If we’re going to question radiation for arthritis, we should ask equally tough questions about the pills and injections we prescribe every day. Our new paper does exactly that. I’m proud to have co-authored this critical review examining how low-dose radiation therapy (LDRT) fits into contemporary osteoarthritis care. The comparison deserves attention: ▪️ Acetaminophen provides an average benefit over placebo below the threshold considered clinically meaningful. ▪️ Hyaluronic acid injections also fall below that threshold in a large meta-analysis. ▪️ Corticosteroid injections can help, but relief is generally measured in weeks. Repeated injections raise concerns about cartilage loss. ▪️ NSAIDs offer established pain relief, but kidney, gastrointestinal, and cardiovascular risks can complicate long-term use. These treatments have a role. They also leave many patients with persistent pain and limited options. This is where the case for LDRT becomes compelling. In the Korean sham-controlled trial, 70.3% of patients receiving six low-dose treatments met clinical response criteria at four months, compared with 41.7% receiving sham. No treatment-related toxicity was reported. Large observational cohorts report pain responses in approximately 60–80% of patients, with relief often lasting months or longer. And in a Russian randomized cohort, long-term disability occurred in 9.5% of LDRT recipients versus 17.8% receiving standard care, a statistically significant difference. The potential value extends beyond lowering a pain score: sustained relief, preserved function, and less reliance on repeated interventions. The evidence is still evolving. Randomized results are mixed, the pooled estimate was not statistically significant, and direct superiority over other treatments remains unproven. Patient selection, dose, and counseling about potential late radiation risks matter. But our paper makes a clear clinical argument: LDRT is a reasonable option to consider for selected older adults whose symptoms persist despite conservative care, with outcomes tracked prospectively. We also challenge the assumption that patients must exhaust repeated injections before this option can even be discussed. The standard should be the same for every treatment: How much does it help? How long does it last? What risks does it carry? Familiarity should not decide which options patients hear about. Evidence should. @ACRORadOnc