RESEARCH - Is radiation synovectomy for arthritis of the knee more effective than intraarticular treatment with steroids?

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Arthritis Rheum. 2005 Nov;52(11):3391-402.

Comment in:

Arthritis Rheum. 2007 Jan;56(1):385.

Arthritis Rheum. 2007 Jan;56(1):386.

Is radiation synovectomy for arthritis of the knee more effective than

intraarticular treatment with glucocorticoids? Results of an

eighteen-month, randomized, double-blind, placebo-controlled,

crossover trial.

Jahangier ZN, s JW, Lafeber FP, Moolenburgh JD, Swen WA, Bruyn

GA, Griep EN, ter Borg EJ, Bijlsma JW.

Dept. of Rheumatology and Clinical Immunology F02.127, University

Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The

Netherlands.

OBJECTIVE: To compare the clinical efficacy and safety of radiation

synovectomy (RSO) with intraarticular (IA) yttrium-90 plus

glucocorticoids (GCs) with the efficacy and safety of IA placebo

yttrium plus GCs and to identify parameters that predict efficacy.

METHODS: The knees of 97 patients with persistent arthritis despite

outpatient treatment with IA GCs (n = 113 knees), were treated with

either IA (90)Y plus GCs (50%) or IA placebo yttrium plus GCs (50%),

followed by 3 days of bed rest in the hospital clinic, with splinting

of the treated knee. Predominant diagnoses were undifferentiated

arthritis (39%) and rheumatoid arthritis (32%). The clinical effect of

therapy was assessed at 6 months using a composite change index (CCI;

range 0-12). The primary outcome measure was the response rate (i.e.,

the percentage of joints with a CCI > or =6). Knees with persistent

arthritis after 6 months underwent crossover therapy (51% of the (90)Y

plus GCs group versus 45% of the placebo plus GCs group). Adverse

effects and radiologic damage during followup were documented.

RESULTS: Neither the response rate (48% in both groups), the mean CCI,

nor the duration of remission was significantly different between

groups. No clinically relevant short-term adverse effects were

observed, except for progression of radiologic damage in 34% of the

(90)Y plus GCs group versus 28% of the placebo plus GCs group (knee

prosthesis placement in 8% versus 1%). The functional and radiologic

status at study entry predicted the clinical effect.

CONCLUSION: Treatment with (90)Y plus GCs with bed rest and splinting

is not superior to IA GCs with bed rest and splinting. Over the short

term, both treatments appeared to be safe, although a negative effect

of (90)Y on cartilage and bone cannot be ruled out. Thus, it appears

that RSO with (90)Y should no longer be considered the treatment of

first choice for persistent arthritis of the knee.

PMID: 16255016

http://www.ncbi.nlm.nih.gov/pubmed/16255016

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