Effectiveness of Radiation Synovectomy with Samarium-153 Particulate Hydroxyapatite in Rheumatoid Arthritis Patients with Knee Synovitis: A Controlled Randomized Double-Blind Trial

Abstract

OBJECTIVES:The aim of the present study was to investigate the effectiveness of Samarium153-particulate hydroxyapatite radiation synovectomy in rheumatoid arthritis patients with chronic knee synovitis.METHODS:Fifty-eight rheumatoid arthritis patients (60 knees) with chronic knee synovitis participated in a controlled double-blinded trial. Patients were randomized to receive either an intra-articular injection with 40 mg triamcinolone hexacetonide alone (TH group) or 40 mg triamcinolone hexacetonide combined with 15 mCi Samarium153-particulate hydroxyapatite (Sm/TH group). Blinded examination at baseline (T0) and at 1 (T1), 4 (T4), 12 (T12), 32 (T32), and 48 (T48) weeks post-intervention were performed on all patients and included a visual analog scale for joint pain and swelling as well as data on morning stiffness, flexion, extension, knee circumference, Likert scale of improvement, percentage of improvement, SF-36 generic quality of life questionnaire, Stanford Health Assessment Questionnaire (HAQ), Lequesne index, use of non-steroidal anti-inflammatory drugs or oral corticosteroids, events and adverse effects, calls to the physician, and hospital visits.RESULTS:The sample was homogeneous at baseline, and there were no withdrawals. Improvement was observed in both groups in relation to T0, but no statistically significant differences between groups were observed regarding all variables at the time points studied. The Sm/TH group exhibited more adverse effects at T1 (p<0.05), but these were mild and transitory. No severe adverse effects were reported during follow-up.CONCLUSION:Intra-articular injection of Samarium153-particulate hydroxyapatite (15 mCi) with 40 mg of triamcinolone hexacetonide is not superior to triamcinolone hexacetonide alone for the treatment of knee synovitis in patients with rheumatoid arthritis at 1 y of follow-up.

Cationic and Anionic Substitutions in Hydroxyapatite

“…In addition, recent studies reported the use of 153 Sm-hydroxyapatite particles as radiation synovectomy agents for the treatment of chronic synovitis [277][278][279], especially knee synovitis [277,278]. Moreover, 153 Sm-hydroxyapatite particles have to be considered as the best candidates for radiation synovectomy due to its shorter half-life and the lower extraarticular leakage of 153 Sm-hydroxyapatite [278].…”

Infiltrações intra‐articulares de triancinolona hexacetonida na artrite reumatóide: preditores de melhora a curto e longo prazo

“…As eficá-cias monoarticular e poliarticular da IIAC foram consideradas superiores ao uso sistêmico de corticosteroides; 10,11 o tornozelo foi considerado a articulação com menor precisão para IIAC às cegas; 6 o uso do ultra-som para guiar a infiltração de TH não aumentou a sua eficácia na articulação do punho, 12 e a utilização de radioisótopos (ítrio-90 e hidroxiapatita particulada de samário-153) não melhorou a eficácia da IIAC de TH, quando comparado com o uso simples da IIAC de TH. 7,8 Doses de TH pouco frequentes, por exemplo, 20 mg para a articulação MCF ou 80 mg para a articulação do joelho, foram utilizadas em nosso estudo. Ainda não foram estabelecidas as doses ideais de TH para IIAC, mas as mais comumente utilizadas são 40 mg para grandes articulaç ões e 10-20 mg para pequenas e médias articulaç ões.…”

“…O aumento da eficácia da IIAC, quando o procedimento foi associado ao uso de ítrio-90 e hidroxiapatita samário-153, foi questionado por estudos precedentes. 7 A análise univariada constatou que variáveis basais como "doses maiores de TH aplicadas via IIAC e por paciente", "infiltração poliarticular" e "estar usando leflunomida" foram associadas com as piores respostas à IIAC. Talvez uma dose mais agressiva de TH administrada via IIAC e um maior número de articulaç ões infiltradas estejam associados a maior exacerbação articular pós-IIAC e, por conseguinte, com uma percepção mais clara de agravamento no curto prazo.…”

“…[6][7][8][9][10][11][12][13] Por outro lado, se TH for injetada fora da articulação, poderá causar graves efeitos adversos locais. 14 Embora já tenham sido estabelecidos alguns conceitos relativos à IIAC, poucos estudos foram publicados com o objetivo de avaliar preditores de resposta em pacientes adultos com AR.…”

Nuclear Medicine in Musculoskeletal Disorders: Clinical Approach

“…Cases reported would further suggest its use in a wider spectrum of rheumatic disorders ranging from spondylitis to Paget's disease and from haemophiliac synovitis to pigmented villonodular synovitis. Nevertheless, despite abundant anecdotal evidence of its efficacy, there is a paucity of controlled trials and those that have been done have produced conflicting results (Dos Santos et al, 2009Santos et al, , 2011 and/or have been of insufficient sample size. Two meta-analyses have been published.…”