Abstract
Background: Retrospective studies have described the effectiveness of low-dose radiotherapy (LD-EBRT) in painful arthrosis of small finger joints, but two recent prospective studies have yielded ambiguous results. To generate accurate data for the planning of a trial, we conducted a prospective, monocentric, observational study to describe the effects of LD-EBRT as precisely as possible. Methods: Twenty-five consecutive patients with symptomatic trapeziometacarpal (TMC) arthrosis were irradiated with 6 × 0.5 Gy. Before, 3, and 12 months after LD-EBRT, we assessed subjective endpoints (modified “von-Pannewitz score”, 10-point visual analogue scale (VAS), “patient-rated wrist evaluation” (PRWE)), and objective measurements (“active range of motion” (AROM), Kapandji index, grip strength, pinch grip). Results: At 3/12 months, 80%/57% reported partial and 4%/18% complete remission according to the “von-Pannewitz” score. VAS “overall pain” significantly decreased from a median of seven (IQR 4) at baseline to three (IQR 6; p = 0.046) and to two (IQR 2; p = 0.013). Similar results were obtained for VAS “pain during exercise”, VAS “pain during daytime”, and VAS “function”. “PRWE overall score” was reduced from 0.5 at baseline (SD 0.19) to 0.36 (SD 0.24, p = 0.05) and to 0.27 (SD 0.18, p = 0.0009). We found no improvements of the objective endpoints (AROM, Kapandji, grip strength) except for flexion, which increased from 64° (SD 12°) at baseline to 73° (SD 9.7°, p = 0.046) at 12 months. Conclusions: We recommend the PRWE score as a useful endpoint for further studies for this indication. To prove a 15% superiority over sham irradiation, we calculated that 750 patients need to be prospectively randomized.
Highlights
Osteoarthritis is one of the most common diseases in elderly patients
Seven patients had to be excluded from analysis: five refused re-presentation for the 3-month check-up, one refused further participation in the study after diagnosis of malignant disease, one did not complete low-dose external beam radiotherapy (LD-EBRT) due to personal reasons
Most had already been treated with non-steroidal anti-inflammatory drugs (NSAIDs) and other conservative therapies without lasting success
Summary
Osteoarthritis is one of the most common diseases in elderly patients. The World. No significant differences in pain relief, function, quality of life, and inflammation were reported These results must be viewed critically, as the statistical design of the study assumed using a power of 80% as a massive benefit from LD-EBRT, which led to the small number of recruited patients. Sci. 2021, 9, 66 more than five years; most of them had arthrosis in many finger joints In these patient groups, such high effectiveness of LD-EBRT is unrealistic [18]. We wanted to provide evidence on the efficacy of LD-EBRT regarding pain reduction, function, and quality of life after short- (3 months) and long-term (12 months) follow-up This assessment of the clinical effects should allow a meaningful design of a randomized trial that might define the role of LD-EBRT in TMC arthrosis
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