Osteoarthritis is the most common form of arthritis. It affects one in seven people — more than 32 million Americans.
The World Health Organization has cited osteoarthritis as the second leading cause of disability in the United States. Due to our aging population, its incidence is rising.
Currently, the most frequently used treatments for osteoarthritis (OA) in the United States are:
- Physical therapy.
- Injections.
- Prescription or over-the-counter medications, particularly nonsteroidal anti-inflammatory drugs (NSAIDs).
However, a therapy yielding good results in research and clinically in other countries has been adopted here in the United States.
Studies have found that low-dose radiotherapy (LDRT) can reduce inflammation and pain. It may be an option for people with OA who haven’t responded to PT and medications. At UPMC Hillman Cancer Center, LDRT is a standard treatment option for osteoarthritis and other inflammatory disorders.
Learn more about the use of low-dose radiation therapy for osteoarthritis at UPMC.
What Is Osteoarthritis?
Osteoarthritis (OA) is a disease that breaks down the joints in the body. Although common among adults 45 and older, it isn’t a regular part of aging.
It most commonly affects the:
- Back
- Hands
- Hips
- Knees
It causes pain, stiffness, and swelling in the affected joint. Although both men and women can get OA, it affects more women than men.
OA can eventually cause changes to bones, cartilage, and joint tissues. This damage causes pain and affects a person’s work or activities of daily living. In some cases, OA can be disabling.
Signs and symptoms of OA
Although there are a variety of osteoarthritis symptoms, the most common include:
- Joint instability – Feeling like it’s loose or wobbly.
- Joint pain – Mainly when moving the joint.
- Loss of mobility — Less ability to move the joint.
- Stiffness — Especially after resting the joint.
- Swelling – In and around the joint, especially after movement.
Pain, stiffness, and swelling are the symptoms that bring most people with osteoarthritis to their primary care provider.
Benefits of Low-Dose Radiotherapy for Osteoarthritis
Low-dose radiotherapy (LDRT) isn’t widely used in managing OA in the United States. It’s used abroad to treat osteoarthritis, and there’s plenty of research indicating it’s both safe and effective.
The benefits of LDRT for OA include:
- Less inflammation
- Less pain
- More mobility
According to a multicenter study out of Germany, other advantages of LDRT, including:
- Cost efficiency.
- Near absence of toxicities.
- Noninvasiveness.
LDRT has a strong anti-inflammatory effect that can relieve pain, reduce the need for steroid injections, and improve mobility.
Talk to your rheumatologist if your OA hasn’t responded to physical therapy, corticosteroid injections, or medication. Roughly 25% of people with osteoarthritis won’t respond to traditional first-line treatments.
How does LDRT work?
Rather than mask symptoms like pain and stiffness, LDRT delivers a low radiation dose directly to the affected joint.
The medical team will first make a custom mold of the affected joint to hold it in place. The mold will ensure we deliver the radiation to the same spot each time. We can typically complete the treatment in six to eight office visits.
The radiation can slow or halt the progression of osteoarthritis. It modulates the immune system to stop it from attacking the joint. This, in turn, reduces the body’s inflammation response in the area and relieves pain.
LDRT is delivered using the same equipment used in radiation therapy for cancer, only at a fraction of the dosage level. The equipment, called a linear accelerator or LINAC, delivers external beam radiation. This is similar to an x-ray on the outside of the skin. The low dose should not affect the skin.
Some patients experience pain relief and better mobility in just one treatment. Six treatments are usually necessary to achieve the best results. Side effects from LDRT are rare, and benefits usually last up to two years. We can repeat the LDRT treatment if relief wears off.
The multicenter study on LDRT for osteoarthritis shows that 65% to 77% of people who undergo LDRT sessions get a response.
Weighing LDRT against the alternatives
LDRT is an easily tolerated, effective, and noninvasive alternative to NSAIDs. NSAIDs are the usual first-line treatment for OA. In 25% of patients, these medicines don’t work or are ineffective.
Also, these medicines carry risks for long-term use. The risks of NSAIDs include:
- Acute or chronic renal failure.
- Cardiovascular events.
- Gastrointestinal bleeds.
These NSAID risks are higher in older patients, who are also more likely to have painful OA. Research shows that about two-thirds of elderly patients who got LDRT joint treatment had pain relief, with no difference by age. Radiotherapy was an effective analgesic for OA, even in the oldest patients.
LDRT is not a first-line treatment, and we don’t recommend it for everyone. Ideal candidates are over 50 and have osteoarthritis that hasn’t responded to PT, injections, or medicine.
Other factors to consider when determining if the benefits outweigh the risks include:
- The joints affected.
- The severity of the arthritis.
- The person’s overall health and medical history,
The person’s compliance with the treatment schedule and preference for noninvasive options could also affect their suitability.
Side effects of LDRT are rare but may include fatigue and a slight worsening of OA pain before it improves.
Why Choose UPMC for LDRT
UPMC Hillman Cancer Center is a longtime leader in radiation therapy treatment for cancer. We are at the forefront of using LDRT to treat osteoarthritis.
We not only treat osteoarthritis with LDRT, but we also train and educate medical professionals on how to manage OA with LDRT.