Abstract
Background: The objective benefits of low dose radiotherapy (LDRT) for non-malignant joint disorders are controversial. This study evaluated changes in pain, quality of life (QoL) and function after LDRT for epicondylitis, plantar fasciitis, and finger osteoarthritis.Materials and Methods: Patients over 40 years old with epicondylitis, plantar fasciitis, and finger osteoarthritis were had pain following at least 6 months of conservative therapy. Patients received 0.5 Gy LDRT twice weekly for 4 weeks repeated once after 8 weeks in patients who failed to achieve complete pain relief. Patients assessed their pain according to the visual analog scale. Handgrip strength was measured with an isometric dynamometer and the fast self-paced walking test was used in patients with plantar fasciitis. QoL was evaluated according to the EQ-5D and HAQ-DI questionnaires.Results: Outcomes for 157 patients (204 sites) were documented at 2, 6, and 12 months after last LDRT. Pain reduction at rest (p < 0.001), during activity (p < 0.001) and increase in handgrip strength (extension p < 0.001, flexion p = 0.002) were highly significant for patients with lateral epicondylitis. Patients with medial epicondylitis reported pain relief at rest (p = 0.041) and during activity (p = 0.041) and significant increase in handgrip strength (p = 0.022). Patients with plantar fasciitis reported pain reduction at rest (p < 0.001), during activity (p < 0.001) and faster walking times (p < 0.001). A trend toward improved QoL was observed. Patients with finger osteoarthritis reported significant pain relief during activity (p < 0.001) and a gain in handgrip strength (p = 0.004), with a trend to both pain relief at rest (p = 0.056) and stronger pinch grip (p = 0.099).Conclusions: LDRT achieved significant pain relief at rest and during activity and a corresponding objective improvement in handgrip strength in patients with epicondylitis. Pain relief at rest, during activity and improvement in walking time were demonstrated in patients with plantar fasciitis. LDRT achieved pain relief during activity, and handgrip strength was improved in patients with finger osteoarthritis. No significant effect was seen on quality of life measures for these conditions. The observed benefits were maintained 12 months after LDRT for all 3 indications and we recommend this low cost, safe intervention for patients over 40 who have failed prior conservative therapy.
Highlights
The objective benefits of low dose radiotherapy (LDRT) for non-malignant joint disorders are controversial
Complete pain response (VAS 0) was achieved in 55/204 (27%) of sites after the first course of low dose radiotherapy and the second course of LDRT was not given in these patients
The planned second course of LDRT was delivered in 149/204 (73%) sites after 2–12 months (25/39 lateral epicondylitis, 8/10 medial epicondylitis, 81/99 finger osteoarthritis, 35/56 plantar fasciitis)
Summary
The objective benefits of low dose radiotherapy (LDRT) for non-malignant joint disorders are controversial. Radiation can inhibit production of nitrous oxide in macrophages, leading to apoptosis [7] and reduced free radical production [8] These in vitro mechanisms have been substantiated in in vivo models [9, 10] and it is plausible that radiation-induced suppression of inflammatory cascades can achieve clinical pain relief in non-malignant musculoskeletal disorders with an active inflammatory component. Finger osteoarthritis affects 20–40% of the population aged 60–70 years of age in Europe and the United States, with a female to male ratio of 3:1 This degenerative joint disease is associated with low-grade inflammation that affects bone, ligaments, cartilage and synovial tissue. It is a heterogeneous condition with a multifactorial etiology and is one of the leading causes of disability worldwide [16]
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