Læknablaðið : fylgirit - 01.05.1978, Page 87

M. Oko, A. Rekonen, A. Ruotsi.
169Er
seems to be the most suitable radio-
isotope for treating small joints of the hand,
because it is a beta-emittor with a low pene-
trating range and a short half-life. The first
material treated with this agent comes from
France| where Menkes and allied have used it
since 1969. Their material consists of 336 patients
and 943 treated joints. Very good and good
results were gained in 477o after six months, in
5-í7o after one year and in 57% after two years.
The dose of 169Er was 0.5 to 1.0 mC in the
metacarpophalangeal joints and 0.25 to 0.5 in
the proximal interphalangeal joints. When
treating mcp-joints with a dose of 1 mC instead
of 0.5 mC an increase of good results was
observed.
When the treated material was divided in groups
according X-ray changes after Steinbrocker's
system the best results were gained in the first
gradc group, but even in the fourth grade group
a good result could be achieved in 3C%.
There was not observed any significant deteriora-
tion of results during observation period from
six months to two years.
The use of 0.25 and 0.5 mC 169Er in pip-joints
did not give any significant difference in the
results.
There was a statistically significant difference
between 169Er and physiological saline solution
after three months.
Side effects were few. In some cases there
were pains after injection. One case of purulent
arthritis developed and in five cases bullous
radiodermatitis appeared in the area of injection
point.
The purpose of our study is to correlate effects
of intra-articular injections of 169Er to
triamcinolonhexacetonide (TCHA). The látter
has been shown to have a fairly long lasting
effect in ameliorating the rheumatoid synovitis.
We started this study in the beginning of this
year. The material consists rheumatoid arthri-
tis patients whose age is over 35 years and who
have a persistent synovitis of pip- or mcp-joints.
Affected joints were treated with 169Er in one
hand and with TCHA in the other hand. The
dose of TCHA was 5 mg and the dose of 169Er
0.25 in the pip-joints and 0.5 mC in the mcp-
joints. After treatment the treated joint was
TREATMENT OF RA
FINGER JOINTS WITH 169ER
immobilized for three days to reduce the leakage
of the radioisotope.
In the next slide some characteristics of 15
first treated patients are shown. All patients
had definite or classical rheumatoid arthritis
aecording to ARA:s criteria. The disease had
begun from two to 23 years before treatment
approximately 9.8 years. The X-ray changes
are rather advaneed in our material. There
was only one case of the first grade, three cases
of the second grade and 11 cases of the third
grade, according to Steinbrocker’s system.
The follow-up time after treatment is stUl rather
short, mean 104 days. In the next figure the
classification which we have used in the evalua-
ting the results are shown.
The results are shown in the next slide. After
three and half months there were more exceUent
results in the TCHA-group. The difference is
statistically highly significant. The correlation
between exceUent plus good results together
gives also statistically significant difference for
the favour of TCHA.
The change of ring size is shown in the next
slide. The ring size decreased more in the
joints treated with TCHA. There were not any
marked changes in the grip strength although in
some single cases the increase of grip strength
was rather remarkable.
Side effects were few. One patient got bullous
dermatitis after three weeks of the treatment in
two fingers, which lasted about two weeks in the
169Er group. No other side effects were observed.
It seems to be very important to give 169Er
strictly intra-articularly. And if there is any
reflux the skin must be cleaned carefuUy after
treatment.
The observation period of our material is stiU
too short to decide if 169Er is better than TCHA
after a longer follow-up time as one could
assume of the results of the French study.
Side effects of 169Er are few, but the use of
radioactive agents is best to reserve for the
patients who have passed the fertUe period of
life.
We'll continue our study to see if 169Er will
give some advantages compared to long acting
intra-articular steroids.
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