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Low-dose radiation therapy for hand osteoarthritis: shaking hands again?

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Abstract

Background

Hand osteoarthritis (HOA) is one of the most common causes of pain and functional disability in western countries and there is still no definitive cure. Low-dose radiation therapy (LDRT) has anti-inflammatory properties that have shown to be effective in the symptomatic relief of various degenerative musculoskeletal disorders. We designed a clinical protocol using LDRT for symptomatic HOA and present results and tolerance in the first 100 patients included.

Materials and methods

Between April 2015 and March 2021, 100 patients with a median age of 60 were treated. Fifty-seven patients suffering from proximal/distal interphalangeal joint pain, 40 patients with thumb arthritis, 2 patients with radiocarpal joint affection and 1 patient with metacarpophalangeal joint pain were enrolled. LDRT comprised of 6 fractions of 0.5–1 Gy on every other day up to a total dose of 3–6 Gy. Clinical response was evaluated according to the visual analog scale (VAS) for pain level and the von Pannewitz score (VPS) for joint functionality. Any patients not achieving subjective adequate pain relief after 8 weeks of treatment were offered a second identical LDRT course.

Results

With a median follow-up of 10.5 months (range 7.55–12.45), 94% reported an improvement in the pain, with a significant reduction in the VAS level after 3, 6 and 12 months (p < 0.001). Sixty-three patients needed a second course of treatment at a median time interval of 12 weeks (range 9–14). The mean VAS score before treatment was 8 (range 3–10). After treatment, it was 5 (range 1–10). After 3, 6 and 12 months, the mean VAS scores were 4 (range 0–9), 3 (range 0–9) and 3.5 (range 0–9), respectively. Seventy patients reported functionality improvements after LDRT according to the von Pannewitz score. No acute or late complications were observed.

Conclusion

LDRT appears to be safe and useful for HOA and is associated with good rates of pain relief and functionality improvements. However, further studies are necessary to confirm these promising results.

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Acknowledgements

To Alyson Kim Turner, for reviewing, revising and editing this manuscript for English Language grammar and syntax.

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The authors declare no financial disclosures.

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Author notes

  1. B. Álvarez and A. Montero have contributed equally to this manuscript and share first authorship.

Authors and Affiliations

  1. Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain

    B. Álvarez, A. Montero, R. Alonso, J. Valero, M. López, R. Ciérvide, E. Sánchez, O. Hernando, M. García-Aranda, X. Chen-Zhao & C. Rubio

  2. Department of Medical Physics, HM Hospitales, Madrid, Spain

    J. Martí & A. Prado

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  1. B. Álvarez
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Contributions

BA, AM study design, data analysis, manuscript writing. All the authors contributed to manuscript writing, editing and reviewing, reviewed previous drafts and provided comments and contributed to the final draft.

Corresponding author

Correspondence to A. Montero.

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All the authors declare no conflict of interest regarding any aspect of the manuscript.

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All procedures performed were in accordance with the ethical standards of the institutional research committee and with the Helsinki declaration.

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Informed consent was obtained from all individuals participants included in this study.

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Álvarez, B., Montero, A., Alonso, R. et al. Low-dose radiation therapy for hand osteoarthritis: shaking hands again?. Clin Transl Oncol 24, 532–539 (2022). https://doi.org/10.1007/s12094-021-02710-w

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