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

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