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THU0132 A Prospective Observational Study on Long-Term Results of 90Yttrium Radiosynoviorthesis of Chronic Knee Synovitis in Rheumatoid Arthritis and Osteoarthritis Patients
  1. M. Szentesi,
  2. Z. Nagy,
  3. P. Géher
  1. Dept. Of Rheumatology, 1 Semmelweis Univ., Chair Of Rheumatology And Physiotherapy, Polyclinic Of The Hospitaller Brothers Of St. John Of God., Budapest, Hungary

Abstract

Background Inflammatory joint diseases are very common and are causing severe disability and reduced activity. Since more than 60 years radiosynoviorthesis is used for treatment of inflammatory joint diseases. In the literature there are very few data about long-term follow-up for more than one year of patients who underwent radiosynovectomy because of inflammatory joint diseases.

Methods Patients: A total of more than 6500 patients was referred to our center for radiosynovectomy because of inflammatory joint diseases since 1985. Long-term follow-up after radiosynovectomy was offered for a prospective observational study to 486 patients, 40 to 86 years of age, suffering either from rheumatoid arthritis or osteoarthritis of the knee joint, starting 5 years after intra-articular administration of 90yttrium citrate. All participants provided written informed consent. In all participants inflammatory knee joint disease was diagnosed on the basis of the American College of Rheumatology. 312 of 345 patients with rheumatoid arthritis were seropositive, 33 seronegative. Mean age of 108 male and 237 female patients was 61.6 years (range 40-84) years. In 180 patients the right knee, in 165 the left knee was treated by radiosynovectomy. Steinbrocker functional stadium II was observed in 165, stadium III in 165 and stadium IV in 15 of them. By radiography grades I (n=9), II (n=201), III (n=135), and IV (n=15) were observed. Grading was done according to Steinbrocker anatomic score. Mean duration of disease was 7.3 years (range 0.5-25), of synovitis (6.4 years (range 0.5-24) Mean number of punctions of the treated joint prior to radiosynovectomy was 12.3 per patient and of steroid administrations prior to radiosynovectomy 10.2. In 195 patients a systemic steroid therapy has been performed. 141 patients suffered from osteoarthritis (m: 46; female:96). All patients had a history of osteoarthritis of the knee joint causing pain and limitation of physical activity. Mean age was 61.5 years (range 40-86). The right knee was treated by radiosynovectomy in 71, the left in 70 patients. Mean duration of disease was 12.3 years (range 5-20), of synovitis 8.2 years (range 5-20). The mean number of punctions prior to radiosynovectomy was 8.7/patient and of intra-articular steroid administration 9.3. Following the Kellgren-Lawrence score in 9 patients grade I, 60 garde II, and 72 grade III was diagnosed. During the follow up period up to 10 years the individual response after radiosynovectomy was evaluated by an objective and subjective point system.

Results In the first ten years excellent and good results were recorded in 71%. They achieved excellent as well as good results at 83% of patients with rheumatoid arthritis, and at 55% of patients with osteoarthritis. Ten years after radiosynoviorthesis 72% of patients did not need another punction.

Conclusions Radiosynoviorthesis is as effectiv method of treating chronic synovitis as surgical synovectomy. Even after a ten-years period 71% the findings were rated as excellent or good. 72% of the patients do not need another punction even after a ten years period. The effectiveness is worsened significantly by the stadium of the disorder and the local x ray phase and diagnosis. P 0.00001. The treatment must be done in rheumatoid arthritis Steinbrocker stadium I-II, local stadium I-II.

Disclosure of Interest : None declared

DOI 10.1136/annrheumdis-2014-eular.4636

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