Re-Evaluating the Need for Hospitalization Following Synovectomy Using Yttrium-90 Silicate

Jaworski, Rudolf A.; McLean, Richard G.; Choong, Kevin K. L.; Smart, Richard C.; Edmonds, John

doi:10.1093/rheumatology/32.11.1012

Cited by 18 publications

(9 citation statements)

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“…This result coresponds with other reported observations, mainly in patients with arthritis. 15,16,21,22 Blood-pool activity is supposed to represent acute synovitis, which is the main target of radiosynovectomy. Nuss et al reported that the severity of synovial hyperplasia was generally unchanged 6 months after radiosynovectomy despite an improvement in hemorrhage frequency based on MRI findings in patients with hemophilia.…”

Section: Discussionmentioning

confidence: 99%

Radiosynovectomy in Hemophilic Synovitis: Correlation of Therapeutic Response and Blood-Pool Changes

Türkmen

Zülflkar

Taşer

et al. 2005

Cancer Biotherapy and Radiopharmaceuticals

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Section: Discussionmentioning

confidence: 99%

Radiosynovectomy in Hemophilic Synovitis: Correlation of Therapeutic Response and Blood-Pool Changes

Türkmen

Zülflkar

Taşer

et al. 2005

Cancer Biotherapy and Radiopharmaceuticals

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“…3 The relatively long half life of 90 Y (2.7 days) is an argument for post-injection immobilisation (usually 72 h) to minimise extra-articular leakage to the bloodstream by intermittent intra-articular pressure in the ambulant patient and as such improve retention in the knee. 4 The clinical outcome of RSO has been suggested to depend on the primary disease and pre-existing radiological damage. 5 Previous studies also indicated that the efficacy might depend on the diagnosis: patients with rheumatoid arthritis might respond better to RSO than those with other arthritides caused by a more pronounced synovial tissue proliferation in rheumatoid arthritis.…”

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confidence: 99%

Pretreatment macrophage infiltration of the synovium predicts the clinical effect of both radiation synovectomy and intra-articular glucocorticoids

Jahangier

2006

Annals of the Rheumatic Diseases

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Objective: To explore whether pretreatment features of synovial tissue in patients with gonarthritis could predict the clinical effect of radiation synovectomy with yttrium-90 ( 90 Y) and glucocorticoids or with intraarticular glucocorticoids alone. Methods: A synovial biopsy was carried out blindly 2 weeks before treatment in 66 patients with persistent gonarthritis, who were randomised to treatment either with 90 Y and triamcinolone or with placebo and triamcinolone. Immunohistochemistry was used to detect T cells, macrophages, B cells, plasma cells, fibroblast-like synoviocytes, adhesion molecules and pro-inflammatory cytokines. Stained sections were evaluated by digital image analysis. Individual patient improvement was expressed using a composite change index (CCI; range 0-12). Successful treatment was defined as CCI >6 after 6 months. Results: Patients with rheumatoid arthritis, psoriatic arthritis, undifferentiated arthritis and other causes of gonarthritis were included. The overall response rate was 47%. Clinical efficacy in both therapeutic groups was similar and not dependent on diagnosis. No significant differences were noted between baseline microscopic features of synovial tissue inflammation in patients with rheumatoid arthritis and in those with non-rheumatoid arthritis (ie, all diagnoses other than rheumatoid arthritis). The number of macrophages in the synovial sublining was significantly higher in responders than in non-responders (p = 0.002), independent of treatment group and diagnosis. The clinical effect was positively correlated with pretreatment total macrophage numbers (r = 0.28; p = 0.03), sublining macrophage numbers (r = 0.34; p = 0.005) and vascular cell adhesion molecule 1 expression (r = 0.25; p = 0.04). Conclusion:The observations support the view that intra-articular treatment either with 90 Y and glucocorticoids or with glucocorticoids alone is especially successful in patients with marked synovial inflammation.

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“…Necrosis of the synovium, followed by fibrosis and, finally, sclerosis, is induced by local irradiation. The half‐life of 90 Y is 2.7 days, and for this reason, the injected extremity is immobilized for 72 hours to minimize extraarticular leakage into the bloodstream that typically occurs through intermittent IA pressure in the nonimmobilized extremity (3). Immobilization itself may also lead to a reduction in synovitis (4–9).…”

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confidence: 99%

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

Jacobs

Lafeber

et al. 2005

Arthritis & Rheumatism

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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 >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.In patients with persistent synovitis despite treatment with nonsteroidal antiinflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and/or intraarticular (IA) glucocorticoids (GCs), radiation synovectomy (or, radiosynoviorthesis [RSO]) may be indicated. RSO is performed by IA administration of a radioactive isotope; yttrium-90 is

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Re-Evaluating the Need for Hospitalization Following Synovectomy Using Yttrium-90 Silicate

Cited by 18 publications

References 0 publications

Radiosynovectomy in Hemophilic Synovitis: Correlation of Therapeutic Response and Blood-Pool Changes

Radiosynovectomy in Hemophilic Synovitis: Correlation of Therapeutic Response and Blood-Pool Changes

Pretreatment macrophage infiltration of the synovium predicts the clinical effect of both radiation synovectomy and intra-articular glucocorticoids

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

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