Abstract
Knee joints (n=30) from 22 adult rheumatoid arthritis (RA) patients who were previously randomized and subjected to a six-month double-blind controlled trial of yttrium-90 vs. triamcinolone hexacetonide with a six-year follow-up. In contrast to most previous studies, there was no co-administration of a steroid agent at the time the radiopharmaceutical was injected. One month after treatment the triamcinolone group had less pain (p<0.05), fewer effusions (p<0.001) and a better range of movement (p<0.01) than the yttrium group. Six months after treatment, the response in the triamcinolone group had partially regressed but was still superior to that of the yttrium group (p<0.05). At the six-year follow-up, half the yttrium-treated knees were found to have required treatment by intra-articular steroid, surgical synovectomy or total knee arthroplasty. The rates for therapeutic success were no different for yttrium-90 or triamcinolone. These results bring into question the reported efficacy of yttrium-90 and suggest that the benefit observed in clinical practice may be dependent upon the co-administration of a corticosteroid agent, and that the long-term benefits of yttrium may be relatively small.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Ansell BM, Crook A, Mallard JB, Bywaters EGL. Evaluation of intra-articular colloidal Au-198 in the treatment of persistent knee effusions. Ann Rheum Dis. 1963;22:435–439.
Beatson TR. Radiation synovectomy (synoviorthesis) for rheumatoid arthritis in the Isle of Man. Gerontology. 1982;28:258–264.
Boerbooms AMT, Buijs WCAM, Danen M, van de Putte LBA, Vandenbroucke JP. Radio-synovectomy in chronic synovitis of the knee joint in patients with rheumatoid arthritis. Eur J Nucl Med. 1985;10:446–449.
Lloyd DC, Reeder EJ. Letter: Chromosome abbreviations and intra-articular yttrium-90. Lancet. 1978;March 18:617.
Makin M, Robin GC. Chronic synovial effusions treated with intra-articular radioactive gold. J Am Med Assoc. 1964;188:725.
McCoy JM. Radioactive yttrium-90 intra-articularly for the treatment of rheumatoid arthritis—1 year follow up. J Med Assoc Ga. 1978;67:361.
Oka M. Radiation synovectomy of the rheumatoid knee with yttrium-90. Ann Clin Res. 1975;7:205–210.
Oka M, Hypen M. Radiation synovectomy—results in rheumatoid knee effusions treated with radioactive yttrium. Scand J Rheum. 1974;3:33.
Onetti CM, Gutierrez E, Hliba E, Aguirre CR. Synoviorthesis with32P-colloidal chromic phosphate in rheumatoid arthritis—clinical, histopathologic and arthrographic changes. J Rheumatol. 1982;9:229–238.
Sledge CB, Zuckerman JD, Zalutsky MR, Atcher RW, Shortkroff S, Lionberger DR, Rose HA, Hurson BJ, Lankenner Jr PA, Anderson RJ, Bloomer WA. Treatment of rheumatoid synovitis of the k knee with intraarticular injection of dysprosium 165-ferric hydroxide macroaggregates. Arthritis Rheum. 1986;29:153–159.
Spooren PFMJ, Rarker JJ, Arens RPJN. Synovectomy of the knee with 90Y. Eur J Nucl Med. 1985;10:441–445.
Szanto E. Long-term follow-up of yttrium-90 treated knee-joint arthritis. Scand J Rheum. 1977;6:209.
Bridgman JF, Bruckner F, Eisen V, Tucker A, Bleehen NM. Irradiation of the synovium in the treatment of rheumatoid arthritis. Q J Med. 1973;166:357–367.
Yates DB, Scott JT, Ramsey N. Abstract: Double-blind trial of yttrium-90 for chronic inflammatory synovitis of the knee. Ann Rheum Dis. 1977;36:481.
Arthritis and Rheumatism Council Multicentre Radiosynoviorthesis Trial Group. Intra-articular radioactive yttrium and triamcinolone hexacetonide: an inconclusive trial. Ann Rheum Dis. 1984;43:620–623.
Lee P. Editorial: The efficacy and safety of radiosynovectomy. J Rheumatol. 1982;9:165–168.
Ropes MW, Bennett EA, Jacox R, Jessar R. 1958 revision of diagnostic criteria for rheumatoid arthritis. Bull Rheum Dis. 1958;9:175.
Bown BM, Darracott J, Garnett ES, Tomlinson RH. Letter: Radioisotope synovectomy. Can Med Ass J. 1975;113:815.
Gumpel JM, Beer TC, Crawley JCW, Farran HEA. Yttrium-90 in persistent synovitis of the knee: a single center comparison. The retention and extra-articular spread of four yttrium-90 radiocolloids. Br J Radiol. 1975;49:337.
Davis P, Jayson MIV. Acute knee joint rupture after yttrium-90 injection. Ann Rheum Dis. 1975;34:62.
Daker MG. Prospective chromosomal study of 30 patients undergoing yttrium-90 synovectomy. Rheumatol Rehabil Suppl. 1979;41.
de la Chapelle A, Oka M, Rekonen A, Ruotsi A. Chromosomal damage after intra-articular injections of radioactive yttrium. Effect of mobilization on biological dose. Ann Rheum Dis. 1972;32:508–572.
Gumpel JM, Stevenson AC. Chromosomal damage after intra-articular injection of different colloids of yttrium-90. Rheumatol Rehabil. 1975;14:7–12.
Stevenson AC, Bedford J, Dolphin GW, Purrott RJ, Lloyd DC, Hill AGS, Hill HFH, Gumpel JM, Williams D, Scott JT, Ramsey NW, Bruckner PE, Fearn CBD. Cytogenic and scanning study of patients receiving intra-articular injections of gold-198 and yttrium-90. Ann Rheum Dis. 1973;32:112–121.
Delbarre F, Menkes CJ, Aignan M, Roucayrol JC, Ingrand J, Sanchez A. Une nouvelle preparation radioactive pour la synoviorthese: le rhenium-186 colloidal. Nouv Presse Med. 1973;2:1372.
Winston MA, Bluestone R, Cracchiolo A, Blahd WH. Radioisotope synovectomy with32P-chromic phosphate—kinetic studies. J Nucl Med. 1973;14:886–889.
Gumpel JM, Mathews SA, Fisher M. Synoviorthesis with Erbium-169: a double-blind controlled comparison of Erbium-169 with corticosteroids. Ann Rheum Dis. 1979;38:341.
Ruotsi A, Hypen M, Rekonen A. Erbium-169 versus triamcinolone hexacetonide in the treatment of rheumatoid finger joints. Ann Rheum Dis. 1979;38:45–47.
Author information
Authors and Affiliations
Additional information
An erratum to this article is available at http://dx.doi.org/10.1007/BF02755888.
Rights and permissions
About this article
Cite this article
Grant, E.N., Bellamy, N., Fryday-Field, K. et al. Double-blind randomized controlled trial and six-year open follow-up of yttrium-90 radiosynovectomy versus triamcinolone hexacetonide in persistent rheumatoid knee synovitis. Inflammopharmacology 1, 231–238 (1992). https://doi.org/10.1007/BF02735372
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02735372