Objective. The objective of this study is to determine the therapeutic efficacy of radiosynovectomy as compared to the conventional intra-articular therapy using steroids on rheumatoid and hemophilic arthropathy.
Methods. Yttrium -90 colloids and Rhenium 188 was injected intra-articularly in the knee of documented cases of RA and HA on one group and intra-articular steroids using Triamcinolone in the other RA group. Baseline radiography and two-phase bone scans were taken. These procedures were repeated at 6 and 12 months post-treatment. Clinical monitoring was done at 1, 3, 6, 9 and 12 months.
Results. There were a total of 60 patients recruited for the study but only 55 patients were evaluable as there were 5 dropouts. Thirty -nine (39) patients consisting of 18 RA patients (mostly females) and 21 HA patients (all males) were included in the first group. Thirty-eight of these patients were given Yttrium-90 colloid with doses ranging from 60 Mbq to 185 Mbq depending on the age of the patients and one patient was given Rhenium -188 colloid. The steroid group consisted of 16 RA patients (18 joints) who were given intra-articular steroids. Clinical parameters were monitored at 1, 3, 6 and 12 months. Improvement was very evident in the first group who underwent radiosynovectomy based on the following: the pain scoring system using the visual analog scale, lesser requirement for drugs, diminution of swelling, ability to ambulate, better quality of life, deformity and lesser episodes of bleeding and hence lesser or no need for Factor VIII transfusion. Objective findings as x-ray and bone scan were also included in considering success rate. The group on intraarticular steroids, which is one form of therapy, showed improvement in the first 2-3 months only and needed repeated injections and continued oral medications.
Conclusion. In conclusion, for the 39 patients who have completed the study after one year, combining both groups of hemophiliacs and rheumatoid arthritic patients, an 84 percent improvement was seen. For the individual groups, a 90 percent improvement was seen among the HA group and 78 percent improvement in the RA group; and both groups almost attained 50 to 70 to 100 percent degree of relief.
In the steroid group, all the patients (16 patients, 18 joints) needed continued concomitant medical treatment after intraarticular steroids and/or oral drugs. They were pain free -61% post treatment although the level was not high as the radiosynovectomy group as it only attained 50-60%degree of relief.
Comparing the efficacy on the two RA groups, the group who underwent radiosynovectomy and the group under intraarticular steroids, the p-value using Chi-square was 0.469 which is not significant considering the limited population as this just reflects the local results. This study was designed to be a multicenter, 12- countries study. As is, the results locally tend to show that radiosynovectomy offers a more comprehensive relief for RA as well as for the hemophilic group.
Radiosynovectomy is a simple, safe and cost-effective procedure that can be done on an outpatient basis. It is indicated in rheumatoid arthritis patients who are refractory to medical therapy and to those patients not suitable for surgery as the hemophiliacs. Radiosynovectomy has to be considered the initial procedure of choice for patients with hemarthroses in hemophiliacs. It provides relief of pain, decrease episodes of bleeding and future joint deformities as well as improve the quality of life. (Author)