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Research ArticleClinical Investigation

Safety and Efficacy of Radiosynoviorthesis: A Prospective Canadian Multicenter Study

Mélanie Desaulniers, Michel Paquette, Stéphanie Dubreuil, Helena Senta, Éric Lavallée, J. Carter Thorne and Éric Turcotte
Journal of Nuclear Medicine July 2024, 65 (7) 1095-1100; DOI: https://doi.org/10.2967/jnumed.123.267297
Mélanie Desaulniers
1Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada;
2Research Center of CHUS, CIUSSSE–CHUS, Sherbrooke, Quebec, Canada;
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Michel Paquette
1Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada;
2Research Center of CHUS, CIUSSSE–CHUS, Sherbrooke, Quebec, Canada;
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Stéphanie Dubreuil
1Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada;
2Research Center of CHUS, CIUSSSE–CHUS, Sherbrooke, Quebec, Canada;
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Helena Senta
1Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada;
2Research Center of CHUS, CIUSSSE–CHUS, Sherbrooke, Quebec, Canada;
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Éric Lavallée
1Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada;
2Research Center of CHUS, CIUSSSE–CHUS, Sherbrooke, Quebec, Canada;
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J. Carter Thorne
3Arthritis Program Research Group Inc., Newmarket, Ontario, Canada;
4Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; and
5Division of Rheumatology, Southlake Regional Health Center, Newmarket, Ontario, Canada
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Éric Turcotte
1Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada;
2Research Center of CHUS, CIUSSSE–CHUS, Sherbrooke, Quebec, Canada;
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  • FIGURE 1.
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    FIGURE 1.

    Enrollment flowchart.

  • FIGURE 2.
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    FIGURE 2.

    Percentage of patients with reduction in pain, swelling, and joint effusion at 3, 6, and 12 mo after radiosynoviorthesis. Upper brackets indicate 95% CI. Number of evaluable patients is 225 at 3 mo, 211 at 6 mo, and 188 at 12 mo for pain; 229 at 3 mo, 213 at 6 mo, and 189 at 12 mo for swelling; and 207 at 3 mo, 200 at 6 mo, and 178 at 12 mo for joint effusion. *Significant improvement in synovitis symptoms compared with baseline (P < 0.001).

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    FIGURE 3.

    Improvement in patient’s functional disability based on HAQ-DI at baseline and during follow-up (3, 6, and 12 mo). Data are mean; brackets represent SD. Nonsignificant reduction in patient’s functional disability was observed at follow-up compared with baseline (P = 0.3). Smallest clinically significant difference in HAQ-DI is 0.25. Number of evaluable patients is 360 at baseline, 325 at 3 mo, 303 at 6 mo, and 251 at 12 mo. *Probability of HAQ-DI improvement decreases statistically significantly at 6 and 12 mo (P < 0.01).

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    FIGURE 4.

    Decrease in disease activity based on DAS28 at baseline and during follow-up (3, 6, and 12 mo). Data are mean; brackets represent SD. No significant reduction in disease activity was observed at follow-up compared with baseline (P = 0.1). Smallest clinically significant difference in DAS28 is 1.2. Number of evaluable patients is 299 at baseline, 265 at 3 mo, 240 at 6 mo, and 200 at 12 mo.

  • FIGURE 5.
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    FIGURE 5.

    Stability of patient’s global assessment of disease activity based on VAS at baseline and during follow-up (3, 6, and 12 mo). Data are mean; brackets represent SD. No significant change in patient’s global assessment of disease activity was observed at follow-up compared with baseline (P = 0.5). Smallest clinically significant difference in VAS 100 mm is reduction of 20 mm. Number of evaluable patients is 286 at baseline, 255 at 3 mo, 238 at 6 mo, and 202 at 12 mo.

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    TABLE 1.

    Patient Characteristics

    CharacteristicData
    Age (y)
     Mean50.5 (SD, 16.9)
     Median51.0 (range, 5.0–87.0)
    Sex
     Female185 (51.4%)
     Male173 (48.1%)
     Unknown2 (0.5%)
    Joint inflammatory disease
     Spondyloarthropathies110 (30.6%)
     RA89 (24.7%)
     Osteoarthritis43 (11.9%)
     Pigmented villonodular synovitis28 (7.8%)
     Hemophilic arthropathy23 (6.4%)
     Undifferentiated arthritis22 (6.1%)
     Juvenile idiopathic arthritis19 (5.3%)
     Other inflammatory arthritis15 (4.2%)
     Recurrent joint effusion after surgery9 (2.5%)
     Unknown2 (0.5%)
    Concurrent medication
     nbDMARD323 (89.7%)
     bDMARD21 (5.8%)
     Unknown16 (4.5%)
    Joint treated
     Knee324 (82.7%)
     Ankle24 (6.1%)
     Elbow18 (4.6%)
     Wrist13 (3.3%)
     Shoulder9 (2.3%)
     Hip4 (1.0%)
    Radiopharmaceutical
     [90Y]Y-citrate327 (83.4%)
     [186Re]Re-sulfide39 (10.0%)
     Unknown26 (6.6%)
    Radiologic class of joint destruction
     0218 (55.6%)
     136 (9.2%)
     235 (8.9%)
     336 (9.2%)
     Unknown67 (17.1%)
    • nbDMARD = nonbiologic disease-modifying antirheumatic drug; bDMARD = biologic disease-modifying antirheumatic drug.

    • Data are number followed by percentage in parentheses, except for age. Total patients = 360, and total joints = 392.

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    TABLE 2.

    Categories and Grades of AEs

    AE categoryAll gradesSevere
    Joint reaction
     Pain9 (16.4%)0 (0.0%)
     Inflammation7 (12.7%)3 (5.5%)
     Swelling6 (10.9%)0 (0.0%)
     Effusion4 (7.3%)1 (1.8%)
     Stiffness1 (1.8%)0 (0.0%)
     Septic arthritis1 (1.8%)1 (1.8%)
    Skin reaction
     Cutaneous necrosis2 (0.6%)1 (1.8%)
     Skin hematoma2 (0.6%)0 (0.0%)
    Systemic reaction
     Flushing16 (4.4%)0 (0.0%)
     Fever and chills2 (0.6%)0 (0.0%)
     Lymphadenopathy2 (0.6%)1 (1.8%)
     Nausea1 (0.3%)0 (0.0%)
     Palpitations1 (0.3%)0 (0.0%)
     Medication error1 (0.3%)1 (1.8%)
    • Data are number followed by percentage in parentheses. Total AEs = 55.

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Journal of Nuclear Medicine: 65 (7)
Journal of Nuclear Medicine
Vol. 65, Issue 7
July 1, 2024
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Safety and Efficacy of Radiosynoviorthesis: A Prospective Canadian Multicenter Study
Mélanie Desaulniers, Michel Paquette, Stéphanie Dubreuil, Helena Senta, Éric Lavallée, J. Carter Thorne, Éric Turcotte
Journal of Nuclear Medicine Jul 2024, 65 (7) 1095-1100; DOI: 10.2967/jnumed.123.267297

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Safety and Efficacy of Radiosynoviorthesis: A Prospective Canadian Multicenter Study
Mélanie Desaulniers, Michel Paquette, Stéphanie Dubreuil, Helena Senta, Éric Lavallée, J. Carter Thorne, Éric Turcotte
Journal of Nuclear Medicine Jul 2024, 65 (7) 1095-1100; DOI: 10.2967/jnumed.123.267297
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