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What part does radiotherapy play in the treatment of rheumatoid arthritis?

Q) Please would you tell me what part radiotherapy plays in the treatment of rheumatoid arthritis? My daughter has it and has been offered radiotherapy to her ankle which has been very swollen and painful for five years. She is in her thirties and on anti-TNF. Has this been used before, and are the results good? Are there any side-effects? And are there other forms of treatment which would be preferable?
Mrs A Nicholls, Broadstone, Dorset (Summer 2005

A) What has been offered here is probably intra-articular radiotherapy with a substance called Yttrium (named after a town in Sweden). Yttrium90 is obtained from nuclear reactors. In the UK our supply comes from Belgium. The radioactivity is injected into the joint under guidance with x-ray or ultrasound, but it doesn’t cause any immediate side-effects such as pain and swelling. The joint must be kept still for 72 hours. As with any injection there's a slight risk of introducing infection into the joint. The results can be very good. The theoretical long-term side-effects include the risk of bone marrow cancer but there's no evidence that this occurs with this technique and, in general, the safety profile is very good.

This answer was provided by Dr Philip Helliwell for the Summer 2005 edition of our magazine, Arthritis Today, and was correct at the time of publication.

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