Low-Dose Radiation Therapy Now Available to Treat Osteoarthritis in Extremity Joints

Osteoarthritis, a progressively debilitating disorder, causes many patients to experience pain that is refractory to traditional treatments such as physical therapy, nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors or surgery. For those experiencing significant impairment in quality of life related to osteoarthritis, low-dose radiation therapy (LDRT) may be an effective noninvasive treatment option. It targets painful joints using radiation doses far lower than those used for cancer treatment.

The Center for Cancer Prevention and Treatment recently started offering LDRT as an alternative treatment for patients living with osteoarthritis, which affects more than 32 million adults in the U.S. Prevalence increases markedly after age 45 and affects approximately 43% of adults age 65 and older, with higher rates observed in postmenopausal women.

“This is an ideal treatment for older patients suffering from chronic pain due to inflammation of tissues surrounding the joints (bursa, fascia, tendons or ligaments) and are not responsive to medications, want to delay surgery or are not good candidates for surgery,” says Venita Williams, MD, medical director of radiation oncology at St. Joseph Hospital. Dr. Williams and her team of radiation oncologists deliver LDRT using a linear accelerator, allowing for precise localized targeting of affected extremity joints while minimizing exposure to surrounding tissues. The process starts with a planning session that includes a CT scan to customize treatment. The patient is scheduled for six treatments, two to three per week, each lasting 10 to 15 minutes.

Unlike oncologic radiation therapy, LDRT employs very low doses designed to modulate inflammatory and immune-mediated pathways rather than induce cell death. This anti-inflammatory effect has been shown to reduce pain and improve joint function. There are no side effects related to low-dose radiation when applied to the extremities, and it does not limit the ability to use surgical treatment if needed in the future.

Radiation oncologist Robert Ash, MD, adds, “Treatments are painless and similar to having an X-ray. Because the radiation dose is so low, most patients have minimal—if any—side effects and no recovery time.”

In addition to osteoarthritis, LDRT is also effective in treating periarticular soft tissue disorders, including enthesopathies, tendinopathies and bursitis. Clinical studies report pain reduction in approximately 70% to 80% of treated patients, with symptom relief lasting 12 months or longer in many cases. Some patients may benefit from a repeat course if symptoms recur.

“After treatment, patients experience a decrease in inflammation in their joints and pain relief,” says radiation oncologist Tanuja Bhandari, MD. “They are able to exercise and do daily activities that were previously difficult or impossible, like walking, knitting and swimming. For osteoarthritis patients with other medical issues like obesity, “LDRT could be applied to reduce or control pain so the patient can begin exercising, lose weight and build strength before surgery,” says Dr. Williams.

“We're anticipating that as more physicians and patients learn about this modality, more patients will participate,” says Dr. Bhandari. The radiation oncology team at St. Joseph Hospital welcomes referrals from primary care providers, rheumatologists, orthopedists, pain specialists and other clinicians managing patients with refractory joint pain. For referrals or information, please contact David Headland at 714-734-6207.