Low-Dose Radiation Therapy for Hand and Thumb Osteoarthritis

Low-dose radiation therapy (LDRT) is an outpatient treatment that directs a very small amount of radiation at an arthritic joint to calm inflammation in the joint lining. Hand osteoarthritis, including the small joints of the fingers and thumb base, is one of the conditions programs discuss LDRT for.

What the Evidence Covers

The evidence for LDRT in hand osteoarthritis is mixed. It helps to know both sides before your consultation.

The randomized trial. A Dutch trial randomly assigned 56 people with hand osteoarthritis to LDRT or a sham treatment. The LDRT group received six treatments of 1 Gy each, 6 Gy in total. At three months, 29% of the LDRT group and 36% of the sham group met the study's definition of a response, so the trial found no benefit over sham. It also found no difference in markers of inflammation.^[1] A later report on the same patients found no evidence of a long-term benefit.^[2]

The larger treatment series. A review of 970 patients aged 65 and older, treated at two German university hospitals, included finger and thumb joints along with knees, hips, shoulders, and feet. Right after treatment, about 60% of treated sites had partial or complete pain relief, and the response did not differ significantly from one joint to another.^[3] This study looked back at people who were treated, without a sham comparison group, so it cannot show how much of the improvement came from the radiation itself.

What this means for you. The Dutch hand trial used a higher total dose than the 3 Gy course most programs use today. The 2025 Korean sham-controlled trial that did find a benefit with 3 Gy enrolled only people with knee osteoarthritis.^[4] The 3 Gy course has not yet been tested against sham treatment in hands. A radiation oncologist can explain how they weigh this evidence for your hands.

For comparison, topical anti-inflammatory medicines, applied directly to the skin over a painful joint, are commonly discussed for hand osteoarthritis specifically, since they can be effective for accessible joints like the hand and may have fewer whole-body effects than oral medicines. LDRT is generally discussed after conservative options like these, along with physical therapy and other measures, have not provided enough relief.

Typical Schedule

• Total dose of about 3.0 Gy, split into 6 treatments of 0.5 Gy each
• Treatments given 2 to 3 times per week, over about 2 to 3 weeks
• Outpatient visits of roughly 10 to 15 minutes each

Who May Be a Candidate

Programs generally consider adults with hand osteoarthritis who have not gotten enough relief from medications (including topical anti-inflammatories), injections, or other conservative treatments. As with other joints, candidacy also depends on age, the extent of structural joint damage, and overall health. A radiation oncologist weighs these together.

Which Hand Joints Are Involved

Hand osteoarthritis most often affects three areas: the joints closest to the fingertips, the middle joints of the fingers, and the joint at the base of the thumb, where the thumb meets the wrist. Bony bumps near the finger joints, called Heberden's and Bouchard's nodes, are common signs. Arthritis at the base of the thumb can make gripping, pinching, turning a key, or opening a jar painful.

If you are considering LDRT, note which joints hurt the most and which daily tasks are hardest. Each treated area is planned on its own, so this helps the radiation oncologist decide what to treat. See Can LDRT Treat More Than One Joint? for more.

Questions to Ask at Your Consultation

• How many patients with hand osteoarthritis has your program treated, and how did they do?
• What dose and schedule do you use for hand joints?
• Can both hands, or several joints, be treated in the same course?
• If the first course does not help enough, would you consider a second course?
• Should I keep using splints, topical medicines, or hand exercises during and after treatment?

References:
1. Minten MJM, et al. Lack of beneficial effects of low-dose radiation therapy on hand osteoarthritis symptoms and inflammation: a randomised, blinded, sham-controlled trial. Osteoarthritis and Cartilage. 2018;26:1283-1290. PubMed
2. van den Ende CHM, et al. Long-term efficacy of low-dose radiation therapy on symptoms in patients with knee and hand osteoarthritis: follow-up results of two parallel randomised, sham-controlled trials. The Lancet Rheumatology. 2020;2:e42-e49. Article
3. Rühle A, et al. Low-dose radiotherapy for painful osteoarthritis of the elderly: a multicenter analysis of 970 patients with 1185 treated sites. Strahlentherapie und Onkologie. 2021;197:895-902. PubMed
4. Kim BH, et al. Clinical Effectiveness of Single Course Low-Dose Radiation Therapy in Knee Osteoarthritis: Short-term Results from the Randomized, Sham-Controlled Trial. ASTRO 67th Annual Meeting Late-Breaking Abstract LBA 06. 2025. Abstract