The authors of the selective literature search (1) did not mention the option of radiotherapy. The effectiveness of radiotherapy in inflammatory degenerative disorders has been known for more than 100 years and is used often and successfully in Germany. In the meantime, S2 guidelines for radiotherapy in benign disorders have been published (2–3).
About 75% of patients with osteoarthritis of the small joints benefit from radiotherapy; the usual treatment is six fractions with single doses of 0.5–1 Gy up to a total dose of 3 Gy or 6 Gy. Even after five years, most patients benefit from sustained pain relief. The tumor risk is negligible in the mostly older patients. For the dose range that is used in radiotherapy of joint arthritis, the literature does not mention any tumor induction (3).
The results of 809 patients after radiotherapy for painful arthritis of the hand and finger joints have been published. A response to the treatment was documented in 63–75% of patients (1). In a recently published study, the effectiveness of radiotherapy in 101 joints of 84 patients with thumb carpometacarpal osteoarthritis (rhizarthrosis) was evaluated—which is a larger number of patients compared to the studies mentioned in the review article. After 12 months, 70% of cases responded to the treatment, and complete pain response was achieved in 26% (4). Unfortunately, no randomized controlled trials have been reported for the radiotherapy of painful arthritis versus the usual therapeutic alternatives or non-treatment.
Prof. Dr. med. Michael Pinkawa
MediClin Robert Janker Klinik
Klinik für Strahlentherapie und Radioonkologie
MVZ MediClin Bonn GmbH, Medizinisches Versorgungszentrum für
Strahlentherapie und Neurochirurgie
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Spies CK, Langer M, Hahn P, Müller LP, Unglaub F: The treatment of primary arthritis of the finger and thumb joint. Dtsch Arztebl Int 2018; 115: 269–75 VOLLTEXT|
|2.||Ott OJ, Niewald M, Weitmann HD, et al.: German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD). DEGRO guidelines for the radiotherapy of non-malignant disorders. Part II: painful degenerative skeletal disorders. Strahlenther Onkol 2015; 191: 1–6 CrossRef MEDLINE|
|3.||Deutsche Gesellschaft für Radioonkologie: Strahlentherapie gutartiger Erkrankungen. Fachgruppenspezifische evidenzbasierte S2e-Leitlinie der Deutschen Gesellschaft für Radioonkologie (DEGRO). Version 1.0 vom 14.11.2013.|
|4.||Kaltenborn A, Bulling E, Nitsche M, Carl U, Hermann RM: The field size matters: low dose external radiotherapy for thumb carpometacarpal osteoarthritis. Strahlenther Onkol 2016; 192: 582–8 CrossRef MEDLINE|