Low-dose radiation therapy for osteoarthritis and enthesopathies: a review of current data

Abstract

Background

Osteoarthritis (OA), the most common degenerative joint disease, is associated with severe functional limitation and impairment of quality of life. Numerous reports have documented the clinical efficacy of low-dose radiotherapy (LD-RT) in the management of various inflammatory disorders, including OA. In this paper, we assessed the clinical literature involving the use of LD-RT in the treatment of OA, its dose-response features, possible underlying mechanistic features, and optimal therapeutic dose range.

Methods

We carried out a systematic review based on the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statements and evaluated articles meeting the inclusion criteria for this review.

Results

A total of 361 articles were identified from databases, such as Scopus, PubMed, Embase, and Science Direct out of which 224 articles were duplicates and were discarded. Of the remaining 137 articles, 74 articles were un-related, 27 articles were review articles, eight were conference abstracts, three were letters, two were editorials, two were notes, and one was a book chapter. Finally, 20 articles met all the inclusion criteria and were included in this systematic review.

Discussion

Several single-arm retrospective/prospective studies showed advantages for LD-RT in the management of OA in terms of pain relief, improvement of mobility and function, and showed minimal side effects. Mechanistic considerations involve positive subcellular effects mediated by the activation of a nuclear factor erythroid 2-related transcription factor (Nrf2) mediated antioxidant response. Further research on both the short- and long-term effects of LD-RT on OA and other inflammatory disorders is recommended.

Keywords:

• Osteoarthritis
• low-dose radiotherapy
• pain
• functioning
• safety
• Nrf2

Acknowledgments

We would like to express our special thanks of gratitude to Clinical Research Development Unit, Hospital Research Development Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran.

Author contributions

SAJ and GD: conceptualization. SAJ, NN, RG, DS, DF, BP, NS, AM, RK, GD, FT, JSW, and MN: data curation. SAJ: funding acquisition. SAJ, NN, RG, DS, DF, BP, NS, AM, RK, FT, and MN: investigation. SAJ, GD, EC, and MN: methodology. SAJ and EC: project administration. SAJ: resources. SAJ and FT: software. SAJ, GD, and EC: supervision. EC: validation. JSW: visualization. SAJ, NN, RG, DS, DF, BP, NS, AM, RK, GD, FT, and JSW: roles/writing original draft. EC and JSW: writing – review and editing.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This study is supported by the Clinical Research Development Unit, Hospital Research Development Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran (grant number 99151 to S.A. Javadinia).

Notes on contributors

Seyed Alireza Javadinia

Seyed Alireza Javadinia, MD, is an Assistant Professor of Radiation Oncology at the Vasei Educational Hospital, Sabzevar University of Medical Sciences, TohidShar BLV, Sabzevar, Razavi Khorasan, 9617747431, Iran.

Nooshin Nazeminezhad

Nooshin Nazeminezhad, MD, is a Consultant Physician at the Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Ruhollah Ghahramani-Asl

Ruhollah Ghahramani-Asl, PhD, is an Assistant Professor of Medical Physics at Department of Medical Physics and Radiation Sciences, Faculty of Paramedicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.

Davood Soroosh

Davood Soroosh, MD, is an Assistant Professor of Forensic Medicine at Department of Internal Medicine, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.

Danial Fazilat-Panah

Danial Fazilat-Panah, MD, is an Assistant Professor of Radiation Oncology at the Department of Radiation Oncology, Babol University of Medical Sciences, Babol, Iran.

Babak PeyroShabany

Babak PeyroShabany, MD, is an Assistant Professor of Hematology Oncology at the Department of Internal Medicine, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.

Seyedeh Naeimeh Saberhosseini

Seyedeh Naeimeh Saberhosseini, MD, is a Resident of Internal Medicine at the Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Arezoo Mehrabian

Arezoo Mehrabian, MD, is a Resident of Radiation Oncology at the Department of Radiation Oncology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Farzad Taghizadeh-Hesary

Farzad Taghizadeh-Hesary, MD, is a Consultant Physician at the Department of Clinical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Mohammad Nematshahi

Mohammad Nematshahi, MD, is an Anesthesiologist and Pain Specialist at the Department of Anesthesiology and Critical Care, Sabzevar University of Medical Sciences, Sabzevar, Iran.

Gaurav Dhawan

Gaurav Dhawan, MBBS, MPH is an Honorary Visiting Professor at Sri Guru Ram Das University of Health Sciences, Amritsar, India.

James S. Welsh

James S. Welsh, MD, MS, FACRO is a Professor & Director of Translational Research, Department of Radiation Oncology, Stritch School of Medicine Loyola University- Chicago, Cardinal Bernardin Cancer Center, Maywood, Illinois, USA and Chief of Radiation Oncology, Hines VA Medical Center, Illinois, USA.

Edward J. Calabrese

Edward J. Calabrese, PhD is a Professor in the Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.

Rachna Kapoor

Rachna Kapoor, MD, MPH is an Internal Medicine Hospitalist at Saint Francis Hospital and Medical Center, Hartford, USA.