Sinovectomia radioisotópica de joelhos com Ítrio-90 e Samário-153 hidroxiapatita em pacientes com artrite reumatoide

• Ano de defesa: 2010
• Autor(a) principal: Santos, Marla Francisca dos [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• dARK ID: ark:/48912/001300001hjxc
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Ítrio; Injeções intra-articulares; Radioisótopo/uso terapêutico; Samário; Artrite reumatoide
• Link de acesso: http://repositorio.unifesp.br/handle/11600/10091

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.