Efficacy of yttrium-90 synovectomy across a spectrum of arthropathies in an era of improved disease modifying drugs and treatment protocols

Aim: To evaluate clinical response rates, duration of response and complication rates of yttrium radiosynovectomy (RSV) in an era of improved disease modifying antirheumatic drugs (DMARDS) and increased access to replacement therapy for clotting factor deficiencies introduced in the mid 2000s. Methods: A retrospective review of 167 consecutive joints treated with RSV between 2000 and 2010 was conducted. Clinical response and complication rates in 167 joints (119 patients: 45 female,74 male, mean age 52 years) with rheumatoid, psoriatic, hemophilic, large joint mono-arthropathy and miscellaneous arthropathies refractory to conventional therapy were reviewed. Clinical response was determined at 3 months with responding patients reviewed again at 36 months to assess whether response was sustained. Comparison of response rates pre- and post-introduction of improved DMARDS in the mid 2000s was also performed. Results: Satisfactory clinical response was highest for large joint mono-arthropathy (85 ) and lower for other arthropathies (47-64 ). A strong relationship was demonstrated between degree and duration of response with 90 of complete responders compared to 41 of incomplete responders having a sustained response at 36 months (P = 0.0001). Major complication rates were low (1 ). No difference was demonstrated in response rates pre- and post-introduction of improved DMARDS in the mid 2000s. Conclusion: In an era of improved DMARDS, yttrium synovectomy remains a safe and effective procedure across a broad spectrum of arthropathies and should continue to be considered in cases refractory to conventional therapies. Complete responders can be expected to have symptom relief for at least 36 months and complication rates are low.