Radiation Synovectomy of knees with Yttrium-90 and Samarium-153 particulate hydroxyapatite in rheumatoid arthritis patients

Objectives. The aim of the present study was to investigate effectiveness of and tolerance to Yttrium-90 and Samarium-153-particulate hydroxyapatite radiation synovectomy in patients with rheumatoid arthritis (RA) and chronic knee synovitis. Methods. Eight-four patients (90 knees) with chronic knee synovitis and RA (according to the American College of Rheumatology criteria) participated in a controlled double-blinded trial. Patients were randomized to receive an intra-articular injection with either 5 mCi Yttrium-90 plus 40 mg of triamcinolone hexacetonide (Y/TH Group), 15 mCi Samarium-153-particulate hydroxyapatite plus 40 mg of triamcinolone hexacetonide (Sm/TH Group) or 40 mg triamcinolone hexacetonide alone (Control Group). Blinded examination at baseline (T0), one (T1), four (T4), 12 (T12), 32 (T32) and 48 (T48) weeks post-intervention was performed on all patients and included a visual analog scale (VAS) for joint pain and swelling, morning stiffness, range of motion, knee circumference, Likert scale, percentage of improvement, Stanford Health Assessment Questionnaire (HAQ), SF-36 Questionnaire, Lequesne index, use of non-steroidal anti-inflammatory drugs, use of oral corticosteroids, events and adverse effects, calls to the physician and hospital visits. Results. The sample was homogeneous at T0 and there were three withdrawals prior to the injections. No differences were found between groups for most variables. Regarding the variable pain (VAS), there was a significantly better response in the Y/TH Group versus the Sm/TH Group at T1 (p = 0.025*) and versus TH alone at T48 (p = 0.026*). The Sm/TH group exhibited more adverse effects (p = 0.042*), but these were mild and transitory. No severe adverse effects were reported during the follow up. Conclusion. With regard to pain, Yttrium-90 radiosynovectomy associated to TH provided better results than Samarium-153-particulate hydroxyapatite radiosynovectomy associated to TH as well as a better response than chemical synovectomy with TH alone.Objetivos: Comparar a efetividade e tolerância da sinovectomia radioisotópica realizada pelo 90Y e pelo 153SmPHYP associados ao HT no tratamento de sinovite crônica de joelhos em pacientes com artrite reumatoide (AR). Material e Métodos: 84 pacientes com AR (90 joelhos) com sinovite crônica de joelhos participaram de um estudo controlado, randomizado, duplo-cego. Os pacientes foram randomizados para receber infiltração do joelho guiada por fluoroscopia com 5 mCi de Ítrio-90 associado a 40 mg de hexacetonide de triancinolona (HT) (grupoY/HT) ou 15 mCi de Samário-153 hidroxiapatita associado a 40 mg de hexacetonide de triancinolona (grupo Sm/HT) ou 40 mg de hexacetonide de triancinolona isolada (grupo HT). Foram realizadas avaliações “cegas” dos pacientes no tempo inicial (T0), após uma (T1), quatro (T4), 12 (T12), 32 (T32), e 48 (T48) semanas da intervenção através dos seguintes instrumentos de avaliação: escala visual analógica (EVA) de dor e edema, rigidez matinal, amplitude de movimento, circunferência do joelho, Escala Visual Analógica de Melhora (EVAM) segundo o paciente e o avaliador, porcentagem de melhora segundo o paciente, questionário de avaliação funcional HAQ, questionário genérico de qualidade de vida SF-36, questionário de avaliação funcional Lequesne de joelho, consumo diário de diclofenaco e de prednisona, número de telefonemas para médico, número de idas ao hospital, número de efeitos adversos. Resultados: a amostra foi homogênea no tempo inicial e houve três perdas antes da intervenção. Houve diferença estatística entre os grupos apenas para a variável EVA de dor (p=0,022*), a favor do grupo Y/HT em relação ao grupo Sm/HT (p=0,025*) em T1 e em relação ao grupo HT (p=0,026*) em T48. O grupo Sm/HT apresentou mais efeitos adversos (p=0,042*) e o grupo HT apresentou mais efeitos adversos não relacionados com o procedimento (0,012*). Para outras variáveis não houve diferença entre os grupos. Conclusão: a sinovectomia radioisotópica do 90Y associado ao HT apresentou melhor resposta do que a do 153SmPHYP associado ao HT e do que a do HT isolado apenas em relação à dor.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)TEDEBV UNIFESP: Teses e dissertaçõe

Effectiveness of Radiation Synovectomy with Samarium-153 Particulate Hydroxyapatite in Rheumatoid Arthritis Patients with Knee Synovitis: A Controlled Randomized Double-Blind Trial

OBJECTIVES: The aim of the present study was to investigate the effectiveness of Samarium153-particulate hydroxyapatite radiation synovectomy in rheumatoid arthritis patients with chronic knee synovitis. METHODS: Fifty-eight rheumatoid arthritis patients (60 knees) with chronic knee synovitis participated in a controlled double-blinded trial. Patients were randomized to receive either an intra-articular injection with 40 mg triamcinolone hexacetonide alone (TH group) or 40 mg triamcinolone hexacetonide combined with 15 mCi Samarium153-particulate hydroxyapatite (Sm/TH group). Blinded examination at baseline (T0) and at 1 (T1), 4 (T4), 12 (T12), 32 (T32), and 48 (T48) weeks post-intervention were performed on all patients and included a visual analog scale for joint pain and swelling as well as data on morning stiffness, flexion, extension, knee circumference, Likert scale of improvement, percentage of improvement, SF-36 generic quality of life questionnaire, Stanford Health Assessment Questionnaire (HAQ), Lequesne index, use of non-steroidal anti-inflammatory drugs or oral corticosteroids, events and adverse effects, calls to the physician, and hospital visits. RESULTS: The sample was homogeneous at baseline, and there were no withdrawals. Improvement was observed in both groups in relation to T0, but no statistically significant differences between groups were observed regarding all variables at the time points studied. The Sm/TH group exhibited more adverse effects at T1 (p<0.05), but these were mild and transitory. No severe adverse effects were reported during follow-up. CONCLUSION: Intra-articular injection of Samarium153-particulate hydroxyapatite (15 mCi) with 40 mg of triamcinolone hexacetonide is not superior to triamcinolone hexacetonide alone for the treatment of knee synovitis in patients with rheumatoid arthritis at 1 y of follow-up

Intra-articular injection with triamcinolone hexacetonide in patients with rheumatoid arthritis: prospective assessment of goniometry and joint inflammation parameters

Objectives: To evaluate local joint variables after intra-articular injection (IAI) with triamcinolone hexacetonide (HT) in rheumatoid arthritis (RA) patients. Methods: We blindly and prospectively (baseline, 1, 4, 12 and 24 weeks) evaluated metacarpophalangeal (MCP), wrist, elbow, shoulder, knee and ankle joints after HT IAI by the following outcome measures: Visual analogue scale 0-10 cm (VAS) for rest pain (VASR)VAS for movement pain (VASM)VAS for joint swelling (VASSw)flexion (FlexG) and extension (ExtG). Results: 289 patients (635 joints) were studied. VASSw (p < 0,001) and VASR (0,001< p < 0.016) improved from TO to T4, T12 and T24 for all joints. VASM improved from TO-T4 (p < 0.021) for all jointsTO-T12 (p < 0.023) for MCF and kneeTO-T24 (p < 0.019) only for MCF and knee. FlexG improved from TO-T4 (p < 0.001) for all jointsTO-T12 (p < 0.001) and TO-T24 (p < 0.02) only for MCF and knee. ExtG improved from TO-T4 (p < 0.001) for all joints except for elbowTO-T12 (p = 0.003) for wrist, MCP and kneeand TO-T24 (p = 0.014) for MCF and knee. Conclusion: VASSw responded better at short and medium term after IAI with HT in our sample of RA patients. (C) 2016 Published by Elsevier Editora Ltda.Univ Fed Sao Paulo, Disciplina Reumatol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Disciplina Reumatol, Sao Paulo, SP, BrazilWeb of Scienc

Effectiveness of radioisotopic synovectomy with samarium-153 particulate hydroxypatite in rheumatoid arthritis patients with knee synovitis: a controlled randomized double-blinded trial

Objetivos: avaliar a longo prazo a efetividade e tolerancia da sinovectomia radioisotopica realizada pelo Samario-153 hidroxiapatita em pacientes com artrite reumat6ide (AR) com sinovite cr6nica de joelho. Metodos: 58 pacientes com artrite reumatoide (60 joelhos) com sinovite cronica de joelhos foram convidados a participar de um estudo controlado, randomizado, duplo-cego. Os pacientes foram randomizados para receber infiltracao do joelho guiada por f1uoroscopia com 40mg de hexacetonide de triancinolona isolada (grupo HT) ou 15mCi de Samario-153 hidroxiapatita associado a 40mg de hexacetonide de triancinolona (grupo Sm). Foi realizada avaliacao cega dos pacientes no tempo inicial (TO), ap6s uma (T1), 4 (T4), 12 (T12), 32 (T32), e 48 (T48) semanas da intervencao e foram aplicados os seguintes instrumentos de avaliacao: escala visual analogica (EVA) de dor e edema, rigidez matinal, goniometria, perimetria articular, escala visual anal6gica de melhora (EVAM) segundo 0 paciente e 0 avaliador, porcentagem de melhora segundo 0 paciente, questionario de avaliacao funcional HAQ (Health Assessment Questionnaire), questionario generico de qualidade de vida SF-36 (The short form 36 health survey questionnaire), questionario Lequesne de joelho, consumo diario de comprimidos de diclofenaco e de prednisona, numero de telefonemas para medico, numero de idas ao hospital, numero de efeitos colaterais locais e sistemicos e numero de eventos. Considerou-se uma significancia estatistica de 5 por cento. Resultados: a amostra foi homogenea no tempo inicial e nao houve perdas. Observou-se melhora de ambos os grupos em relacao ao tempo inicial, porem nao houve diferenca estatistica entre os grupos para as variaveis analisadas no decorrer do estudo. 0 grupo Sm apresentou mais efeitos adversos no T1 (p<0,05), porem foram leves e transit6rios. Nenhum efeito adverso grave foi relatado durante o estudo. Conclusao: a sinovectomia radioisot6pica provocada pelo Samario-153 hidroxiapatita na dose de 15mCi nao foi efetiva no tratamento de sinovite de joelho em pacientes com AR acompanhados por um anoBV UNIFESP: Teses e dissertaçõe

Estudo piloto sobre a eficácia do losartan no tratamento do fenômeno de Raynaud (FRy) e correlação com alterações na microcirculação em pacientes com esclerose sistêmica (ES) Pilot study on losartan efficacy in the treatment of Raynaud's phenomenon (RP) and correlation with microcirculation alterations in patients with systemic sclerosis (SSc)

OBJETIVOS: Avaliar a eficácia do losartan no tratamento do fenômeno de Raynaud (FRy) em pacientes com FRy secundário à esclerose sistêmica (ES). Avaliamos também as anormalidades bioquímicas da microcirculação, através de dosagem da lacticemia de polpa digital associada a um estímulo frio (LPD-EF) e às anormalidades anatômicas da microcirculação, através da capilaroscopia periungueal (CPU), antes e após a intervenção terapêutica, buscando possíveis correlações com a ação do losartan no nível microvascular. MÉTODOS: Trata-se de um estudo aberto em que foram selecionados consecutivamente dez pacientes com diagnóstico de ES e FRy presentes na seleção. Sete pacientes receberam losartan 50 mg/dia e três, 100 mg/dia VO por quatro semanas. Os pacientes foram avaliados quanto à eficácia da droga, através de questionários aplicados no dia 0 e ao término das semanas 1, 2, 3, e 4. Capilaroscopia periungueal e o teste da LPD-EF foram realizados no início e ao final do estudo. RESULTADOS: Observamos melhora significativa na escala de gravidade do FRy ao analisarmos as semanas 0 a 4 (p=0,048). Em relação à escala visual analógica da dor, ao número de ataques de FRy por dia e à duração estimada dos ataques, observamos queda nos parâmetros analisados entre as semanas 0 a 4, mas tal diminuição não alcançou diferença significante. Não houve diferença significativa em relação aos parâmetros analisados pela CPU e aos valores de "LPD entre as semanas 0 e 4. CONCLUSÕES: O losartan parece apresentar benefício terapêutico discreto ou moderado em pacientes com FRy secundário à ES, não modificando os parâmetros morfológicos ou bioquímicos da microcirculação.<br>OBJECTIVES: To evaluate the efficacy of losartan for the treatment of Raynaud's phenomenon (RP) secondary to systemic sclerosis. We also evaluated the biochemical abnormalities of the microcirculation using the cold stimulus-fingertip lacticemy test (CS-FTL), and the morphological alterations of the microcirculation, by nailfold capillaroscopy, before and after treatment as well as possible correlations with losartan action at the microvascular level. METHODS: In this open study we selected ten patients with systemic sclerosis diagnosis and Raynaud's phenomenon present on the selection. Seven patients received losartan 50 mg once a day and three received 100 mg once a day for four weeks. Patients were evaluated for drug efficacy by standard questionnaire on day 0 and at the end of weeks 1, 2, 3, and 4. Nailfold capillaroscopy and the CS-FTL test were performed at baseline and at the end of treatment. RESULTS: There was a reduction in the RP severity scale between weeks 0 and 4 (p=0.048). There was a reduction on pain visual analogic scale, number of RP episodes/day, and the duration of the RP episodes between the weeks 0 and 4, but this reduction did not reach statistical significance. Additionally there was no statistically significant change in nailfold capillaroscopy parameters and "FTL values between weeks 0 and 4. CONCLUSION: Losartan seems to have modest to moderate clinical benefit in RP secondary to SSc and induced no detectable modification in biochemical or morphological microcirculation parameters

Infiltrações intra-articulares de triancinolona hexacetonida na artrite reumatóide: preditores de melhora a curto e longo prazo

Objetivos: Identificar fatores preditivos de resposta &#224; infiltra&#231;&#227;o intra-articular (IIA) com triancinolona hexacetonida (TH). M&#233;todos: Este estudo foi realizado em pacientes de artrite reumat&#243;ide (AR) (segundo crit&#233;rios do American College of Rheumatology) submetidos &#224; IIA (infiltra&#231;&#227;o mono, pauci ou poliarticular). Avalia&#231;&#227;o: Um observador &#8220;cego&#8221; avaliou prospectivamente as articula&#231;&#245;es uma semana (T1), quatro semanas (T4), 12 semanas (T12) e 24 semanas (T24) ap&#243;s IIA. As medidas de desfecho foram Escala Visual Anal&#243;gica (0-10 cm) em repouso, em movimento e para articula&#231;&#245;es edemaciadas. As vari&#225;veis cl&#237;nicas e demogr&#225;ficas e aquelas relacionadas &#224; infiltra&#231;&#227;o no in&#237;cio do estudo foram analisadas de acordo com a resposta &#224; IIA. Resultados: Foram estudados 289 pacientes com AR (635 articula&#231;&#245;es) com m&#233;dia de idade de 48,7 (&#177; 10,68) anos; 48,5% eram caucasianos, EVA para dor global = 6,52 (&#177; 1,73). Na an&#225;lise univariada, as vari&#225;veis relativas &#224;s melhores respostas em seguida &#224; IIA (melhora >70%) foram: &#8220;IIA no cotovelo e metacarpofalangeanas (MCF)&#8221; e &#8220;classe funcional II&#8221;. Na an&#225;lise multivariada, &#8220;homens&#8221; e &#8220;n&#227;o brancos&#8221; foram os preditores com melhor resposta &#224; IIA na T4, enquanto &#8220;IIA no cotovelo e MCF&#8221;, &#8220;infiltra&#231;&#227;o poliarticular&#8221;, &#8220;uso de metotrexato&#8221; e &#8220;dose total maior de TH&#8221; obtiveram a melhor resposta na T24. Conclus&#227;o: Foram identificados diversos fatores preditivos de boa resposta &#224; IIA em pacientes com AR. Os preditores de melhor resposta para IIA de TH em longo prazo foram &#8220;aplicar IIA no cotovelo e MCF&#8221; e &#8220;aplicar infiltra&#231;&#227;o poliarticular&#8221;

Intra-articular injection with triamcinolone hexacetonide in patients with rheumatoid arthritis: prospective assessment of goniometry and joint inflammation parameters

Abstract Objectives: To evaluate local joint variables after intra-articular injection with triamcinolone hexacetonide in rheumatoid arthritis patients. Methods: We blindly and prospectively (baseline, 1, 4, 12 and 24 weeks) evaluated metacarpophalangeal, wrist, elbow, shoulder, knee and ankle joints after triamcinolone hexacetonide intra-articular injection by the following outcome measures: visual analogue scale 0–10 cm (VAS) for rest pain (VASR); VAS for movement pain (VASM); VAS for joint swelling (VASSw); flexion (FlexG) and extension (ExtG). Results: 289 patients (635 joints) were studied. VASSw (p < 0.001) and VASR (0.001 < p < 0.016) improved from T0 to T4, T12 and T24 for all joints. VASM improved from T0 to T4 (p < 0.021) for all joints; T0 to T12 (p < 0.023) for MCF and knee; T0 to T24 (p < 0.019) only for MCF and knee. FlexG improved from T0 to T4 (p < 0.001) for all joints; T0 to T12 (p < 0.001) and T0 to T24 (p < 0.02) only for MCF and knee. ExtG improved from T0 to T4 (p < 0.001) for all joints except for elbow; T0 to T12 (p = 0.003) for wrist, metacarpophalangeal and knee; and T0 to T24 (p = 0.014) for MCF and knee. Conclusion: VASSw responded better at short and medium term after IAI with triamcinolone hexacetonide in our sample of RA patients