Low-dose radiation may help osteoarthritis symptoms with no side effects

More than 32.5 million people in the United States have osteoarthritis, a degenerative joint condition and the most common type of arthritis. This means that for 1 out of 7 adults, severe joint pain and stiffness may be a daily reality.

Because it affects the joints that tend to take the most wear and tear, like the hands, feet and knees, osteoarthritis can limit a person’s range of motion. That can make it a serious detriment to a person’s health.

“Osteoarthritis may increase a person’s risk of heart disease because they can't be as active when they're having pain,” explained Dr. Michael Nichols, a radiation oncologist at the Novant Health Cancer Institute in Wilmington. People with osteoarthritis make an average of $4,040 less per year than adults without arthritis, Nichols pointed out, because of lost wages due to time off work for chronic pain. It’s also the leading cause of disability in the U.S., the Centers for Disease Control and Prevention reports.

Traditionally, osteoarthritis is treated with pain killers like ibuprofen and naproxen, or steroid injections. But Nichols said there’s a new option in southeastern North Carolina from a source you might not expect: low-dose radiation.

While we associate radiation with the treatment of cancer, it can be used in a much smaller dose to treat osteoarthritis. Low-dose radiation therapy (LDRT) has virtually no side effects and can help patients lead more comfortable lives in just a few treatments.

“It's pretty cool,” Nichols said. “I love that we can treat osteoarthritis and patients get better almost immediately. … It's great because you just really see this almost instant quality of life improvement.”

Radiation has long been used in Germany for osteoarthritis. But it’s not as commonly used in other countries, despite numerous studies that show its effectiveness for long-term pain relief and improvement of joint mobility.

How does LDRT work?

LDRT slows or halts the progression of osteoarthritis, rather than masking the symptoms, like a pain-relieving pill would, Nichols said. A dose of radiation directed at the site of osteoarthritis can decrease the body’s production of inflammation in that area.

“It modulates the immune system and stops the attack on the joint,” Nichols said.

A course of LDRT consists of six treatments, each appointment taking about a half-hour in the radiation clinic. The time actually receiving the radiation, which Nichols refers to “on beam” time, is very brief.

“It’s about 15 seconds,” he said.

How does LDRT differ from radiation for cancer?

To deliver radiation therapy at the site of the osteoarthritis, the medical team uses the same equipment they use in radiation for cancer: a linear accelerator, or LINAC. The LINAC delivers therapeutic radiation from outside the skin, like an X-ray. The medical team uses a custom mold of the targeted body part to ensure the radiation is delivered to the exact right spot each time.

But the amount of radiation is much smaller than that used to kill cancer cells. A team of medical physicists tests the equipment daily to ensure the measurements are correct. (You can read more about that here.)

An absorbed dose of radiation is called a gray. While a radiation treatment for breast cancer may be between 40 and 60 gray, LDRT for osteoarthritis is typically just three gray. Because of this, there is no skin redness or burning.

“A patient can leave the clinic and go out to lunch after,” Nichols said.

Nichols said some patients experience pain relief and improved mobility after just one treatment, with maximum results achieved after six treatments. The results typically last for about two years, after which the patient has the option to undergo treatment once more.

“It's a very rapid response,” Nichols said. “About two-thirds of the patients will get a response. With at least one study out of Spain, 94% of patients had a response.”

Are there risks to LDRT for osteoarthritis?

Because the dose of radiation used in LDRT is so small, there’s very little risk of side effects. The greatest risk, Nichols said, is that the LDRT treatments simply won’t be effective for complete pain relief. But with a two-thirds success rate, Nichols thinks LDRT is worth trying. Plus, he said, the treatment is covered by Medicare.

One specific: if LDRT is performed at the site of a nail bed for osteoarthritis of a finger or toe, the nail might fall out. In the unlikely event that this happens (the doctor takes measures to prevent it) then it should grow back after treatments are done, Nichols said.

An exciting future for osteoarthritis patients

For Nichols, who has specialized in treating breast, lung and GYN cancers since 2008, launching the LDRT program in Wilmington has been an exciting new project. When he learned about the success of an osteoarthritis treatment with little to no side effects and no down time, he knew he wanted to make it available as a service to his community.

“It has really been a lot of fun,” Nichols said.

The first patient Nichols treated with LDRT loved golf but his game was suffering because of osteoarthritis pain. After LDRT, he was back in the game with no discomfort and full mobility.

“That was just so cool, to improve his quality of life with something so simple,” Nichols said.