The treatment of rheumatoid arthritis, osteoarthritis, and non-specific synovitis by intra-articular injection of radioactive colloidal gold (Â¹â¹â¸Au)

Kim, Sung Joon; Kim, Tai Seung

Abstract

When the effusion and pain of the joint caused by rheumatoid arthritis, osteoarthritis, and non-specific synovitis is persistent in spite of various conservative measures, the intra-articular injection of radioactive colloidal gold is recommended. Although the cause of rheumatoid arthritis and similiar types of inflammatory arthritis is not well known, the basic pathology appears to be in the synovium Colloidal particles of radioactive coiloidal gold injected into an inflamed joint are phagocytosed and dispersed uniformly on the superficial layers of the synovium Radioactive colloidal gold was first introduced in the malignant peritoneal effusions by Muller in 1950, and it was later used by Andrew and Mackay in malignant pleural effusion in 1953 and 1957. The malignant ascite, pleural effusion, and synovial effusion are collections of fluid in closed cavities lined by a thin sensitive endothelial layers; and apart from repeated aspirations, accepted forms of treatment frequently fail to cure or even control the effusions. Because of this resemblance it was decided in 1957 to attempt to treat persistent synovial effusions by intra-articular injection of radioactive colloidal gold. 198Au has a half-life of 2.7 days and emits both beta and gamma rays, Beta rays, which produce 90% of the therapeutic effect, penetrate tissue to an average depth of 1 to 2 mm. The particle of colloidal suspension of 198Au is 20 to 50 mu. The colloidal state of the preparation aids in limiting radiation to the synovial surface, and it has been shown that large colloidal particles are not absorbed into the blood or lymphatic systems after intra-articular injection and penetrate no deeper than the synovial tissues as a result of phagocytic activity. Good results have been reported since the radioactive colloidal gold was introduced in the treatment of persistent effusion of the human knee by Makin in 1963. The knee is chosen as the most suitable joint for this trial because of the ease of performing accurately intra-articular injections and the ease with which knee effusions can be recognized and measured. Furthermore, the knee joint is superficial and distant from vital structures which may be radio-sensitive. In this study, thirty-nine knee and three ankle effusions and pains unresponsive to the usual methods of therapy were treated by intra-articular injection of radioactive colloidal gold from November 1964 to January 1979 with follow up. Thirteen cases had classical rheumatoid arthritis; ten osteoarthritis; fifteen non-specific synovitis; two pigmented villonodular synovitis; one post-synovectomy, and one tuberculous arthritis. The results were as follows; 1. In eleven cases(84.6%) of rheumatoid arthritis, fourteen cases (93.3%) of nonspecific synovitis, and five cases(50.0%) of osteoarthritis, the effusion disappeared. 2. In twelve cases(92.3%) of rheumatoid arthritis thirteen cases(86.7%) of non-specific synovitis, and only two cases(20.0%) of osteoarthritis, the pain disappeared. 3. As a whole, in thirty-three cases(78.6%), the effusion disappeared and in twenty-eight cases (66.7%), the pain disappeared.