Extended report
Double blind glucocorticoid controlled trial of samarium-153
particulate hydroxyapatite radiation synovectomy for chronic knee
synovitis
E K O'Duffya, G P R Clunieb, D Luia, J C W Edwardsb, P J Ella
a Institute of Nuclear
Medicine, University College London, b Rheumatology Unit, University
College London
Correspondence to: Professor P J Ell, Institute of Nuclear Medicine, The Middlesex Hospital, Mortimer Street, London W1N 8AA.
Accepted for publication 4 May 1999
BACKGROUND
Samarium-153
particulate hydroxyapatite (Sm-153 PHYP) is a relatively new radiation
synovectomy agent developed for the treatment of chronic synovitis.
Although it has been shown that the levels of unwanted extra-articular
radiation are lower after intra-articular injection of Sm-153 PHYP than
yttrium-90 colloid, its clinical efficacy has not been rigorously studied.
OBJECTIVESTo
establish whether Sm-153 PHYP radiation synovectomy results in a
clinically useful benefit sustained at one year.
METHODSIn a
randomised double blind study, patients received either intra-articular
40 mg triamcinolone hexacetonide alone or 40 mg triamcinolone
hexacetonide combined with Sm-153 PHYP in an outpatient clinic.
RESULTSSixty patients
(28 male, 32 female), median age 51 (18-75) with chronic knee
synovitis were studied. Diagnoses included: rheumatoid arthritis
(n=29); psoriatic arthritis (n=9); ankylosing spondylitis (n=3);
reactive arthritis (n=2); undifferentiated seronegative oligoarthritis
(n=13) and miscellaneous inflammatory conditions (n=4). More patients
who received Sm-153 PHYP/triamcinolone hexacetonide sustained clinical
benefit a year after treatment compared with patients who received
corticosteroid alone (12 of 31 (39%) v 6 of
29 (21%), a difference of 18% more patients (95% CI 
5% to 41%))
though the difference was not significant (
2=2.31,
0.2>p>0.1, n=60). Despite the variation in injected activity (median
563 MBq, range 218-840 MBq), there was no obvious relation between low
levels of injected activity (<555 MBq) and relapse within 12 months of
treatment (2 =2.61, 0.2>p>0.1, n=31).
CONCLUSIONSThere was
no clear beneficial clinical effect of combined Sm-153
PHYP/triamcinolone hexacetonide injection over triamcinolone hexacetonide alone a year after treatment for chronic knee synovitis.
© 1999 by Annals of the Rheumatic Diseases
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