Is low dose radiation therapy effective for treating osteoarthritis?

Low-Dose Radiation Therapy Is Not Recommended for Osteoarthritis Treatment

Based on current evidence, low-dose radiation therapy is not recommended for the treatment of osteoarthritis due to lack of substantial beneficial effects compared to sham treatment.

Evidence Against Low-Dose Radiation Therapy for Osteoarthritis

• Multiple randomized controlled trials have failed to demonstrate significant benefits of low-dose radiation therapy (LDRT) for osteoarthritis symptoms compared to sham treatment 1, 2, 3
• A 2018 randomized, blinded, sham-controlled trial found no significant difference in the proportion of responders between LDRT and sham treatment groups in hand osteoarthritis patients (LDRT: 29% vs. sham: 36%) 1
• Long-term follow-up data (6 and 12 months) from randomized trials showed no delayed beneficial effects of LDRT for both knee and hand osteoarthritis 2
• A 2019 randomized, double-blinded trial specifically for knee osteoarthritis found similar response rates between LDRT (44%) and sham treatment (43%) groups at 3 months post-intervention 3

Safety Concerns with Radiation Therapy

• Radiation therapy has been associated with increased risk of malignancies, particularly leukemia (RR 2.74,95% CI 2.10 to 3.53) and cancers at irradiated sites (RR 1.26,95% CI 1.19 to 1.32) 4
• The carcinogenic potential of radiation therapy, even at low doses, raises significant safety concerns that outweigh the unproven benefits in osteoarthritis treatment 4
• While some studies report minimal side effects from LDRT, long-term safety data remains insufficient 5

Current Guideline Recommendations for Osteoarthritis Management

• The 2023 American College of Rheumatology (ACR) guidelines for osteoarthritis management do not include radiation therapy as a recommended treatment option 4
• Standard non-operative therapies for osteoarthritis include:
  • Non-pharmacological approaches (exercise, weight management, physical therapy) 4
  • Pharmacological treatments (NSAIDs, acetaminophen, intra-articular corticosteroid injections) 4
• For moderate-to-severe osteoarthritis not responding to conservative management, joint replacement surgery may be considered rather than radiation therapy 4

Ongoing Research

• A protocol for a new randomized controlled trial (LoRD-KNeA) was published in 2023, aiming to further evaluate the efficacy and safety of LDRT for knee osteoarthritis with different dosing regimens 6
• This ongoing research acknowledges the lack of supporting evidence from previous randomized studies using modern methodologies 6

Conclusion

The available high-quality evidence from multiple randomized controlled trials consistently shows that low-dose radiation therapy does not provide significant benefits for osteoarthritis symptoms compared to sham treatment. Additionally, the potential long-term risks associated with radiation exposure raise serious safety concerns. Therefore, established non-pharmacological and pharmacological treatments should be prioritized for osteoarthritis management, with joint replacement surgery considered for patients with advanced disease not responding to conservative measures.