yttrium-silicate and Osteoarthritis

In 51 patients treated with Yttrium-90 (Y-90) synovectomy for rheumatoid (inflammatory) arthritis (IA) and OA of the knee we found that decreased retained knee activity (RKA) and increased extra-articular activity in lymph nodes and liver are more likely to be found in IA than OA and following bilateral knee injections. Joint inflammation, as assessed by radionuclide blood pool scan but not by SF white cell count, correlates with decreased RKA and increased activity in lymph nodes. Intra-articular steroid had no significant effect on retention or extra-articular uptake. Strict hospital immobilization improves RKA of Y-90 in IA but not in OA. Y-90 synovectomy in OA shows good RKA and low extra-articular uptake. We recommend strict immobilization following Y-90 synovectomy, particularly in IA patients and/or those with high joint blood flow.

Topics: Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid; Bed Rest; Evaluation Studies as Topic; Female; Hospitalization; Humans; Knee; Liver; Lymph Nodes; Male; Middle Aged; Osteoarthritis; Patient Discharge; Postoperative Period; Radionuclide Imaging; Silicates; Synovial Membrane; Yttrium; Yttrium Radioisotopes

The advantages of radiation synovectomy, using preparations containing dysprosium-165 (Dy-165), over conventional materials based on yttrium-90 (Y-90) include a more ideal spectrum of decay energies, and a much shorter half-life permitting quicker and more efficient treatment. A new therapeutic agent, Dy-165 hydroxide macroaggregates, has been developed for the treatment of arthritis making use of these advantages. As part of a clinical trial of this material 42 patients were examined for micronucleus frequency in their peripheral blood lymphocytes prior to, and 2 weeks after, radiation synovectomy using Dy-165 hydroxide macroaggregates or Y-90 silicate. In the majority of patients from each treatment group no significant increase in micronucleus frequency was observed. This indicates that in these cases leakage of material from the site of treatment was not resulting in detectable irradiation of circulating cells irrespective of the choice of radiopharmaceutical. The maximum increase in micronucleus frequency observed corresponded to a radiation dose to circulating cells of approximately 0.3 Gray.

Topics: Adult; Arthritis, Rheumatoid; Dysprosium; Female; Humans; Knee Joint; Lymphocytes; Male; Micronuclei, Chromosome-Defective; Middle Aged; Osteoarthritis; Radioisotopes; Silicates; Silicic Acid; Synovial Membrane; Yttrium

In 33 patients with chronic arthritis of the knee, 48 knees were treated with an intra-articular injection of 5 mCi yttrium silicate (90Y). There were 27 patients with rheumatoid arthritis (RA) and 6 with osteoarthrosis (OA); the mean follow-up period was 33 months. At clinical investigation after 1 year, no signs of pain or swelling were found in 15 knees. In most cases, pain and swelling improved subjectively, with a mean duration of 11 months; in 20 knees, the improvement lasted more than 22 months. When radiographs showed severe destruction, 90Y treatment was unsuccessful, but an important new finding was that most patients with mild or moderate radiological abnormalities appeared to have a long-lasting improvement. The result did not correlate with erythrocyte sedimentation rate (ESR), haemoglobin or Rose titre at the time of injection or at follow up, suggesting that the result of the treatment is more dependent on local factors than on the disease activity. The results of 90Y treatment in 6 OA knees with persistent swelling were promising regarding swelling, even in patients with moderate radiological abnormalities. The main side-effect was a sometimes painful swelling of the knee, which was always successfully treated with an intraarticular corticosteroid injection. In 90Y-treated knees, the incidence of unstable joints was not significantly higher than in non-treated knees. In conclusion, 90Y synovectomy may be a successful treatment for patients older than 50 years with chronic arthritis of the knee due to RA and probably also OA, even when moderate radiological abnormalities are present.

Topics: Aged; Arthritis; Arthritis, Rheumatoid; Female; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis; Silicates; Silicic Acid; Synovial Membrane; Yttrium; Yttrium Radioisotopes