Is radiation therapy effective for treating hand arthritis?

Radiation Therapy for Hand Arthritis: Not Recommended

Radiation therapy is not recommended for the treatment of hand osteoarthritis as high-quality evidence shows it lacks substantial beneficial effects on symptoms and inflammation compared to sham treatment. 1

Evidence Against Radiation Therapy for Hand OA

A randomized, blinded, sham-controlled trial specifically investigating low-dose radiation therapy (LDRT) for hand osteoarthritis found:

• No significant difference in responder rates between LDRT and sham treatment groups (29% vs 36%) 1
• No significant differences in clinical outcomes or inflammatory markers 1
• The confidence interval of the treatment effect makes it very unlikely that LDRT provides more than a 20% improvement over placebo 1

Recommended Treatment Approaches for Hand OA

Non-Pharmacological Interventions (First-Line)

1. Splinting/Orthoses

   • Particularly beneficial for trapeziometacarpal (thumb base) joint OA 2, 3
   • Custom-made neoprene or rigid rest orthoses worn at night can be effective 3

2. Exercise Therapy

   • Range of motion exercises 2, 3
   • Strengthening exercises for hand muscles 2, 3
   • Supervised exercise programs are more effective than unsupervised 3

3. Joint Protection Education

   • Techniques to minimize stress on affected joints 2, 3
   • Instruction in ergonomic principles 3
   • Pacing of activities to reduce joint strain 3

4. Thermal Modalities

   • Local application of heat (e.g., paraffin wax, hot packs) especially before exercise 2
   • Can provide temporary pain relief 2

5. Assistive Devices

   • Evaluation for ability to perform activities of daily living 2, 3
   • Provision of adaptive equipment as needed 2, 3

Pharmacological Interventions

1. Topical NSAIDs (First-Line)

   • Effective for pain relief with ES = 0.77 (95% CI 0.32 to 1.22) 2
   • Safer profile than oral NSAIDs, especially in older adults 3

2. Oral Paracetamol/Acetaminophen (Second-Line)

   • For mild to moderate pain 3
   • Use at lowest effective dose 3

3. Oral NSAIDs (Third-Line)

   • Consider only if topical NSAIDs and paracetamol are ineffective 3
   • Use at lowest effective dose for shortest duration 3
   • Monitor for side effects, especially in older adults 3

4. Chondroitin Sulfate

   • May be considered, though evidence for hand OA is limited 3

Surgical Options

Consider surgical interventions only when non-pharmacological and pharmacological treatments have failed to provide adequate pain relief 3:

• For thumb base (trapeziometacarpal) OA: trapeziectomy or arthroplasty 3
• For DIP joints: arthrodesis (joint fusion) 3
• Single surgical procedures may be as effective as combined procedures with fewer complications 3

Why Not Radiation Therapy?

Despite some reports suggesting potential benefits of low-dose radiation therapy for hand OA 4, 5, the highest quality evidence from a randomized, blinded, sham-controlled trial clearly demonstrates that LDRT does not provide significant benefits over placebo treatment 1. The European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) guidelines do not include radiation therapy in their recommended treatment approaches for hand OA 2, 3.

Additionally, radiation therapy carries potential risks including radiation exposure to patients and healthcare providers 6, making its use particularly questionable when safer and more effective alternatives exist.

Treatment Algorithm for Hand OA

1. Initial Management:

   • Education about the condition
   • Joint protection techniques
   • Exercise therapy (range of motion and strengthening)
   • Thermal modalities
   • Splinting for thumb base OA

2. If symptoms persist:

   • Topical NSAIDs

3. If inadequate response:

   • Oral paracetamol/acetaminophen

4. If still inadequate:

   • Oral NSAIDs (with appropriate precautions)
   • Consider chondroitin sulfate

5. For refractory cases:

   • Surgical consultation

6. Follow-up and monitoring:

   • Evaluate response to treatment at 4-6 weeks
   • Monitor for medication side effects
   • Reassess ability to perform activities of daily living