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X-ray treatment for rheumatoid arthritis?
June 5, 2014 10:37 PM   Subscribe

Can you point me to any research or even provide anecdotal evidence in the effective use of radiation, specifically x-ray treatment, in reducing the symptoms of rheumatoid arthritis in the hand?

A friend related a story to me today regarding her grandmother, who has rheumatoid arthritis with severe deformation of her hands. However, one of her hands was injured recently in a car accident and as a result, she required a series of about ten x-rays to the one hand. Within days, that hand began to loosen up and regain function almost to the point of no pain and complete use of the hand to a near normal state.

Her other uninjured but crippled hand has remained in the same painful, distorted condition it was in before the accident. Doctors haven refused to x-Ray the other hand for Reasons. Dr. Google has only turned up articles on the use of x-rays for diagnostic purposes. Have you or someone you known had a similar improvement of RA symptoms after radiation, specifically x-rays, or do you know of any research that might convince the doctors to reconsider?
posted by tamitang to Health & Fitness (4 answers total) 2 users marked this as a favorite
 
Here is a paper that tested if radiotherapy (X-rays) made any improvement in symptoms for patients with RA (rheumatoid arthritis): Teleradiotherapy of joints in rheumatoid arthritis: lack of efficacy . The results were that there was no improvements shown during the study, and so the X-ray treatments were halted for ethical reasons.

Doctors haven refused to x-Ray the other hand for Reasons

Some RA patients receive therapies — immunosuppressive drugs — that deliberately weaken their immune system to help control the damaging effects of joint inflammation, and as a group (or "cohort") patients with RA already have increased risks for contracting certain cancers (cite, cite).

Doctors have Reasons for wanting to minimize a patient's radiation exposure if there is a lack of evidence for benefit, and probably are taught to be even more conservative about administering X-rays if the patient has a disease whose treatments generally put them at greater risk for cancer.
posted by Blazecock Pileon at 3:38 AM on June 6 [1 favorite]


The best I can find for you is a German case-series from the early 90s. Reading it, it is anecdata at best (subjective decrease in pain only, using retrospective patient questionnaires, no controls), and given that the only RCT I can find had to be stopped early (Blazecock Pileon linked to the same one) you will have difficulty persuading a radiologist to break IRMER regulations (or US equivalent) on an unproven treatment even if you can get a rheumatologist to put the request in - it's not "reasons", it puts their licence, and the licences of their radiographers, at risk. Even in cancer patients, there is a limit to how much radiotherapy people can be given because it is really harmful (even mild cases of radiation dermatits can be horribly painful). No responsible doctor is going to blithely irradiate somebody based on what is possibly placebo effect.

You could look if laser therapy is available locally (evidence for that is pretty weak too but at least there are no side effects), or see if there are any experimental radiotherapy trials ongoing anywhere else. However given the early-20th century craze for irradiating everything, if it worked reliably we would probably already know about it.

I doubt you know the details of her care, but if your friend's grandmother has active disease there are lots of other treatments out there that have been shown to work and aren't as risky. She should really talk to her rheumatologist if her disease is poorly controlled.
posted by tinkletown at 8:13 AM on June 6 [1 favorite]


I would suspect that the injury somehow caused the improvement, not the x-rays. Did she have physical therapy on the hand?
posted by Johnny Wallflower at 8:52 AM on June 6 [2 favorites]


As you may know, RA is a relapsing-remitting disease, making it very difficult to identify cause and effect. My close pal with RA couldn't walk because her knee swelled to dodgeball size. Then it got better and she could walk fine.
posted by Jesse the K at 11:23 AM on June 6 [1 favorite]


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