Radiation therapy for OA?

[dozitgetchahi]

I’m a rheumatologist…at my multispecialty PP, my CMO came to me recently and told me they were interviewing a rad onc candidate who was keen on doing RT for OA of various joints. He wanted to know what I thought of this.

I’ve reviewed some articles and the data seems somewhat spotty etc. Is this a legit treatment modality for OA? Is this something that is done out there with any frequency? I’d never really heard of it until he brought it up.

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[catachip]

It’s legit and used extensively in Europe, especially Germany. Americans are just afraid of radiation.

 

[elementaryschooleconomics]

I personally use this quite frequently in my own practice. Many other posters you'll find here do as well.

It works. If you stumble upon those stupid "randomized control trials" from 2017/2018 - they're hot garbage and not worth the paper they're printed on. They treated less than 30 people in the experimental arm and powered the stats to only be positive with a 40% improvement...in severe, chronic pain patients. Not even fentanyl can do that.

There's never been a recorded case of secondary malignancy with LDRT either. It's 1/20th the dose we use to treat cancer (or lower). We're not trying to kill cells so much as alter inflammatory cytokines and cell signaling.

Insurance almost always pays for it (unless you get a dummy with an axe to grind at a local level). I've never had a denial, personally.

I still can't believe it sort of...died in America. I've literally seen people stop walking with a cane after I've treated their knees. It's insane.

 

[thesauce]

Yes. It is covered by most insurances including Medicare and works great

 

[SneakyBooger]

I've treated over a thousand joints.

 

[Neuronix]

I’m a rheumatologist…at my multispecialty PP, my CMO came to me recently and told me they were interviewing a rad onc candidate who was keen on doing RT for OA of various joints. He wanted to know what I thought of this.

I’ve reviewed some articles and the data seems somewhat spotty etc. Is this a legit treatment modality for OA? Is this something that is done out there with any frequency? I’d never really heard of it until he brought it up.

You should hire that rad onc candidate IMO. That's a forward thinking, practice growing person.

 

[evilbooyaa]

I’m a rheumatologist…at my multispecialty PP, my CMO came to me recently and told me they were interviewing a rad onc candidate who was keen on doing RT for OA of various joints. He wanted to know what I thought of this.

I’ve reviewed some articles and the data seems somewhat spotty etc. Is this a legit treatment modality for OA? Is this something that is done out there with any frequency? I’d never really heard of it until he brought it up.

The TL;DR:
Very commonly used in Germany.

Some people in Europe (not Germany) ran extremely underpowered phIII trials and got a negative result. They also did the radiation in a different manner than the Germans do.

There are now a multitude of people doing this off-protocol since the RT dose is so incredibly low and seeing significant clinical benefit.

There are some ph II trials actively enrolling around the country for this as well, replicating the German experience. Eventual plan to run a phIII version of them.