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Response to: 'Is it time to redefine the role of low-dose radiotherapy for benign disease?' by Montero et al
  1. Elien A M Mahler1,
  2. Michiel JM Minten1,
  3. Mathilde M Leseman-Hoogenboom2,
  4. Philip M P Poortmans2,3,
  5. Jan Willem Leer2,
  6. Simone S Boks4,
  7. Frank H J van den Hoogen5,
  8. Alfons A den Broeder1,
  9. Cornelia H van den Ende1
  1. 1 Department of Rheumatology, Sint Maartenskliniek Nijmegen, Nijmegen, The Netherlands
  2. 2 Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
  3. 3 Department of Radiation Oncology, Institut Curie, Paris, France
  4. 4 Department of Radiology, Sint Maartenskliniek Nijmegen, Nijmegen, The Netherlands
  5. 5 Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Elien A M Mahler, Department of Rheumatology, Sint Maartenskliniek, Nijmegen 6500 GM, The Netherlands; e.mahler{at}

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We thank the authors, with affiliations of six departments of radiation oncology in Spain and Germany, for their interest in our randomised controlled trials (RCT) and their compliments on the study designs.1 Our studies showed no substantial beneficial effect on symptoms of low-dose radiation therapy (LDRT) in patients with knee and hand osteoarthritis (OA).2 3 These findings dispute the effectiveness of radiation therapy at low doses in OA as commonly used in certain parts of the world. However, the authors mention several aspects, which should be taken into account when definitively appreciating our results, which we like to reply on in this letter.

We agree that OA is a serious health problem considering its high clinical burden, the high and rising prevalence, and the growing impact on healthcare and future economic costs.4 Subsequently, there is a clear need to improve management of OA that is supported by scientific evidence, as no effective disease-modifying treatments are available. Therefore, current treatment focuses primarily on the reduction of symptoms including pain and loss of function while the importance and efficacy of non-surgical treatment modalities have been described in several international clinical guidelines for the management of knee and hand OA.5 6 Of note, the authors mention approaches (ie, local heat, magnetic therapy and shock wave) not supported by evidence or included in international guidelines for the management of OA.

The authors state that the analgesic effect of radiation therapy is smaller in OA than other osteoarticular disorders (eg, calcaneodynia, achillodynia, bursitis trochanterica). This statement is based on findings of two observational studies with heterogeneous populations using a single transition question (von Pannewitz scale) that is likely to be biased by social desirability, in particular when assessed by telephone. The inferior design of those studies does not allow evidence-based discrimination …

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  • Handling editor Josef S Smolen

  • Contributors Drafting of the manuscript: EAMM, CHMvdE. Critical revision of the manuscript for important intellectual content: all authors. Final approval of the manuscript: all authors. All authors take responsibility for the integrity of the work and agreed to submit the response for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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