The Mechanisms and Efficacy of Photobiomodulation Therapy for Arthritis: A Comprehensive Review
Abstract
:1. Introduction
2. Arthritis
2.1. Joint
2.2. RA
2.3. OA
3. The Mechanism of PBM on Arthritis Treatment
3.1. ATP
3.2. Blood Flow
3.3. Regulation of Cytokines
3.4. Enzyme
3.5. Gene
4. PBM Regulates Arthritis-Related Cells
4.1. Polymorphonuclear Cells
4.2. Macrophages
4.3. T (Treg) Cells
4.4. Fibroblast-like Synoviocytes
5. PBM Regulates Arthritis Animals
5.1. Establish Arthritis Animal Models
5.2. Studies on In Vivo Treatment of Arthritis with PBM
5.3. Effects of PBM Parameters on Animal Models of Arthritis
6. Clinical Studies of PBM in the Treatment of Arthritis
6.1. Clinical Evaluation of Arthritis
6.2. Clinic Trials
7. Conclusions and Prospects
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
References
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Type of Arthritis | Methods | Mechanism |
---|---|---|
OA | surgical intervention | surgical methods, such as destabilization of the medial meniscus, can be used to create an animal model that mimics the mechanical stress and inflammation that occur in human OA. |
papain solution | papain is a proteolytic enzyme that can break down cartilage and induce arthritis in animal models. It is commonly used to create OA models. | |
injecting small amounts of senescent cells | Injecting small amounts of senescent cells: senescent cells are cells that have stopped dividing but remain active and can secrete proinflammatory cytokines. Injecting small amounts of these cells can induce arthritis in animal models. | |
RA | CIA | collagen-induced arthritis (CIA) is an autoimmune disease model that involves immunization with type II collagen and adjuvant to induce an autoimmune response against the animal’s own cartilage. |
CFA | complete Freund’s adjuvant (CFA) is a non-specific immunostimulant that can induce inflammation and arthritis in animal models. | |
other types of arthritis | microcrystalline arthritis | microcrystalline compounds, such as monosodium urate and calcium pyrophosphate dihydrate, can induce arthritis in animal models by stimulating the immune system and causing inflammation. |
zymosan | zymosan is a polysaccharide derived from yeast cell walls that can activate the immune system and induce inflammation and arthritis in animal models. |
Modeling Method | Wavelength (nm) | Power Density (mW/cm2) | Dose (J/cm2) | Light Source | Effect | Reference |
---|---|---|---|---|---|---|
The OA model was induced by anterior cruciate ligament transection | 808 | 1700 | 50 | (GaAlAs) diode laser | These results suggest that exercise training and LLLT were effective in preventing cartilage degeneration and modulating inflammatory processes induced by knee OA. | [77] |
intradermal injection of an emulsion of bovine type II collagen and complete Freund’s adjuvant | 570, 940 | 141.54 | 5 | LED | the 940 nm light can inhibit the swelling of arthritis and reduce the production of IL-1β, IL-6 and MMP-3. | [133] |
injection of zymosan | 628, 685, 830 | 25 | 2.5 | Laser (685 nm and 830 nm) and LED (628 nm) | Laser light significantly inhibited edema, vascular permeability and pain perception, while LED light had no effect. | [134] |
injection of zymosan | 830 | 200 | 3, 30 | AlGaAs laser | PMN cells pro-apoptotic gene expression increased PBM at 30 J/cm2. | [89] |
anterior cruciate ligament transection | 630, 870 | N/A | 2 (red), 2.5 (IR) | LED | PBM effectively reduced inflammation levels in arthritis. | [78] |
injection of CFA | 880 | 4976.11 | 2985.668 | laser | PBM improved cartilage defects and reduced inflammatory cells. | [135] |
injection of collagenase | 660, 780 | 750 | 7.5 | laser | PBM can accelerate the initial breakdown of collagenase damaged cartilage and stimulate fibroblast synthesis of repaired collagen iii. | [136] |
Papain-induced inflammation | 808 | 1785.71, 3571.42 | 142.4 | laser | 50 mW LLLT is more effective in regulating inflammatory mediators (IL-1B, IL-6) and inflammatory cells (macrophages and neutrophils). | [76] |
injection of CFA | 658 | 69.11 | N/A | diode laser | PBM reduced macrophage number and relieves swelling. | [137] |
injection of papain solution | 632 | 3.1 | 2.79 | He-Ne lasers | PBM enhanced the biosynthesis of arthritic cartilage and lead to the improvement of arthritic histopathological changes. | [121] |
bone defect by motorized round drill | 830 | 2653.92 | 249.47 | laser | PBM may promote the development of new bone by regulating the expression of inflammatory genes and angiogenic genes as well as the immune expression of COX2 and VEGF in the early stage of bone healing. | [67] |
injection of papain solution | 660, 808 | 3570 | 142.8 | InGaAlP (660 nm), AsGaAl (808 nm) | PBM on 808 nm laser promoteed angiogenesis and reduces the formation of fibrosis. | [122] |
injection of CFA | 780 | 150 and 400 | 4.5 and 72 | GaAlAs laser | PBM effectively reduced the inflammatory response and FLS cell number in the inflammatory site. | [110] |
surgical procedure | 780 | 500 | 10 | AsGaAl diode laser | PBM decreased the release of TNF-α and IFN-γ in monocytes. | [71] |
Induced microcrystalline arthritis | 670 | 1500 | 18 | InGaAlP laser | PBM reduced the synovium inflammatory process and tissue injuries. | [82] |
Bilateral translumbar aortic incision | 830 | 3530 and 7060 | 60 and 12 | GaAlAs laser | PBM stimulated new bone formation, vascular fibrosis, and angiogenesis. | [126] |
collagenase injection | 660 | 3570 | 35.71 and 107.14 | infrared laser unit | PBM reduced the production of pro-inflammatory markers such as IL-6 and TNF-α. | [72] |
collagen-induced arthritis | 830 | 6.4 | 7.64 | Ga-Al-As diode laser device | PBM inhibited the CCL2 productions in CIA rats. | [138] |
injection of zymosan | 810 | 5 and 50 | 3 and 30 | A diode laser | PBM reduces PGE2 production, and long-term PBM is more effective in treating arthritis. | [139] |
collagen-induced arthritis | 780 nm | 100 | 7.7 | laser | PBM could modulate the inflammatory response both in early as well as in late progression stages of RA. | [140] |
injection of CFA | 830 | 250 | 3 | GaAlAs laser | PBM could increase the remodeling and enhancing tissue repair in arthritis. | [141] |
injection of zymosan | 830 | 200 | 30 | (GaAlAs) low-level infrared laser | PBM could alter the inflammatory state and stimulate immune cells to accelerate the relief of arthritis symptoms. | [70] |
surgical procedure | 660 and 780 | 1750 | 25.025 | AlGaInP (660 nm) and AlGaAs (780 nm) | PBM was able to modulate the inflammation phase, optimize the transition from the inflammatory to the regeneration phase and improve the final step of regeneration, enhancing tissue repair. | [98] |
Inducing microcrystalline arthritis | 632.8 | 200 | 8 | He-Ne Laser | PBM reduced TNF-α and PGE2 production in the treatment of microcrystalline arthritis. | [125] |
injection of CFA | 660 nm | 500 | 5 | InGaAIP | PBM could reduce leukocyte migration and restore joint function. | [142] |
injection of zymosan | 660 | 250 | 2.5 | InGaAIP | PBM could effectively reduce inflammation and inhibit collagen degradation. | [93] |
collagen-induced arthritis | 830 | 100 | 5 | Ga-Al-As diode laser device | PBM effectively reduced CXCR4 gene expression. | [91] |
Class | Evaluate Methods | Performance |
---|---|---|
subjective judgment | VAS | The pain score ranges from 1 to 10, with 0 indicating no pain and 10 indicating the most severe pain |
DASH | DASH is a patient assessment of upper limb function. The two-part rating scale contains 30 indicators, mainly by examining activities related to daily life, including the degree of limitation of living ability and social activity ability | |
HAQ | The content of the survey is to select and score each joint site according to its difficulty in daily life. | |
WOMAC | The structure and function of the hip and knee were evaluated from pain, stiffness and joint function, and the functional description was mainly aimed at the lower limbs. | |
objective judgment | ROM | A universal goniometer will be used to measure the angular range of knee motion in patients with knee arthritis |
Peripheral blood assay | The contents of IL-6, NK-KB, C-reactive protein and erythrocyte sedimentation rate in peripheral blood were determined. | |
Radiographic analysi | The structure of the patient’s joints was reconstructed by X-CT and MRI and so on. | |
stiffness time | The longer the morning stiffness, the worse the arthritis |
Types of Arthritis | Objects | Wavelengths (nm) | Power Density (mW/cm2) | Evaluation Methods | Effects | Reference |
---|---|---|---|---|---|---|
RA | 82 RA patients | 785 | 70 | VAS, HAQ and DASH | Low levels of aluminum-gallium arsenide laser therapy were ineffective in wavelength, dose, and power for hand treatment in patients with rheumatoid arthritis. | [22] |
60 RA patients | 808 | 100 | HAQ, ELISA, and blood routine test | It could be concluded that laser acupuncture is effective in the adjuvant treatment of elderly rheumatoid arthritis. | [79] | |
18 RA patients | 633 | 10 | ROM, VAS and morning stiffness (MS) | Of these cases, 2 had a positive development on the joint ability score but not on the VAS or MS, while the third patient had an improvement on the VAS but not on the other parameters. | [170] | |
25 female RA patients | 820 | 50 | VAS, Blood test for hand function | A total of 72 percent of patients reported pain relief. There were no significant changes in other clinical, functional, scintillation, or laboratory features. | [169] | |
OA | One hundred consecutive randomly selected elderly patients with bilateral symptomatic knee arthritis | 810 | 20 | WOMAC | After 6 years of follow-up, patients in the PBM group benefited significantly, only 1 patient needed joint replacement, and 9 patients in the non-PBM group needed surgery (p < 0.05). | [151] |
22 female and 5 male knee OA patients | 830 | 50 | VAS, blood and urine tests | The results showed that PBM could alleviate pain and improve microcirculation in the irradiated area of KOA. | [159] | |
145 patients aged 50 to 75 years with knee joint | 904 | 40 | WOMAC, VAS, ROM | The specific PBM parameters need to be better defined. | [172] | |
40 knee OA patients | 850 | 50 | WOMAC, and VAS | PBM appeared to be an effective method for short-term pain relief and functional improvement in patients with chronic knee osteoarthritis. | [160] | |
90 knee OA patients | 904 | 10–20 | WOMAC, and VAS | The use of different doses and durations of PBM did not affect the results, and both regimens are safe and effective for the treatment of knee OA. | [161] | |
40 knee OA patients | 904 | 60 | WOMAC, VAS, muscle strength testing and ROM | PBM combined with exercise can effectively relieve pain, function, and mobility in patients with knee osteoarthritis. | [162] | |
49 knee OA patients | 830 | 30 | VAS | PBM applied to specific acupoints in a short period of time, together with exercise, can effectively reduce the pain of knee osteoarthritis patients and improve their quality of life. | [163] | |
53 male knee OA patients | 830 | 50 | WOMAC and VAS | In the treatment of patients with osteoarthritis, high-intensity laser therapy combined with exercise was more effective than low-intensity laser therapy combined with exercise, and both treatments were better than exercise alone. | [164] | |
60 knee OA patients | 830 | 50 | WOMAC | PBM had no effect on pain in patients with knee OA. | [20] | |
34 knee OA patients (32 female) | 658, 785 | 40 | VAS, and ROM | PBM is a safe, noninvasive, efficient, and effective method to reduce pain, swelling, and increase joint mobility in patients with Heboden and Buchar osteoarthritis. | [165] | |
34 chronic knee OA patients | 905 | 500 | VAS, X-CT, Biochemical test analysis (urine) | PBM treatment is effective in reducing pain and improving cartilage thickness through biochemical changes. | [158] | |
88 hands OA patients | 860 | 3000 | VAS, and ROM | PBM was no better than placebo in reducing pain, morning stiffness, or improving functional status. | [21] | |
37 hands OA patients | 808 | 40 | Pain stress tests, hand grip tests | PBM did not improve hand grip strength significantly, but it reduces the pain. | [171] | |
47 knee OA patients | 904 | 60 | VAS, HAQ, and ROM | PBM can improve pain and function in patients with knee osteoarthritis in the short term. | [166] | |
36 female and 14 males had degenerative osteoarthritis in both knees | 633, 830 | 8–122 | VAS | PBM is effective in relieving pain and disability in degenerative knee osteoarthritis. | [171] | |
Other | 61 patients with lower back pain for at least 12 weeks | 810 | 50 | VAS and ROM | In chronic low back pain, PBM combined with exercise is more beneficial than long-term exercise alone. | [168] |
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Zhang, R.; Qu, J. The Mechanisms and Efficacy of Photobiomodulation Therapy for Arthritis: A Comprehensive Review. Int. J. Mol. Sci. 2023, 24, 14293. https://doi.org/10.3390/ijms241814293
Zhang R, Qu J. The Mechanisms and Efficacy of Photobiomodulation Therapy for Arthritis: A Comprehensive Review. International Journal of Molecular Sciences. 2023; 24(18):14293. https://doi.org/10.3390/ijms241814293
Chicago/Turabian StyleZhang, Renlong, and Junle Qu. 2023. "The Mechanisms and Efficacy of Photobiomodulation Therapy for Arthritis: A Comprehensive Review" International Journal of Molecular Sciences 24, no. 18: 14293. https://doi.org/10.3390/ijms241814293