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A new method, employing radiation, for inactivating inflamed synovial tissue was investigated. An attempt was made to produce radiation synovectomy, using the principle that colloidal Au/sup 198/, when injected into the knee joint, would behave like other particles and localize on the synovial membrane. A pilot study was undertaken to see if satisfactory diffusion throughout the knee joint and localization on the synovial membrane occurred. In four patients suffering from rheumatoid arthritis with persistent knee effusions, a tracer dose of 50 mu C Au/sup 198/ was injected. At 1, 6, and 24 hours a scan of the knee was made, initially using a well-collimated scintillation counter with a 1/2 in. dia. sodium iodide crystal and later an automatic scanner. At 6 and 24 hours the regional lymph glands were also checked. Provided there was an effusion of moderate size, the introduction of colloidal Au/sup 198/ into the knee joint was followed by its rapid diffusion throughout that cavity followed by localization on the synovial membrane. Thirty injections were given in 24 patients and all were followed for a minimum of one year. The range of dosage varied from 480 to 1000 r (mean 690 r). Clinical assessment of the statemore » of the knees as previously described was made on the 3rd, 7th, and 21st day, and subsequently at 3 months and at 1 yr after the injection. The one-yr follow-up of 30 therapeutic injections showed a good result in 16, some effect in 7, and none in 7. In the 14 cases in which bilateral knee effusions were present, the treated knee tended to do better than the control. It is suggested that failure of this form of therapy may be due to the inability of the Au/sup 198/ to penetrate far enough into very thickened synovial membrane. Yttrium-90, with its considerably greater penetration (over 3 mm) into the tissue, may be preferable and warrants further investigation. (BBB)« less

Evaluation of Intra-articular Colloidal Gold Au 198 in the Treatment of Persistent Knee Effusions