e38 Radiation (yttrium) synovectomy at Freeman Hospital, Newcastle-upon-Tyne 2015-2017: a review of practice and patient experience

Abstract

Background: Radiation synovectomy (RS) involves an intra-articular injection of a radioactive colloid like yttrium-90 citrate to treat synovitis. One estimate suggests approximately 100 such procedures are performed annually in the UK, although it is more common in Europe. At the Freeman Hospital, one rheumatologist (BT) performs RS with assistance from staff from the nuclear medicine department. Patients are sent an information leaflet by post and have clinical assessment, ultrasound imaging and pre-procedure counselling. Postprocedure care includes wearing a brace for 48 hours. Method(s): A questionnaire was designed to understand patients' opinions of the pre-procedure information, the procedure itself, and their perception of the efficacy of RS. It was sent by post to all 29 patients who had RS at Freeman Hospital between January 2015 and April 2017, and their clinic letters were reviewed retrospectively. Additional information included the number of steroid injections they received in the affected joint, comparison between steroid injections and RS in terms of tolerability and effectiveness and whether they would recommend RS to other patients. Result(s): 25 patients completed the questionnaire (40:60 female: male) and there were 4 non-respondents. Amongst the respondents, the diagnoses were: psoriatic arthritis 44%, pigmented villonodular synovitis (PVNS) 20%, juvenile idiopathic arthritis (JIA) 8%, undifferentiated inflammatory arthritis 5%, osteoarthritis 5% and ankylosing spondylitis 4%. Mean age was 47 years (19 - 72 years). The total number of procedures performed was 33; three patients had more than one procedure. Yttrium-90 was used for 30 knees and rhenium-186 was used for two elbows and one ankle joint. Median number of steroid injections in the affected joint reported by respondents (excluding PVNS) was six (Range: 1-41). In this group of patients (n=20), 10% found RS less painful than a steroid injection, 75% found it similar to a steroid injection and 15% found it more painful. In terms of effectiveness, 75% of this patient group found RS more effective, 20% similar and 5% less effective than a steroid injection. Only one respondent reported having a side effect from RS - a temporary increase in joint pain. Mean reported duration of effect for a steroid injection was 6.1 weeks compared to 10.4 months for RS; the duration of effect may be longer as some patients reported ongoing efficacy at the time of the survey. 80% of respondents would recommend RS to someone in a similar position. Conclusion(s): In an era of biologic and intensive DMARD treatments for inflammatory arthritis, fewer patients require RS. However in our experience, with careful patient selection and counselling, the procedure remains a useful option for patients with resistant monoor oligoarticular disease and for selected patients with PVNS. This survey suggests that RS is well-tolerated and offers prolonged benefit compared to steroid injections.