The intra-articular distribution of ⁹⁰Yttrium does not influence the clinical outcome of radiation synovectomy of the knee

ZN Jahangier ^1*, F M van der Zant ², JWG Jacobs ¹, HG Riedstra ³, GM Gommans ², JF Verzijlbergen ⁴, JWJ Bijlsma ¹ and JW van Isselt ¹

¹ UMC Utrecht, Netherlands
² Medical Center Alkmaar, Netherlands
³ Medisch Centrum Leeuwarden, Netherlands
⁴ St. Antonius Hospital Nieuwegein, Netherlands

^* To whom correspondence should be addressed. E-mail: njahangier{at}hotmail.com.

Accepted 2 December 2006

Abstract

Objectives:To assess the impact of the intra- articular distribution of ⁹⁰Yttrium-citrate (⁹⁰Y) on the clinical effect of radiosynoviorthesis (RSO) of the knee and on ⁹⁰Y leakage from this joint.

Methods:Patients with arthritis of the knee received 185 MBq ⁹⁰Y combined with a glucocorticoid, followed by clinical bed rest. Intra- articular ⁹⁰Y distribution, measured with a dual head gamma camera immediately or after 24 hours, was scored as mainly diffuse or mainly focal. Leakage to regional lymph nodes, the liver and spleen was assessed with a dual head gamma camera after 24 hours. Clinical effect was scored after 6 months by a composite change index (CCI), range 0-12; responders were defined as having a CCI 6.

Results:Seventy-eight knees of 69 patients, mostly suffering from undifferentiated arthritis (42%) or RA (28%), were treated. ⁹⁰Y distribution was mainly diffuse in 54% and mainly focal in 46% with clinical response rates of 40% vs. 56%, respectively, P=0.3. CCI was not correlated with distribution. ⁹⁰Y leakage was found only to the liver and the spleen (mean leakage 0.4% and 1.1%, respectively). Leakage was significantly less in case of diffuse intra- articular ⁹⁰Y distribution, whereas leakage to the liver was correlated with distribution (r=0.68, P<0.001). ⁹⁰Y leakage was not correlated with CCI.

Conclusions:Intra-articular ⁹⁰Y distribution does not influence the clinical effect of RSO of the knee. Although ⁹⁰Y leakage from the joint is less if ⁹⁰Y distributes diffusely in the joint cavity, leakage does not seem to hamper the clinical effect.

Keywords: arthritis, distribution, glucocorticoid, leakage, yttrium-90-colloid

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