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Ann Rheum Dis 1999;58:554-558 doi:10.1136/ard.58.9.554
  • Extended report

Double blind glucocorticoid controlled trial of samarium-153 particulate hydroxyapatite radiation synovectomy for chronic knee synovitis

  1. E K O’Duffya,
  2. G P R Clunieb,
  3. D Luia,
  4. J C W Edwardsb,
  5. P J Ella
  1. aInstitute of Nuclear Medicine, University College London, bRheumatology Unit, University College London
  1. Professor P J Ell, Institute of Nuclear Medicine, The Middlesex Hospital, Mortimer Street, London W1N 8AA.
  • Accepted 4 May 1999

Abstract

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.

OBJECTIVES To establish whether Sm-153 PHYP radiation synovectomy results in a clinically useful benefit sustained at one year.

METHODS In 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.

RESULTS Sixty 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 (χ2=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 (χ2 =2.61, 0.2>p>0.1, n=31).

CONCLUSIONS There 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.

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