XRT for spine arthritis, or just extremities?

[IonsAreOurFuture]

We've discussed many times here the merits of low dose RT for arthritis, but it seems to always be extremity. I guess my in-house program has taken off too well, because I got a referral for refractory spine arthritis pain, in a patient requiring interventions like nerve ablations.

Has anyone here seen published or treated spine before? I'm sure someone must have tried it for ankylosing spondylitis or "rheumatism" back in the day.

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[IonsAreOurFuture]

Here's the recent Red Journal review article for reference, they do mention Ankyl. Spond, but they gave 20 Gy total to the whole spine and SI joints. They did see some 2nd malignancies at that large dose and field size (probably half of the patient's marrow):

https://www.redjournal.org/action/showPdf?pii=S0360-3016%2822%2900357-1

 

[TheWallnerus]

Here's the recent Red Journal review article for reference, they do mention Ankyl. Spond, but they gave 20 Gy total to the whole spine and SI joints. They did see some 2nd malignancies at that large dose and field size (probably half of the patient's marrow):

https://www.redjournal.org/action/showPdf?pii=S0360-3016%2822%2900357-1

It's been a long time since step 1/2/3, but arthritis ≠ ankylosing spondylitis?

 

[OTN]

I've done it for OA of the cervical, thoracic, and lumbar spine. It works.

 

[IonsAreOurFuture]

Correct, Wallnerus. OA and RA and AS are different disease entities. I don't know if there's any good treatment for AS.

There was always a surgeon at UCLA that I would see walking around stooped dramatically forward. I don't know if it was due to him being tall and always hunched over the operating table for days on end, or AS. Now that I have a smartphone, I think my kyphosis will be equally bad soon.

 

[IonsAreOurFuture]

I've done it for OA of the cervical, thoracic, and lumbar spine. It works.

Same doses I presume, 0.5 Gy x 6 fx over 2 to 3 weeks?

 

[deleted1111261]

Yeah same doses

I’ve had good results

But a few no responses

 

[OTN]

Same doses I presume, 0.5 Gy x 6 fx over 2 to 3 weeks?

yep

 

[Palex80]

It's been a long time since step 1/2/3, but arthritis ≠ ankylosing spondylitis?

Yes and no. Ankylosing spondylitis = Bechterew's disease.
It is a type of rheumatic arthritis. RT has been mostly used for osteoarthritis, which is rather a degenerative disease and not a rheumatic one.

Would LDRT still work for rheumatic arthritis? Probably yes, it has simply not been studied that much, is my guess.
Rheumatic arthritis is. however, a systemic disease. Even if you treat the joint, that individual patient may relapse with pain, since he has an instrinsic hyperinflammation.

 

[madchemist89]

I thought RT used to be a treatment for ankylosing spondylitis back in the day.

 

[Palex80]

I thought RT used to be a treatment for ankylosing spondylitis back in the day.

Yes, different dose spectrum though.

 

[thesauce]

I've done it for OA of the cervical, thoracic, and lumbar spine. It works.

Same

 

[evilbooyaa]

It's been a long time since step 1/2/3, but arthritis ≠ ankylosing spondylitis?

It is a type of arthritis. Arthritis is a VERY broad spectrum of disease

LDRT is mostly for OSTEOarthritis, which is a different (than AS) subtype of arthritis.