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Irradiation of the synovium in the treatment of rheumatoid arthritis.

The use of irradiation of the synovium in the treatment of rheumatoid arthritis is presented. A colloidal resin of radioactive yttrium (90Y) or saline was injected intra-articularly into 44 knee joints under double blind conditions. Patients selected for treatment had chronic effusions which were resistant to all forms of therapy, other than surgical synovectomy. All patients were followed up for one year.

There was a sustained improvement in joint range in 13 cases (57 per cent) and of knee circumference in eight cases (35 per cent) (P < 0.005 and < 0.05 respectively) compared with the control. In seven patients (30 per cent) the joint effusion had completely resolved. Intra-articular yttrium had no advantage over saline for the prevention of radiological deterioration of the joint. Irradiation of the synovium produced a significant reduction in the acid phosphatase concentration of the synovial fluid. One-third of the patients developed general and local reactions to the 90Y injection.