Knee Osteoarthrtis(OA) – Arthritis Pills Don’t Work That Well -What Else?

A New England Journal Medicine article several years ago demonstrated that compared to placebo not much by pills worked well for OA knee. This leaves one looking for options.

As you can see, there is no significant difference between any form of therapy and placebo. By using some form of measure involving activity, they were abloe to get Celecoxib to show some improvement but this is not great. WOMAC and HAQ pain scales

One novel treatment includes use of radioactive Yttrium instillation
Nucl Med Commun. 2009 Apr 7. [Epub ahead of print] Yttrium-90 radiation synovectomy in knee osteoarthritis: a prospective assessment at 6 and 12 months. Chatzopoulos D, Moralidis E, Markou P, Makris V

97 patients

Criteria:

“(i) knee pain at stress severe enough to prevent engagement from daily activities for at least 3 months before the therapeutic procedure, resistant to systematic intake of analgesics, anti-inflammatory medication and intraarticular corticosteroid injections;

(ii) early-phase bone scan findings consistent with synovial inflammation.

Radionuclide treatment was not denied in patients with debilitating knee pain and advanced radiographic alterations, if they were unwilling to undergo knee arthroplasty or were poor candidates for surgery”

“185MBq 90Y silicate (Yttriumsilicat, Nycomed Amersham, UK) instilled in the joint cavity in combination
with triamcinolone hexacetonide 20 mg to minimize reactive synovitis provoked by irradiation [11]. Then, the injected joint was immobilized in extension by an elastic knee brace and 90Y bremsstrahlung scintigraphy was obtained to verify homogeneous distribution of the radioactive material within the joint cavity. Subsequently, patients were advised to rest and abstain from weight bearing of the respective knee for at least 3 days after the injection and discharged with instructions regarding radiation protection and follow-up visits.”

“symptoms modifying drugs were discontinued after treatment in most cases.”

side effects – “A moderately increased joint effusion was observed in three patients within few days after treatment and arthrocentesis was performed to resolve knee discomfort. An allergy occurred immediately after one procedure, which responded promptly to antihistaminic medication ”

3/4 had a >50% improvement in pain when seen at 6 and 12 months. 2/3 were considered to have a statisfactory response at 6 and 12 months.

Comment – For those not candidates for knee replacement, this could be a godsend. The article was Greek. The question is whether anyone would do it here…

Anyone with experience with this technique?