56 patients with hand osteoarthritis were randomized to either low dose radiation therapy or sham intervention. Protocols were administered over 6 sessions for the duration of 2 weeks, with follow-up performed at 1, 2, and 3 months after treatment. The primary outcomes of OMERACT-OARSI response rate at 3 months demonstrated no significant difference between the LDRT group and the sham group. In addition, no significant differences were observed for changes in clinical scores of pain and function, or ultrasound parameters of effusion, synovial thickening, and Power Doppler signal intensity.