Top Line: What better way to bring in the new year than by introducing low dose radiation for arthritis to your practice?
The Study: While the radiation part is pretty simple, it can be difficult to know just where to start in offering this treatment. Here’s a helpful review of low dose RT for osteoarthritis. Osteoarthritis is typically characterized by a pro-inflammatory process in the joint space that leads to damage to the articular cartilage. While it often starts from degenerative changes to the cartilage, an inflammatory cascade of events promotes the further breakdown of cartilage and subchondral bone. Across several randomized trials and retrospective series, the majority of patients (as many as two-thirds) treated with LDRT have a positive response to treatment, and similar proportions respond to a second course. The appropriate patient has chronic OA that hasn’t responded to standard first line treatments like exercise, weight loss, NSAIDs, and intra-articular injections. Also, they should ideally be older, though there’s no strict cutoff, and they should have limited surgical options or desire to avoid surgery, which should ideally be discussed with an orthopedic surgeon. The best evidence for LDRT is in larger joints, but it can still be used for small joints such as in the hand. The target volume is the entire affected joint including all articular surfaces and the joint capsule. One of the most widely used regimens is a dose of 3 Gy delivered in 6 twice weekly fractions (0.5 Gy per fraction). Typically, conformal anterior/posterior fields are used, and bolus is often needed for small joints to get adequate coverage. There is usually little to no toxicity with the exception of fingernails or toenails, which should be shielded when possible. It usually takes about 4-12 weeks for response, and patients are often re-evaluated at 6-8 weeks. If the response is inadequate, many patients may still respond to a second course 8-12 weeks after the first.
TBL: Low dose RT is an effective and low risk way to treat refractory osteoarthritis in appropriately selected patients. | Schlamann, Semin Radiat Oncol 2025
The Study: While the radiation part is pretty simple, it can be difficult to know just where to start in offering this treatment. Here’s a helpful review of low dose RT for osteoarthritis. Osteoarthritis is typically characterized by a pro-inflammatory process in the joint space that leads to damage to the articular cartilage. While it often starts from degenerative changes to the cartilage, an inflammatory cascade of events promotes the further breakdown of cartilage and subchondral bone. Across several randomized trials and retrospective series, the majority of patients (as many as two-thirds) treated with LDRT have a positive response to treatment, and similar proportions respond to a second course. The appropriate patient has chronic OA that hasn’t responded to standard first line treatments like exercise, weight loss, NSAIDs, and intra-articular injections. Also, they should ideally be older, though there’s no strict cutoff, and they should have limited surgical options or desire to avoid surgery, which should ideally be discussed with an orthopedic surgeon. The best evidence for LDRT is in larger joints, but it can still be used for small joints such as in the hand. The target volume is the entire affected joint including all articular surfaces and the joint capsule. One of the most widely used regimens is a dose of 3 Gy delivered in 6 twice weekly fractions (0.5 Gy per fraction). Typically, conformal anterior/posterior fields are used, and bolus is often needed for small joints to get adequate coverage. There is usually little to no toxicity with the exception of fingernails or toenails, which should be shielded when possible. It usually takes about 4-12 weeks for response, and patients are often re-evaluated at 6-8 weeks. If the response is inadequate, many patients may still respond to a second course 8-12 weeks after the first.
TBL: Low dose RT is an effective and low risk way to treat refractory osteoarthritis in appropriately selected patients. | Schlamann, Semin Radiat Oncol 2025