Clinical Trial of Dysprosium-165 HMA in the Treatment of Rheumatoid Knee Synovitis

Bae, Sang Cheol; Kim, Dong Yook; Kim, Tae Hwan; Jun, Jae Bum; Jung, Sung Soo; Lee, In Hong; Yoo, Dae Hyun; Kim, Seong Yoon; Kim, Sug Jun; Lee, Jong Seok; Jeon, Dae Geun; Lee, Soo Yong; Lim, Sang Moo; Park, Kyung Bae; Kim, Jae Rok

Abstract

OBJECTIVES
To evaluate the efficacy and safety of radiation synovectomy with Dy-165 HMA in chronic rheumatoid synovitis of the knee
METHODS
Two hundred thirty six knees of 212 patients with rheumatoid arthritis and persistent synovitis of the knee were treated with the intraarticular injection of 250~300 mCi of Dy-165 HMA which was prepared by KAERI. Efficacy was assessed by the following parameters: visual analog scale of the knee pain while walking and resting, circumference of the knee, range of motion of the knee. The final global assessment was classified as good, fair or poor. Estra-articular leakage of Dy-165 HMA was determined by blood pool and urine radioactivity and scintigraphic evaluation of liver, groin, and knee joints.
RESULTS
l) The optimum radiation dose was 260mCi. 2) The mean follow up periods were 50.4(24-112) weeks. 3) Forty four percent of the knees showed good results, 32% fair results, and 24% shwoed good results. 4) In knees with stage I radiographic changes, 81% showed improvement, of which 54% showed good results. In knees with stage II changes, 78% showed improvement including 39% of the patients with good results. There was a direct correlation between the radiographic stage and response to treatment. 5) The mean period of improvement for the 180 knees that reponded to treatment was 41.4(24-106) weeks. Ten of the 180 knees with improvement relapsed after the mean period of 64(28-80) weeks. 6) Leakage of radioactivity from the injected joint was minimal. 7) Adverse reactions were rare(radiation burn : 4, transient postinjection "flare" : 14).
CONCLUSIONS
The optimum radiation dose in Korean was somewhat less than of other foreign reports. Dy-165 HMA radiation synovectomy is a safe and useful therapy for chronic synovitis of the knee joint.