Low-dose radiation therapy for refractory hand osteoarthritis: a case report

Background Hand osteoarthritis (HOA) is a common degenerative joint disorder affecting a substantial proportion of older adults, particularly at the distal interphalangeal and first carpometacarpal joints. Current management is largely limited to symptomatic therapies, and no disease-modifying treatment is approved. Low-dose radiation therapy (LDRT) has re-emerged as a noninvasive option for osteoarthritis, with observational studies suggesting anti-inflammatory benefit, though randomized trial evidence remains mixed. We report a case of severe, refractory hand osteoarthritis in a patient with limited pharmacologic options who was treated with LDRT. Case presentation: A 70-year-old White female with a more than 15-year history of progressive hand osteoarthritis presented with severe, refractory pain and functional limitation of the distal interphalangeal, proximal interphalangeal, and first carpometacarpal joints bilaterally. Her disease course included erosive changes, joint deformity, and prior arthrotomy with debridement, with only transient benefit from corticosteroid injections and surgical intervention. Systemic nonsteroidal anti-inflammatory drugs were contraindicated due to a history of Helicobacter pylori infection complicated by recurrent bleeding gastric ulcers, and disease-modifying therapies were not pursued due to insurance barriers. Given her advanced age, contraindication to NSAIDs, and limited surgical options, she was treated with LDRT to the bilateral hands, delivering 3 Gy in 6 fractions over two weeks. Her pain improved from 6–7/10 to near resolution by treatment completion, with improved grip strength and restored sleep and no reported adverse effects. Partial recurrence of pain (4/10) was noted approximately two months later, prompting consideration of a repeat treatment course. Conclusions This case illustrates the clinical course of a patient with severe, treatment-refractory hand osteoarthritis and multiple contraindications to standard pharmacologic therapy who experienced meaningful, though partially durable, symptomatic improvement following low-dose radiation therapy. Given the uncertainty in existing randomized trial data, further study is needed to clarify which patient phenotypes are most likely to benefit from this approach.