knees) with chronic knee synovitis and RA (according to the American College of Rheumatology criteria) participated in a controlled, double-blinded trial. Patients were randomized to receive an intra-articular injection with either 5 mCi Yttrium-90 plus 40 mg of triamcinolone hexacetonide (Y/TH Group), 15 mCi Samarium-153 hydroxyapatite plus 40 mg of triamcinolone hexacetonide (Sm/TH Group), or 40 mg triamcinolone hexacetonide alone (Control Group). Blinded examination at baseline, 1, 4, 12, 32, and 48 weeks post-intervention included a visual analog scale for joint pain and swelling, morning stiffness, range of motion, knee circumference, Likert scale, percentage of improvement, Stanford Health Assessment Questionnaire, Lequesne index, use of non-steroidal anti-inflammatory drugs and corticosteroids, events and adverse effects, calls to the physician, and hospital visits. There were three withdrawals prior to the injections. Regarding the pain, there was a significantly better response in the Y/TH Group versus the Sm/TH Group at T1 (p = 0.025) and versus TH alone at T48 (p = 0.026). The Sm/TH group had more adverse effects (p = 0.042), but these were mild and transitory. For the pain parameter alone, Yttrium-90 radiosynovectomy associated to TH proved superior to Samarium-153 hydroxyapatite radiosynovectomy associated to TH at T1 and to synovectomy with TH at T48. No other statistically significant inter-group differences were detected.

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Acknowledgements

This study was supported by the Brazilian fostering agency Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).

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Authors and Affiliations

  1. Division of Rheumatology, Universidade Federal de São Paulo–Escola Paulista de Medicina (UNIFESP), São Paulo, Brazil

    Marla Francisca dos Santos, Rita Nely Vilar Furtado, Monique Sayuri Konai & Jamil Natour

  2. Department of Radiology, Division of Nuclear Medicine, Universidade Federal de São Paulo–Escola Paulista de Medicina (UNIFESP), São Paulo, Brazil

    Mario Luiz Vieira Castiglioni & Renata Rosa Marchetti

  3. Instituto de Pesquisas Energéticas e Nucleares, Universidade de São Paulo, São Paulo, Brazil

    Constancia Pagano Gonçalves Silva

  4. Disciplina de Reumatologia, Universidade Federal de São Paulo, Rua Botucatu, 740, CEP 04023-900, São Paulo, SP, Brazil

    Jamil Natour

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  1. Marla Francisca dos Santos
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  2. Rita Nely Vilar Furtado
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Correspondence to Jamil Natour.

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dos Santos, M.F., Furtado, R.N.V., Konai, M.S. et al. Effectiveness of radiation synovectomy with Yttrium-90 and Samarium-153 particulate hydroxyapatite in rheumatoid arthritis patients with knee synovitis: a controlled, randomized, double-blinded trial. Clin Rheumatol 30, 77–85 (2011). https://doi.org/10.1007/s10067-010-1626-9

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  • DOI: https://doi.org/10.1007/s10067-010-1626-9

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