[Methods of efficacy assessment of the knee joint radiosynoviorthesis- personal experience].

ABSTRACT

OBJECTIVE: Introduction: Radiosynoviorthesis (RS) is local method of treatment of remittent joint effusions among patients who obtained general improvement after disease modifying anti-rheumatic drugs therapy but one or a few joints stay resistant to this treatment and intraarticular corticosteroids injections. The aim: The attempt to identification methods of efficacy assessment of the 90yttrium knee joint RS. PATIENTS AND METHODS: Material and methods: The study group consisted of 43 patients with rheumatoid arthritis (RA) and 19 patients with inflammatory spondyloarthropaties (SPA) where 8 patients were treated for ankylosing spondylitis (AS), 4 for psoriatic arthritis (PsA) and 7 due to undifferentiated inflammatory spondyloarthropaties (USPA). The efficacy of RS was measured subjectively by the patient, physically by the physician and with the help of chosen scores (DAS28), questionnaires (HAQ), laboratory parameters [ESR, level of CRP, osteoprotegerin (OPG), serum amyloid A (SAA), hialuronic acid (HA)] and three-phase bone scintigraphy of affected knee joints. RESULTS: Results: In RA patients very good results - no knee effusion were obtained in 25 (58,1%) joints, good results - minimal effusion in 10 (23,3%) knees and lack of improvement in 8 (18,6%) patients. Cumulatively very good and good results were obtained in 35 (81,4%) treated knee joints. In SPA patients very good results were noted in 12 (63,2%), good in 5 (26,3%), lack of improvement in 2 (10,5%) patients. Cumulatively very good and good results were obtained in 17 (89,5%) treated knee joints. We observed favorable profile changes of chosen scores (DAS28), questionnaires (HAQ), laboratory parameters (ESR, CRP, OPG, SAA, HA) and results of three-phase bone scintigraphy of knee joints. CONCLUSION: Conclusions: 90Yttrium RS is effective treatment of recurrent knee joints effusion in patients with RA i SPA. RS despite being local treatment decreases unspecific inflammatory process and systemic disease activity among patients with RA i SPA. The anatomic period of affected knee joints has negative correlation with treatment efficacy. 90Yttrium RS is safe procedure, favourable profile changes of cartilage and bone turn-over markers after therapy indicates protective influence of RS on these structures. The treatment response based on physical examination, subjective patient's evaluation, acute phase laboratory parameter levels and appropriate scores, questionnaires and imaging exams is fast and long-lasting.