Osteoarthritis, Degenerative joint disease, Arthritis, Hand, Knee, Knie, Artrose, Gewrichtsslijtage
Conditions
Interventions
The experimental intervention arm consists of external beam radiotherapy with a total dose of 6 Gy. This total dose is applied in 6 fractions of 1 Gy, spread over 2 weeks, according to the 2002 consen
Sponsors
Sint Maartenskliniek Nijmegen
Eligibility
Inclusion criteria
Inclusion criteria: Hand OA: •Hand OA according to the 1990 ACR diagnostic criteria for hand OA (Altman 1990) •Mean VAS pain during hand activities of both hands > 4 during 15 of the last 30 days. •Treatment failure of conventional treatment (pain medication and occupational or physical therapy) •Age ≥50 years •Able to read, write and sufficiently communicate in Dutch Knee OA: •Osteoarthritis in the index knee, according to the ACR classification criteria for symptomatic OA of the knee (Altman 1986) •Mean VAS pain during activities of the index knee > 4 during 15 of the last 30 days •Treatment failure of conventional treatment (pain medication and physical therapy) •Age ≥50 years •Able to read, write and sufficiently communicate in Dutch
Exclusion criteria
Exclusion criteria: Hand OA: •Treatment by an occupational or physical therapist in the last 3 months •Scheduled for surgical treatment of the hands in the next 6 months, or previous surgical treatment of the joints in the hands (eg release of median nerve entrapment or trigger finger correction are allowed) •Pain of MCPJs and / or wrist being predominant: patients will be asked to name the two most painful joint areas: PIPJs, DIPJs, MCPs, thumb base, wrist. Because radiotherapy will be targeted on the PIPJs, DIPJs and thumb base joint, pain at wrists and MCPJs could interfere with the outcome on pain at treated joint sites. •Other active rheumatic diseases than OA with possible hand localisation •Cognitive deficits affecting the scoring process •Received intramuscular of intra-articular corticosteroid injections in the previous 4 weeks •Fibromyalgia according to the 2010 ACR diagnostic criteria for fibromyalgia (Wolfe 2011) •Any other syndrome(s) or condition(s) that could interfere with the assessment of pain •Severe current psychiatric disorders assessed by physician •K&L score >3 Knee OA: Treatment by an occupational or physical therapist in the last 3 months •Scheduled for surgical treatment of the knees in the next 6 months, or previous surgical treatment of the knee •VAS pain > 2/10 in the contralateral knee •VAS pain > 2/10 in one or both hips •Other rheumatic diseases than OA with possible knee localisation •Cognitive deficits affecting the scoring process •Received intramuscular of intra-articular corticosteroid injections in the previous 4 weeks •Fibromyalgia according to the 2010 ACR diagnostic criteria for fibromyalgia (Wolfe 2011) •Any other syndrome(s) or condition(s) that could interfere with the assessment of pain •Severe current psychiatric disorders assessed by physician •K&L score >3
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The primary outcome measure is the percentage of responders according to the 2004 OMERACT-OARSI responder criteria (Pham 2004), 14 weeks after baseline: either improvement in pain or function ≥50% and an absolute improvement of ≥20 points , or 2 in the following: pain, function or patient’s global assessment (all ≥20% relative and ≥10 points absolute). The following outcome measures will be used for the responders criteria: subscales pain and hand functioning of the AUSCAN questionnaire, for hand OA, and LEFS and KOOS questionnaires, for function and pain in knee OA, respectively, and patient global assessment on a VAS for both patient groups. | — |
Secondary
| Measure | Time frame |
|---|---|
| - Synovitis, measured by MRI (Knee OA), ultrasound (Hand OA) and hsCRP serum level - Patient reported outcome measures for pain, function and stiffness (WOMAC-pain, WOMAC-function, WOMAC-stiffness) and quality of life (SF-36) - Health care use (questionnaire) - Physical examination of the joints (pain, swollen, bony enlargements, etc.) | — |
Contacts
Public ContactC.H.M. Ende, van den
Sint Maartenskliniek, Dept. Reumaresearch, PO box 9011
Outcome results
None listed