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Laser Therapy Research for Arthritis and Osteoarthritis

Low Level Laser Therapy and Its Effects on the Quality of Life for Patients Suffering from OsteoArthritis Knee Pain in the Medial Compartment: A Detailed Analysis by Questionnaire

Schnee A, Hanson R
DFW Spine & Joint Center, Irving, TX, United States

Introduction: The aim of this study was to assess the effects of low- level laser therapy for patients specifically diagnosed with moderate to severe (bone on bone) osteoarthritis knee pain in the medial compartment of the knee by using questionnaires.

Materials and Methods: We used the ML830 DC laser manufactured by MicroLight Corporation of America. Twenty treatments were delivered 4X a week over a 5 week period. The wavelength used was 830nm, continuous wave, with an output power of 90mw. The laser probe is made up of three laser diodes. The size of the area treated was 16.5 cm2. The laser was placed directly on the skin along the medial joint line of the knee, where the osteoarthritis was diagnosed, on two separate points, for a total of 20 minutes. The power density was .005 W/cm 2 and the energy density was 6.55 J/cm 2 . The total dose per treatment session was 108 J. Patients were treated at the DFW Spine & Joint Clinic from June 2010 thru April 2011. There were a total of 119 knees treated representing 86 patients. One hundred nineteen questionnaires were completed and collected after the patients' 20th treatment.

Results: There were a total of 86 patients diagnosed and treated for moderate to severe (bone on bone) osteoarthritis in the medial joint compartment with symptoms of knee pain. This diagnosis was a result of either an x-ray or an MRI. Out of those patients 33 had both knees treated and 53 patients had only one knee treated. There were a total of 34 males and a total of 52 females, with a mean age of 66.13 years.
Patients were asked to rate their overall change in activity, limitations, symptoms, emotions, and quality of life after completing 20 treatments using PGIC Scale (Patients' Global Impression of Change). Patients who had both knees treated were asked to fill out two different questionnaires, one for each knee treated. On the 20th treatment 2.5% of the patients rated no change/ almost the same in their knee, 17.6% rated their knee a little better/ somewhat better, 54.6% rated moderately better/better, and 25.2% rated the change in their knee a great deal better. Overall 79.8% rated the overall improvement of their knee either moderately better to a great deal better. None of the patients rated that the treatments had negative effects on their quality of life or that they experienced more knee pain on the completion of their 20th treatment.

Conclusion:Our results indicate that Low-level laser therapy significantly improves the overall quality of life and related factors for patients diagnosed with moderate to severe (bone on bone) osteoarthritis knee pain in the medial compartment of the knee making this therapy an ideal treatment for patients with chronic knee pain.

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Infrared Diode Laser in Low Reactive-Level Laser Therapy (LLLT) for Knee Osteoarthrosis

MA Trelles, J Rigau, P Sala, RG Calderhead, and T Ohshiro

Instituto Medico Vilafortuny, Cambrils (Tarragona) Spain,
International Medical Laser Information Service, Tochigi
Japann Medical Laser Laboratory Tokyo Japan

Abstract: Degenerative joint disease (DJD), in particular in the knee, is difficult to cure successfully at present, often requiring surgical intervention. In addition, the chronic DJD patient often exhibits symptoms of both a physiological and psychological nature. A study is presented using low reactive-level laser therapy (LLLT) with an 830 nm infrared continuous wave gallium aluminium arsenide (GaAIAs) diode laser, with an output power of 60mW, in light contact laser therapy for a population of 40 patients (incident power density approximately 3W/cm2). Four points around the patella were irradiated for 60s each ( energy density of 180J/cm2 per point) two sessions per week for eight weeks. Radiological, pain score and joint mobility assessments were made before the first session, immeditaely after, and at 4 months after the final LLLT session. All the other medication and physical therapy was discontinued at least 15 days prior to the first treatment session. Thirty-three patients (82%) reported significant removal of pain and recovery of articular joint mobility. The remaining seven patients felt there was no significant effect following LLLT, and returned to their original pretherapy medication. The side effects were minimal. LLLT is concluded to be safe, effective and noninvasive alternative to conventional surgical and medical treatment modalities for DJD patients

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Beneficial Effects of Laser Therapy in the Early Stages of Rheumatoid Arthritis Onset

Contantin Ailioaie and Laura Marinela Lupusoru-Ailioaie

Medical Office for Laser Therapy, 1 Bistrita, B 10-2, 6600 - Iassy, Romania
Al.I. Cuza University, Dept. of Medical Physics, Iassy, Romania

Abstract: The purpose of this study was to determine the effects of laser therapy in pain reduction and/or recovery of patients at the onset of Rheumatoid Arthritis (RA), comparatively with the traditional nonsteroidal anti-inflammatory drugs (NSAIDs). Fifty-nine patients with RA of 6-12 months duration were included in the study. The patients were divided into 3 groups: Group 1 (21 patients) received laser therapy; Group 2 (18 patients) was submitted to placebo laser therapy and NSAIDs medication; Group 3 (20) patients was treated only with NSAIDs. Physical therapy was instituted in all three groups. GaAIAs diode laser of 830 nm wavelength and 200 mW maximum power output power was used. Group 1 received laser therapy once each day, eight days per month, for a total of 32 treatments during a four-month period. The parameters used were 2-4 J/cm2 energy density, and a frequency of 5Hz or 10Hz depending on the number and severity of pain in the affected joints. Placebo laser treatment was given to group 2. The functional activity score, the acute phase reactants (ESR and C - reactive protein), T-Lymphocytes and NK (natural killer) - cells were estimated. Synovial biopsies and Magnetic Resonance Imaging (MRI) of the synoviall membrance were perfomed as well. The analysis of the clinical and biological parameters at the end of treatment showed a statistically significant decrease of duration of morning stiffness, of pain at rest and during movements, and improved acute phase reactants. The overall efficacy rate in these studies was 86% in the first group, 50% in the laser placebo group and 40% in the NSAIDs-treated third group. After four months of treatment, our investigations showed that 830nm infrared laser therapy promoted the restoration of function, relieved pain and limited the complications of RA.

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Anti-Inflammatory Effect of Low-Level Laser and Light-Emitting Diode in Zymosan-Induced Arthritis

de Morais NC, Barbosa AM, Vale ML, Villaverde AB, de Lima CJ, Cogo JC, Zamuner SR.
Laboratory of Inflammation, Institute of Research and Development, University of Vale do Paraí ba , Sáo José dos Campos, Brazil.

Photomed Laser Surg. 2009 Sep 25. [PMID: 19780633]

Abstract Objective: The aim of this work was to investigate the effect of low-level laser therapy (LLLT) and light-emitting diode (LED) on formation of edema, increase in vascular permeability, and articular joint hyperalgesia in zymosan-induced arthritis.

Background Data: It has been suggested that low-level laser and LED irradiation can modulate inflammatory processes.

Material and Methods: Arthritis was induced in male Wistar rats (250-280 g) by intra-articular injection of zymosan (1 mg in 50 muL of a sterile saline solution) into one rear knee joint. Animals were irradiated immediately, 1 h, and 2 h after zymosan administration with a semiconductor laser (685 nm and 830 nm) and an LED at 628 nm, with the same dose (2.5 J/cm(2)) for laser and LED. In the positive control group, animals were injected with the anti-inflammatory drug dexamethasone 1 h prior to the zymosan administration. Edema was measured by the wet/dry weight difference of the articular tissue, the increase in vascular permeability was assessed by the extravasation of Evans blue dye, and joint hyperalgesia was measured using the rat knee-joint articular incapacitation test.

Results: Irradiation with 685 nm and 830 nm laser wavelengths significantly inhibited edema formation, vascular permeability, and hyperalgesia. Laser irradiation, averaged over the two wavelengths, reduced the vascular permeability by 24%, edema formation by 23%, and articular incapacitation by 59%. Treatment with LED (628 nm), with the same fluence as the laser, had no effect in zymosan-induced arthritis.

Conclusion: LLLT reduces inflammatory signs more effectively than LED irradiation with similar irradiation times (100 sec), average outputs (20 mW), and energy doses (2 J) in an animal model of zymosan-induced arthritis. The anti-inflammatory effects of LLLT appear to be a class effect, which is not wavelength specific in the red and infrared parts of the optical spectrum.

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Clinical Application of GaAIAs 830 NM Diode Laser in Treatment of Rheumatoid Arthritis

Kanji Asada, Yasutaka Yutani, Akira Sakawa and Akira Shimazu.
Department of Orthopedic Surgery, Osaka City University Medical School, Japan

The authors have been involved in the treatment of rheumatoid arthritis (RA), in particular chronic poly-arthritis and the associated pain complaints. The biggest problem facing such patients is joint contracture, leading to bony ankylosis. This in turn severely restricts the range of motion (ROM) of the RA-affected joints, thereby seriously restricting the patient's quality of life (QOL). The authors have determined that in these cases, daily rehabilitation practice is necessary to maintain the patient's QOL at a reasonable level.

The greatest problem in the rehabilitation practice is the severe pain associated with RA- affected joints, which inhibits restoration of mobility and improved ROM. LLLT or low reactive level laser therapy has been recognized in the literature as having been effective in pain removal and attenuation. The authors accordingly designed a clinical trial to assess the effectiveness of LLLT in RA related pain (subjective self-assessment) and ROM improvement (objective documented data).

From July 1988 to June 1990, 170 patients with a total of 411 affected joints were treated using a GaAlAs diode laser system (830 nm, 60 mW C/W). Patients mean age was 61 years, with a ratio of males: females of 1: 5.25 (16%: 84%). Effectiveness was graded under three categories: excellent (remarkable improvement), good (clearly apparent improvement), and unchanged (little or no improvement).

Results:For pain attenuation, scores were: excellent - 59.6%; good - 30.4%; unchanged - 10%.

For ROM improvement the scores were: excellent - 12.6%; good - 43.7%; unchanged - 43.7%. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%

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The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial

Hegedus B, Viharos L, Gervain M, Gálfi M.
Physio- and Balneotherapy Center, Orosháza-Gyopáros, Hungary.

Photomed Laser Surg. 2009 Aug;27(4):577-84. [PMID: 19530911]

INTRODUCTION: Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as a biomodulatory effect on microcirculation. This study was designed to examine the pain-relieving effect of LLLT and possible microcirculatory changes measured by thermography in patients with knee osteoarthritis (KOA).

MATERIALS AND METHODS: Patients with mild or moderate KOA were randomized to receive either LLLT or placebo LLLT. Treatments were delivered twice a week over a period of 4 wk with a diode laser (wavelength 830 nm, continuous wave, power 50 mW) in skin contact at a dose of 6 J/point. The placebo control group was treated with an ineffective probe (power 0.5 mW) of the same appearance. Before examinations and immediately, 2 wk, and 2 mo after completing the therapy, thermography was performed (bilateral comparative thermograph by AGA infrared camera); joint flexion, circumference, and pressure sensitivity were measured; and the visual analogue scale was recorded.

RESULTS: In the group treated with active LLLT, a significant improvement was found in pain (before treatment [BT]: 5.75; 2 mo after treatment : 1.18); circumference (BT: 40.45; AT: 39.86); pressure sensitivity (BT: 2.33; AT: 0.77); and flexion (BT: 105.83; AT: 122.94). In the placebo group, changes in joint flexion and pain were not significant. Thermographic measurements showed at least a 0.5 degrees C increase in temperature—and thus an improvement in circulation compared to the initial values. In the placebo group, these changes did not occur.

CONCLUSION: Our results show that LLLT reduces pain in KOA and improves microcirculation in the irradiated area.

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Reduction of CXCR4 expression in Rheumatoid Arthritis rat joints by Low Level Diode Laser Irradiation

Lin Zhang, Hiroki Kajiwara, Noboru Kuboyama and Yoshimitsu Abiko
Department of Biochemistry and Molecular Biology, Nihon University School of Dentistry
Department of Oral Molecular Pharmacology, Nihon University School of Dentistry

(Received December 21, 2010)(Accepted February 18, 2011)

Abstract Background: Rheumatoid arthritis (RA) is an inflammatory joint disorder, whose progression leads to the destruction of cartilage and bone. Chemokines and their receptors are potential therapeutic targets in RA. Among these, it has been suggested that CXC chemokine 4 (CXCR4) and its ligand CXC ligand 12 (CXCL12) are involved in RA pathogenesis. Low-level laser irradiation (LLLI) is currently being evaluated for the treatment of RA; however, the molecular mechanisms underlying its effectiveness remain unclear.

Aim: To understand the anti-inflammatory effect of LLLI, we used the collagen-induced arthritis (CIA) rat as RA model and analyzed the gene expression profile in synovial membrane in the hindpaw joints of control, CIA and CIA + LLLI. Expression of CXCR4 and CXCL12 genes were also studied.

Materials and Methods: Total RNA was isolated from the synovial membrane tissue of CIA rat joints or CIA joints treated with LLLI (830 nm Ga-Al-As diode), and gene expression profiles were analyzed by DNA microarray (41,000 rat genes). The mRNA levels were confirmed by reverse transcription polymerase chain reaction (RT-PCR) and real-time PCR. Immunohistochemical examination to examine CXCR4 protein expression was also carried out.

Results: DNA microarray analysis showed that CXCR4 gene expression was increased in CIA tissue and LLLI treatment significantly decreased CIA-induced CXCR4 mRNA levels. In contrast, CXCL12 did not show any significant changes. The microarray data of CXCR4 mRNA levels were further validated using RT-PCR and real-time PCR. Increased CXCR4 mRNA levels by CIA and its reduction following LLLI was successfully confirmed. CXCR4 production was increased in CIA joints and its production was decreased by LLLI.

Conclusion: Decreased CXCR4 expression may be one of the mechanisms in LLLI-mediated reduction of RA inflammation.

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Low-level laser irradiation treatment reduces CCL2 expression in rat rheumatoid synovia via a chemokine signaling pathway.

Zhang L, Zhao J, Kuboyama N, Abiko Y.
Department of Biochemistry and Molecular Biology, Nihon University School of Dentistry at Matsudo, 870-1, Sakaecho-Nishi 2, Matsudo, Chiba, 271-8587, Japan.

Lasers Med Sci. 2011 Sep;26(5):707-17. Epub 2011 May 4. PMID: 21541773

Rheumatoid arthritis (RA) is an inflammatory joint disorder whose progression leads to the destruction of cartilage and bone. Although low-level laser irradiation (LLLI) is currently being evaluated for the treatment of RA, the molecular mechanisms underlying its effectiveness remain unclear. To investigate possible LLLI-mediated antiinflammatory effects, we utilized a collagen-induced arthritis (CIA) rat model and analyzed gene expression profiles in the synovial membranes of the knee joint. Total RNA was isolated from the synovial membrane tissue of the joints of untreated CIA rats or CIA rats treated with LLLI (830 nm Ga-Al-As diode), and gene expression profiles were analyzed by DNA microarray (41,000 rat genes), coupled with Ingenuity pathways analysis (IPA). DNA microarray analysis showed that CCL2 gene expression was increased in CIA tissue, and that LLLI treatment significantly decreased CIA-induced CCL2 mRNA levels. IPA revealed that chemokine signal pathways were involved in the activation of CCL2 production. These microarray data were further validated using real-time PCR and reverse transcription PCR. Immunohistochemistry confirmed that CCL2 production was decreased in CIA rats treated with LLLI.
These findings suggest that decreased CCL2 expression may be one of the mechanisms involved in LLLI-mediated RA inflammation reduction.

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Rheumatoid arthritis-affected temporomandibular joint pain analgesia by linear polarized near infrared irradiation.

Yokoyama K, Oku T.
Department of Anesthesia, School of Dentistry, Kagoshima University Dental Hospital, Sakuragaoka, Japan.

Can J Anaesth. 1999 Jul;46(7):683-7. [PMID: 10442966]

PURPOSE: To describe a new short-term treatment for pain in rheumatoid arthritis (RA)-affected temporomandibular joint (TMJ).

CLINICAL FEATURES: We investigated four female patients (age 42.8+/-26.0 yr) with chronic rheumatoid arthritis affecting a single TMJ. Patients had received antirheumatic drugs such as sodium aurothiomalate, and as a result showed no symptoms in other body joints. Linear polarized near infrared radiation using Super Lizer was applied weekly with and/or without jaw movement to the unilateral skin areas overlying the mandibular fossa, anterior articular tubercle, masseter muscle and posterior margin of the ramus of the mandible. The duration of irradiation to each point was two seconds on and ten seconds off per cycle and the intensity at each point was approximately 138 J x cm(-2) at a wavelength of 830 nm. Interincisal distance was measured with maximal mouth opening in the absence and presence of pain before and after each treatment. Additionally, subjective TMJ pain scores assessed using a visual analog scale were performed for painful maximal mouth opening before and after each irradiation. TMJ pain disappeared after only four treatments. Moreover, painless maximal mouth opening without pain after irradiation in three patients was on average improved to 5.3+/-2.1 mm. However, one case was observed where the opening length prior to irradiation did not improve, despite the fact that the RA-affected TMJ pain had disappeared.

Conclusion: Application of linear polarized near infrared irradiation to patients with RA-affected TMJ pain is an effective and non-invasive short-term treatment.

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