Low-Dose Radiation For Osteoarthritis

If arthritis pain is making it harder to walk, exercise or enjoy daily activities, and treatments like physical therapy or medications haven't provided enough relief, you may be wondering what other options are available before surgery. Low-dose radiation therapy is one treatment that may help reduce pain and inflammation for some people with osteoarthritis.

While many people associate radiation therapy with cancer treatment, low-dose radiation therapy is being used in some cases to help manage pain and inflammation associated with osteoarthritis and other musculoskeletal conditions.

Sandeep Bhave, MD, a board-certified radiation oncologist at Franciscan Health Indianapolis, explains how this osteoarthritis treatment differs from traditional radiation therapy, who may benefit and what patients can expect during the treatment process.

Key Takeaways: Low-Dose Radiation For Osteoarthritis

• Low-dose radiation therapy uses a small fraction of the radiation dose used for cancer treatment and may help reduce pain and inflammation associated with osteoarthritis and other musculoskeletal conditions.
• Treatment may be an option for some patients with mild to moderate pain who have not found adequate relief from conservative arthritis treatments such as physical therapy, exercise, weight loss or topical medications. Most patients notice improvement within two to three months.
• Low-dose radiation may provide long-lasting relief for arthritis pain and can be considered as a non-invasive option before more invasive treatments such as surgery.

Why Does Osteoarthritis Cause Pain and Stiffness?

Osteoarthritis develops when the articular cartilage, the smooth, protective tissue covering the ends of bones, gradually breaks down in your joint. As osteoarthritis progresses, changes can occur in the underlying bone, including the development of bone spurs and cysts.

These changes can lead to joint pain, stiffness and swelling. They also may make movement and everyday activities more difficult.

Osteoarthritis is the most common form of arthritis and affects millions of adults in the United States.

What Is Low-Dose Radiation Therapy?

Radiation therapy uses high-energy X-rays to treat a variety of medical conditions, most commonly cancer. However, low-dose radiation therapy uses a significantly smaller amount of radiation.

"Instead of delivering doses designed to destroy cancer cells, low-dose radiation uses a small fraction of the radiation typically prescribed for cancer," Dr. Bhave said.

The dose used for musculoskeletal conditions is about 3% of the standard radiation dose used for cancer treatment. At these much lower doses, radiation has been shown to be effective for a variety of musculoskeletal conditions, including osteoarthritis.

How Does Low-Dose Radiation Therapy Help Osteoarthritis Pain?

Low-dose radiation therapy helps reduce inflammation inside affected joints, which may decrease pain and improve mobility for some people with osteoarthritis.

What Conditions May Benefit From Low-Dose Radiation Therapy?

In addition to osteoarthritis, low-dose radiation can be used for several musculoskeletal conditions to help decrease pain and inflammation.

Dr. Bhave said these conditions include:

• Plantar fasciitis
• Tennis elbow
• Hip bursitis, also known as greater trochanteric pain syndrome

How Does Low-Dose Radiation Help With Pain?

At the low doses used for musculoskeletal conditions, radiation works differently than it does during cancer treatment.

"At low doses used for musculoskeletal conditions, radiation acts less like cancer treatment and more like a powerful anti-inflammatory therapy," Dr. Bhave said.

The treatment can help calm inflammation by reducing the number of inflammatory white blood cells entering the joint. It also decreases the release of inflammatory signals called cytokines and helps eliminate activated inflammatory cells.

The goal is to reduce inflammation, which can lead to less pain and improved mobility.

Who May Be a Candidate For Low-Dose Radiation?

According to Dr. Bhave, the best candidates are generally patients with mild to moderate pain. These patients may have not experienced adequate relief from conservative treatments for arthritis pain.

These treatments may include:

• Physical therapy
• Exercise
• Weight loss
• Topical medications or creams

“We typically prefer to treat patients older than 50,” Dr. Bhave said. “This helps balance the treatment benefits with the very small long-term risks associated with radiation exposure.”

When Should You Ask About Low-Dose Radiation Therapy?

You may want to talk with a provider if:

• Arthritis pain is limiting daily activities.
• Physical therapy has not provided enough relief for your arthritis pain.
• Topical medications for arthritis are no longer helping.
• You want to delay surgery or are looking for a non-invasive treatment option for osteoarthritis pain.

What Can You Expect During Low-Dose Radiation Treatment?

Before you receive low-dose radiation for osteoarthritis, you will have a consultation. During the consultation, Dr. Bhave or a colleague will evaluate you, confirm the diagnosis and assess the severity of your osteoarthritis or other musculoskeletal condition. The team will then determine whether low-dose radiation is an appropriate treatment option.

The next step is a CT simulation. This specialized planning scan helps the team create customized immobilization devices to ensure the patient is positioned consistently during each treatment.

About a week later, treatment begins.

“Low-dose radiation is delivered in six treatments over two weeks, with treatments scheduled every other weekday,” Dr. Bhave said. “Each visit takes about 15 minutes, although the radiation itself is delivered in only a minute or two.”

"Most of the appointment is spent carefully positioning you to make sure the treatment is delivered precisely," Dr. Bhave said.

When Will Patients Notice Improvement After Low-Dose Radiation?

Unlike some treatments that may provide relatively quick relief, the effects of low-dose radiation develop gradually.

"Most people do not notice improvement immediately," Dr. Bhave said. “It often takes about two months or longer to experience meaningful symptom relief.”

A follow-up appointment is typically scheduled about three months after treatment to determine whether the patient has benefited.

According to Dr. Bhave, about 70% of patients experience a benefit.

“When patients do respond, the benefit can be long-lasting, with many experiencing relief for years,” he said. ”If it comes back later on, we can talk about repeat treatment. The radiation therapy is given at such a low dose that it doesn't preclude us from doing any surgery.”

Can I Receive More Than One Round Of Low-Dose Radiation?

For patients who do not respond initially to low-dose radiation, a second course may be considered. Dr. Bhave said about half of those patients may benefit from additional treatment, resulting in an overall potential response rate of about 80% to 85%.

What Are Side Effects From Low-Dose Radiation?

Side effects of low-dose radiation for arthritis pain are extremely uncommon, and most patients do not notice any side effects during treatment.

Dr. Bhave notes that the main theoretical risk is radiation-induced cancer. He estimates the risk at approximately one in 10,000 for this treatment dose, while emphasizing that this potential risk should be weighed against the potential benefits of treatment.

The treatment also does not prevent patients from pursuing other treatment options for their arthritis pain in the future. According to Dr. Bhave, patients can still undergo procedures such as joint replacement, arthroscopic surgery or steroid injections if needed.

Learn More About Arthritis Treatment Options

If osteoarthritis pain is affecting your quality of life and conservative treatments have not provided enough relief, Franciscan Health's orthopedic, primary care and radiation oncology specialists can help you explore your treatment options.

Schedule an appointment with a Franciscan Health provider to discuss whether low-dose radiation therapy may be right for you.

Frequently Asked Questions: Low-Dose Radiation Therapy For Arthritis Pain

Do I need a physician referral for low-dose radiation therapy?

You do not need a physician referral for low-dose radiation therapy for osteoarthritis pain.

Is low-dose radiation covered by insurance?

Low-dose radiation therapy for osteoarthritis is typically covered by commercial insurance plans. However, coverage can vary based on a person's specific insurance plan.

Is low-dose radiation covered by Medicare?

Low-dose radiation therapy for osteoarthritis is typically covered by Medicare. Coverage can vary based on a person's specific plan.

Will I feel radiation being delivered?

Patients do not feel the radiation while it is being delivered, and they do not become radioactive.