Long-Term Follow-up of⁹⁰Yttrium-Treated Knee-Joint Arthritis

Abstract

The results are reported of the treatment of 33 patients with long-standing, therapy-resistant synovitis and effusion of the knee by intra-articular injection of 90Yttrium. In 25 patients with bilateral gonitis the effect of the treatment was compared with the effect of local corticosteroid therapy to the contralateral knee. The irradiated group showed statistically significantly better therapeutic results at 3, 6, and 12 months and the effect weakened in proportion to the length of the follow-up period. At the final check-up at 3.5 years, 52% of this group showed improvement, as against 26% of the controls. The difference in radiological deterioration at the end of the observation period between the two groups was not significant. Local remission in the treated joint in spite of high general activity was recorded in 7 patients. In 4 patients, in whom the results were unsatisfactory, severe articular destruction and instability were noted prior to therapy. Assessment of the correlation between clinical diagnosis and therapeutic results shows that the treatment seems to be most successful in patients with rheumatoid arthritis and unsatisfactory in patients with psoriatic arthritis. General reactions were observed in 1, and local reactions in 2 patients. Irradiation therapy seems to be the treatment of choice in patients over 40, with long-standing knee arthritis of rheumatic origin.

Radiosynovectomy using yttrium-90, phosphorus-32 or rhenium-188 radiocolloids versus corticoid instillation for rheumatoid arthritis of the knee

“…Szanto [30] demonstrated a significant benefit of Y-90 compared to intra-articular methylprednisolone (59 vs. 14% improved at 12 months after therapy, P \ 0.01). The ARC trial [31], comparing Y-90 and intra-articular triamcinolone hexacetonide, was terminated prematurely because of recruitment problems.…”

“…There are three controlled studies comparing RSO using Y-90 to intra-articular steroids alone [30][31][32]. Szanto [30] demonstrated a significant benefit of Y-90 compared to intra-articular methylprednisolone (59 vs. 14% improved at 12 months after therapy, P \ 0.01).…”

Efficacy and Safety of Radiation Synovectomy With Yttrium-90: A Retrospective Long-Term Analysis of 164 Applications in 82 Patients

“…Fourteen of 62 knee joints controlled by X-ray showed a subpatellar calcification; 12 of these cases had a homogeneous intra-articular distribution in the scintigraphic control whereas two showed a hot spot [13]. DISCUSSION Previous studies have demonstrated the efficacy of radiation synovectomy with Y90 and the statistically significant superiority of Y90 to saline, non-radioactive yttrium and corticosteroids [14,15] in the treatment of the large and medium sized joints in RA, PsA and OA [16,18].…”

The Role of Synovial Macrophages in Rheumatoid Arthritis and Osteoarthritis: Its Implications for Radiosynovectomy

“…Radiosynovectomy has been used since 1952, and the radionuclide yttrium-90 has been preferred for knee radiosynovectomies since the 1970s, due to strong β radiation and little γ-radiation. It has been diffi cult to evaluate the technique using double-blind clinical trials, although two trials show superiority of yttrium-90 knee radiosynovectomy over intra-articular triamcinolone [ 86 ] or methylprednisolone acetate [ 87 ]. Indications for radiosynovectomy include rheumatoid arthritis, other forms of chronic infl ammatory arthritis like psoriatic arthritis or ankylosing spondylitis with peripheral joint involvement, haemophilic synovitis and infl ammatory osteoarthritis.…”