Hammadeh Bara M, Aldalati Abdullah Yousef, Al Matairi Alzahra'a, Elshabrawi Mohamed Nasser, Qtaishat Fares A, Al-Qunbar Ahmad M, Alzibdeh Abdulla, Abuodeh Yazan, Abuhijla Fawzi
Faculty of Medicine, Balqa' Applied University, Salt, Jordan.
Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Rheumatol Int. 2025 Sep 1;45(9):210. doi: 10.1007/s00296-025-05942-z.
Osteoarthritis (OA) is the most prevalent form of arthritis and a major cause of disability worldwide. Conventional treatments often provide limited relief and carry long-term risks, highlighting the need for safer, non-pharmacologic alternatives. Low-dose radiotherapy (LDRT) has emerged as a potential option due to its anti-inflammatory effects and favorable safety profile.
To evaluate the efficacy and safety of LDRT in managing OA-related pain and functional limitations, and to guide future research on its role in non-pharmacologic OA management.
This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD42024599334). A comprehensive search of five databases was conducted through June 2025 to identify studies evaluating LDRT for osteoarthritis. Eligible studies included human participants with clinically diagnosed OA, assessing LDRT efficacy or safety. Two reviewers independently screened and extracted data. Risk of bias was assessed using the Cochrane ROB 2 tool. A random-effects meta-analysis was performed using R software, with heterogeneity evaluated by I² and tau² statistics.
Twelve studies involving 1,750 participants were included, with six eligible for meta-analysis. LDRT showed no significant benefit over sham treatment in reducing pain (SMD: -0.92; P = 0.13) or improving function (SMD: 0.22; P = 0.22). While most adverse events were similar between groups, nail reactions were significantly more common with LDRT (RR: 2.24; 95% CI: 1.13-4.45). Overall, adverse events were more frequent in the LDRT group (RR: 1.44; 95% CI: 1.08-1.92). No significant differences were observed in treatment response rates. Risk of bias was generally low, and evidence certainty ranged from moderate to high. GRADE assessment indicated high certainty for adverse events but moderate certainty for pain and functional outcomes.
This meta-analysis found that low-dose radiotherapy (LDRT) offers no significant benefit over sham treatment for osteoarthritis in terms of pain or function, despite mild adverse effects. Current evidence does not support its use over standard therapies, and due to clinical heterogeneity and limited follow-up, LDRT should remain investigational reserved for research or select refractory cases.
骨关节炎（OA）是最常见的关节炎形式，也是全球致残的主要原因。传统治疗通常缓解有限且存在长期风险，这凸显了对更安全的非药物替代疗法的需求。低剂量放疗（LDRT）因其抗炎作用和良好的安全性已成为一种潜在选择。
评估低剂量放疗（LDRT）治疗骨关节炎相关疼痛和功能受限的疗效和安全性，并指导未来关于其在骨关节炎非药物治疗中作用的研究。
本系统评价和荟萃分析遵循PRISMA指南，并在PROSPERO（CRD42024599334）注册。截至2025年6月，对五个数据库进行了全面检索，以识别评估低剂量放疗治疗骨关节炎的研究。符合条件的研究包括临床诊断为骨关节炎的人类参与者，评估低剂量放疗的疗效或安全性。两名评审员独立筛选和提取数据。使用Cochrane ROB 2工具评估偏倚风险。使用R软件进行随机效应荟萃分析，通过I²和tau²统计评估异质性。
纳入了12项研究，共1750名参与者，其中6项符合荟萃分析条件。在减轻疼痛（标准化均数差：-0.92；P = 0.13）或改善功能（标准化均数差：0.22；P = 0.22）方面，低剂量放疗与假治疗相比无显著益处。虽然两组之间大多数不良事件相似，但低剂量放疗组的指甲反应明显更常见（相对风险：2.24；95%置信区间：1.13 - 4.45）。总体而言，低剂量放疗组的不良事件更频繁（相对风险：1.44；95%置信区间：1.08 - 1.92）。治疗反应率未观察到显著差异。偏倚风险总体较低，证据确定性从中度到高度不等。GRADE评估表明不良事件的确定性高，但疼痛和功能结局的确定性为中度。
这项荟萃分析发现，低剂量放疗（LDRT）在疼痛或功能方面对骨关节炎的治疗效果并不优于假治疗，尽管存在轻微不良反应。目前的证据不支持其优于标准疗法的使用，并且由于临床异质性和随访有限，低剂量放疗应保留用于研究或特定难治性病例的研究。
