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The intra-articular distribution of 90yttrium does not influence the clinical outcome of radiation synovectomy of the knee
  1. Z N Jahangier1,
  2. F M van der Zant2,
  3. J W G Jacobs1,
  4. H G Riedstra3,
  5. G M M Gommans4,
  6. J F Verzijlbergen5,
  7. J W J Bijlsma1,
  8. J W van Isselt6
  1. 1Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Medical Center Alkmaar, Alkmaar, The Netherlands
  3. 3Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
  4. 4Westfries Gasthuis, Hoorn, The Netherlands
  5. 5Sint Antonius Hospital, Nieuwegein, The Netherlands
  6. 6University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to:
    Z N Jahangier
    Department of Rheumatology and Clinical Immunology F02.127, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; njahangier{at}; njahangier{at}


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% versus 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.

  • arthritis
  • yttrium
  • glucocorticoid
  • distribution
  • leakage
  • CCI, composite change index
  • GC, glucocorticoids
  • RSO, radiosynoviorthesis
  • SF, synovial fluid
  • 90Y, 90yttrium-citrate

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  • Funding: This work was supported by a grant from the Netherland’s Organization for Scientific Research (NWO) 920-03-053.

  • Competing interests: None declared

  • Published Online First 11 January 2007