Response of radiation therapy to erosive osteoarthritis: a case report

Summary: Background: Erosive osteoarthritis (OA) is a more severe form of osteoarthritis, that often involves the hands, usually the distal interphalangeal joints and proximal interphalangeal joints with imaging showing central erosions with saw tooth and gull wing deformities (1). The progressive destruction of the joint cartilage may further destroy the bone, the joint capsule, and surrounding muscles causing pain both during movements and eventually at rest. (2). Currently there is no cure for OA, including erosive OA, as the etiology of the disease is multifactorial. However, the goal of current therapy is alleviation of symptoms and improvement of quality of life. Treatments include reducing risk factors, intraarticular treatments, physical treatments, alternative therapies, and surgical therapy. Some conservative therapies include weight loss to offload pressure, physiotherapy, and orthopedic devices. These palliative treatments are more successful in those with OA and not as effective in those with erosive OA (3). Case Presentation: This is a case of a 71 year-old-female with a medical history of primary and erosive osteoarthritis. The patient was diagnosed with bilateral hand osteoarthritis in her 20’s. She had been on several treatments/medications including corticosteroid injections but has remained without relief. She also suffered from loss of functional ability as she had minimal sensation of her fingers, inability to tightly squeeze her fists, weakness in hand strength, and occasional dropping of objects. The patient was referred for radiation therapy for further treatment. She was prescribed a total of 3Gy over 6 fractions to her bilateral hands using complex photon. The patient was re-evaluated at 12 weeks post-treatment. At her follow-up, her pain was a 0/10 in her bilateral hands. Due to her success with treatment, she opted to continue with low-dose palliative therapy for her bilateral knees due to uncontrolled pain from OA. Discussion: Radiation therapy has been used to treat skeletal diseases in Europe for many years, especially in Germany and Spain. In Germany, over one third of radiation therapy treatments are geared towards benign diseases, including erosive OA. Low dose radiation therapy has been shown in multiple clinical trials to reduce pain in 63-90% of patients, without acute side effects. Radiation therapy has been proven to have dose-dependent therapeutic effects. Conventional and hypo-fractionated radiation therapy have antiproliferative effects that are beneficial in treating malignancy while low dose radiation therapy of less than 1 Gray per fraction have anti-inflammatory effects (4). Conclusion: This case provides another example that demonstrates the benefit of radiation therapy in symptomatic relief in patients with erosive OA. References 1. Favero M, Belluzzi E, Ortolan A, Lorenzin M, Oliviero F, Doria A, Scanzello CR, Ramonda R. Erosive hand osteoarthritis: latest findings and outlook. Nat Rev Rheumatol. 2022 Mar;18(3):171-183. doi: 10.1038/s41584-021-00747-3. Epub 2022 Feb 1. PMID: 35105980. 2. Niewald, M., Müller, L.N., Hautmann, M.G. 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 198, 370–377 (2022). https://doi.org/10.1007/s00066-021-01866-2 3. Abramoff B, Caldera FE. Osteoarthritis: Pathology, Diagnosis, and Treatment Options. MedClin North . 2020 Mar;104(2):293-311. doi: 10.1016/j.mcna.2019.10.007. Epub 2019 Dec 18. PMID: 32035570. 4. Dove A, Cmelak A, Darrow K, McComas K, Chowdhary M, Backta J, Kirschner A. The Use of Low-Dose Radiation Therapy in Osteoarthritis: A Review. International Journal of Radiation Oncology Phys, Vol 114, No 2, pp 2-3-220 (2022). https://doi.org/10.1016/j.ijrobp.2022.04.029