Z Orthop Unfall
DOI: 10.1055/a-2489-5071
Review

How Effective is Low-dose Radiotherapy (LD-RT) for Heberden's Osteoarthritis? An Analysis of the Current Literature

Article in several languages: English | deutsch
Ute Schreiner
1   Geschäftsstelle Mannheim, Deutsche Arthrose-Hilfe e.V., Mannheim, Deutschland (Ringgold ID: RIN608265)
,
Helmut Huberti
1   Geschäftsstelle Mannheim, Deutsche Arthrose-Hilfe e.V., Mannheim, Deutschland (Ringgold ID: RIN608265)
› Author Affiliations

Abstract

Introduction

Low-dose radiotherapy is an established treatment option for non-malignant skeletal disorders. It is used in the treatment of Heberden’s osteoarthritis (HA), but the evidence of efficacy does not seem to be certain. This paper reviews current literature for scientific evidence of efficacy in the treatment of HA.

Methods

The PubMed and Cochrane Library databases were searched for relevant publications.

Results

9 publications were identified that published data from 7 studies. Only one study was randomised, placebo-controlled and double-blinded. None of the studies exclusively investigated HA. The studies were all inhomogenous with regard to inclusion criteria, follow-up criteria, radiation mode and interpretation or treatment success. In the RCT, no difference was found between the verum and control groups.

Conclusion

The study situation is currently weak. The researched publications are not sufficiently focused on the collective of Heberden’s osteoarthritis and are generally too inhomogenous with regard to the criteria applied. Future targeted studies are therefore required to prove efficacy.



Publication History

Received: 03 March 2024

Accepted after revision: 22 November 2024

Article published online:
27 January 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 
  • References

  • 1 Kleinert HE, Kutz JE, Fishman JH. et al. Etiology and treatment of the so-called mucous cyst of the finger. J Bone Joint Surg Am 1972; 54: 1455-1458
  • 2 Jackson DS, Kellgren JH. Hyaluronic acid in Heberden’s nodes. Ann Rheum Dis 1957; 16: 238-240
  • 3 Alexander CJ. Heberden’s and Bouchard’s nodes. Ann Rheum Dis 1999; 58: 675-678
  • 4 Thaper A, Zhang W, Wright G. et al. Relationship between Heberden’s nodes and underlying radiographic changes of osteoarthritis. Ann Rheum Dis 2005; 64: 1214-1216
  • 5 Fassbender H. Pathology of rheumatic Diseases. New York: Springer; 1975
  • 6 Cicuttini FM, Baker J, Hart DJ. et al. Relation between Heberden’s nodes and distal interphalangeal joint osteophytes and their role as markers of generalised disease. Ann Rheum Dis 1998; 57: 246-248
  • 7 Tan AL, Grainger AJ, Tanner SF. et al. High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis. Arthritis Rheum 2005; 52: 2355-2365
  • 8 McGonagle D, Lories RJ, Tan AL. et al. The concept of a “synovio-entheseal complex” and its implications for understanding joint inflammation and damage in psoriatic arthritis and beyond. Arthritis Rheum 2007; 56: 2482-2491
  • 9 McGonagle D, Tan AL, Grainger AJ. et al. Heberden’s nodes and what Heberden could not see: the pivotal role of ligaments in the pathogenesis of early nodal osteoarthritis and beyond. Rheumatology (Oxford) 2008; 47: 1278-1285
  • 10 Mücke R, Micke O, Seegenschmiedt MH. et al. S2e-Leitlinie der Deutschen Gesellschaft für Radioonkologie (DEGRO) Strahlentherapie gutartiger Erkrankungen. 2022 Accessed November 28, 2024 at: https://www.degro.org/wp-content/uploads/2022/12/20221130-Strahlentherapie-gutartiger-Erkrankungen-Version-3.0.pdf
  • 11 Kern PM, Keilholz L, Forster C. et al. Low-dose radiotherapy selectively reduces adhesion of peripheral blood mononuclear cells to endothelium in vitro. Radiother Oncol 2000; 54: 273-282
  • 12 Hildebrandt G, Maggiorella L, Rödel F. et al. Mononuclear cell adhesion and cell adhesion molecule liberation after X-irradiation of activated endothelial cells in vitro. Int J Radiat Biol 2002; 78: 315-325
  • 13 Gaipl US, Meister S, Lodermann B. et al. Activation-induced cell death and total Akt content of granulocytes show a biphasic course after low-dose radiation. Autoimmunity 2009; 42: 340-342
  • 14 Kern P, Keilholz L, Forster C. et al. In vitro apoptosis in peripheral blood mononuclear cells induced by low-dose radiotherapy displays a discontinuous dose-dependence. Int J Radiat Biol 1999; 75: 995-1003
  • 15 Voll RE, Herrmann M, Roth EA. et al. Immunosuppressive effects of apoptotic cells. Nature 1997; 390: 350-351
  • 16 Lodermann B, Wunderlich R, Frey S. et al. Low dose ionising radiation leads to a NF-kappaB dependent decreased secretion of active IL-1beta by activated macrophages with a discontinuous dose-dependency. Int J Radiat Biol 2012; 88: 727-734
  • 17 Wunderlich R, Ernst A, Rödel F. et al. Low and moderate doses of ionizing radiation up to 2 Gy modulate transmigration and chemotaxis of activated macrophages, provoke an anti-inflammatory cytokine milieu, but do not impact upon viability and phagocytic function. Clin Exp Immunol 2015; 179: 50-61
  • 18 Budras KD, Hartung K, Munzer BM. [Light and electron microscopy studies of the effect of roentgen irradiation on the synovial membrane of the inflamed knee joint]. Berl Munch Tierarztl Wochenschr 1986; 99: 148-152
  • 19 Fischer U, Kamprad F, Koch F. et al. [The effects of low-dose Co-60 irradiation on the course of aseptic arthritis in a rabbit knee joint]. Strahlenther Onkol 1998; 174: 633-639
  • 20 Deloch L, Fuchs J, Rückert M. et al. Low-Dose Irradiation Differentially Impacts Macrophage Phenotype in Dependence of Fibroblast-Like Synoviocytes and Radiation Dose. J Immunol Res 2019; 2019: 3161750
  • 21 Frey B, Gaipl US, Sarter K. et al. Whole body low dose irradiation improves the course of beginning polyarthritis in human TNF-transgenic mice. Autoimmunity 2009; 42: 346-348
  • 22 Weissmann T, Rückert M, Zhou JG. et al. Low-Dose Radiotherapy Leads to a Systemic Anti-Inflammatory Shift in the Pre-Clinical K/BxN Serum Transfer Model and Reduces Osteoarthritic Pain in Patients. Front Immunol 2021; 12: 777792
  • 23 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097
  • 24 Alvarez B, Montero A, Alonso R. et al. Low-dose radiation therapy for hand osteoarthritis: shaking hands again?. Clin Transl Oncol 2022; 24: 532-539
  • 25 Donaubauer AJ, Zhou JG, Ott OJ. et al. Low Dose Radiation Therapy, Particularly with 0.5 Gy, Improves Pain in Degenerative Joint Disease of the Fingers: Results of a Retrospective Analysis. Int J Mol Sci 2020; 21
  • 26 Juniku N, Micke O, Seegenschmiedt MH. et al. Radiotherapy for painful benign skeletal disorders: Results of a retrospective clinical quality assessment. Strahlenther Onkol 2019; 195: 1068-1073
  • 27 Minten MJM, Leseman-Hoogenboom MM, Kloppenburg M. et al. Lack of beneficial effects of low-dose radiation therapy on hand osteoarthritis symptoms and inflammation: a randomised, blinded, sham-controlled trial. Osteoarthritis Cartilage 2018; 26: 1283-1290
  • 28 Niewald M, Moumeniahangar S, Müller LN. et al. ArthroRad trial: randomized multicenter single-blinded trial on the effect of low-dose radiotherapy for painful osteoarthritis-final results after 12-month follow-up. Strahlenther Onkol 2024; 200: 134-142
  • 29 Niewald M, Müller LN, Hautmann MG. et al. ArthroRad trial: multicentric prospective and randomized single-blinded trial on the effect of low-dose radiotherapy for painful osteoarthritis depending on the dose-results after 3 months’ follow-up. Strahlenther Onkol 2022; 198: 370-377
  • 30 Van den Ende CHM, Minten MJM, Leseman-Hoogenboom MM. et al. Long-term efficacy of low-dose radiation therapy on symptoms in patients with knee and hand osteoarthritis: follow-up results of two parallel randomised, sham-controlled trials. Lancet Rheumatol 2020; 2: E42-E49
  • 31 Hautmann MG, Rechner P, Neumaier U. et al. Radiotherapy for osteoarthritis-an analysis of 295 joints treated with a linear accelerator. Strahlenther Onkol 2020; 196: 715-724
  • 32 Rogers S, Eberle B, Vogt DR. et al. Prospective Evaluation of Changes in Pain Levels, Quality of Life and Functionality After Low Dose Radiotherapy for Epicondylitis, Plantar Fasciitis, and Finger Osteoarthritis. Front Med (Lausanne) 2020; 7: 195