Radiation Aid

Relieving rheumatoid arthritis

For Adele Lojko, 59, the eight steps leading from the sidewalk to the front door of her suburban Boston home were a barrier as forbidding as the Great Wall of China. Often confined to a wheelchair with severe rheumatoid arthritis, she had to be carried up and down the steps. But now, after many years of needing assistance whenever she came or left, Mrs. Lojko proudly navigates that once insurmountable hurdle by herself, needing only a cane.

Mrs. Lojko is one of ten Boston and eleven San Francisco-area rheumatoid arthritis patients treated with a new program of radiation therapy that has produced promising results in relieving both pain and stiffness from this sometimes crippling disease. Radiation therapy is one of the standard treatments for Hodgkin's disease and other cancers of the lymph nodes; in the past 25 years, it has helped raise the cure rate for Hodgkin's disease from 30% to 80%. While refining their techniques, Hodgkin's researchers noticed that irradiation also seemed to relieve arthritis in laboratory animals. Stanford University's Dr. Henry S. Kaplan, 63, one of the pioneers in Hodgkin's treatment, then devised a similar therapy for rheumatoid arthritis victims who had failed to respond to conventional treatment, which included use of cytotoxic (cell damaging) and anti-inflammatory drugs.

Using a high-energy X-ray beam, researchers at Stanford administered a total of 2,000 rads of radiation (less than half the dosage for Hodgkin's disease) to the lymph nodes of the neck, chest, abdomen, thymus gland and spleen. Patients were treated five days a week for five weeks. Within a month, all the patients started to improve; six months after the irradiation, disagreeable symptoms such as morning stiffness, pain and swelling within the joints were all significantly reduced.

Researchers at Harvard used a larger radiation dose (3,000 rads), but the radiation was administered at intervals: three weeks of treatment would be followed by two weeks of rest over a four-month period. While the symptoms were relieved for up to a year, the results were not as successful as those at Stanford, possibly because of the gaps between treatments. Harvard Radiation Therapist James A. Belli, 50, says patients' response depends on how far their disease has advanced. "If the joints have not been structurally altered," says he, "the pain is almost completely eliminated." Side effects were transient and similar to those experienced by Hodgkin's patients: fatigue, sore throat and occasional diarrhea.

Rheumatoid arthritis is one of many autoimmune diseases, in which the body's immune system attacks its own tissues. In rheumatoid arthritis, the body responds as if the joints were a foreign element, using different types of white blood cells to attack and destroy the supposed invader. Though researchers still hope to develop drugs that control the body's immune system, radiotherapy may provide interim relief for some of the nearly 6.5 million Americans suffering from rheumatoid arthritis. -

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