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

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.
To establish whether Sm-153 PHYP radiation synovectomy results in a clinically useful benefit sustained at one year.
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.
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 (chi(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 (chi(2) =2.61, 0.2>p>0.1, n=31).
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.
AuthorsE K O'Duffy, G P Clunie, D Lui, J C Edwards, P J Ell
JournalAnnals of the rheumatic diseases (Ann Rheum Dis) Vol. 58 Issue 9 Pg. 554-8 (Sep 1999) ISSN: 0003-4967 [Print] ENGLAND
PMID10460188 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
Chemical References
  • Anti-Inflammatory Agents
  • Glucocorticoids
  • Hydroxyapatites
  • Radioisotopes
  • samarium hydroxyapatite
  • Samarium
  • Triamcinolone Acetonide
  • triamcinolone hexacetonide
  • Administration, Topical
  • Adult
  • Aged
  • Anti-Inflammatory Agents (therapeutic use)
  • Chronic Disease
  • Combined Modality Therapy
  • Double-Blind Method
  • Female
  • Glucocorticoids
  • Humans
  • Hydroxyapatites (therapeutic use)
  • Knee Joint
  • Male
  • Middle Aged
  • Radioisotopes (therapeutic use)
  • Samarium (therapeutic use)
  • Synovitis (radiotherapy)
  • Triamcinolone Acetonide (analogs & derivatives, therapeutic use)

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