Arthritis

The influence of irradiation with low-level diode laser on the proteoglycan content in arthrotically changed cartilage in rabbits

Tonio Gottlieba, Björn Jörgensenb, Ewa Rohdec, Gerhard Müllerc, Eike Eric Schellera,_

aEv. Krankenhaus Hubertus, Spanische Allee 10-14, 14129 Berlin, Germany

bEndozentrum Martin Luther Krankenhaus, Caspar-Theyß-Str. 27-31, 14193, Berlin, Germany

cInstitut fu¨r Medizinische Physik und Lasermedizin, Charite´ Campus Benjamin Franklin, Fabeckstr. 60-62, 14195, Berlin, Germany

Received 24 November 2005; accepted 16 December 2005

Zusammenfassung

Einfluss der Bestrahlung mit niederenergetischem Diodenlaser auf den Proteoglykanabbau im arthrotischen Kaninchenknorpel.

In einem tierexperimentellen Arthrosemodell wurde der Verlauf der Arthrose nach makroskopischen Gesichtspunkten und nach Aspekten des Proteoglykan- bzw. Glykosaminoglykangehaltes des Knorpels untersucht.

Der Einfluss der Knorpelbestrahlung mit niederenergetischem Diodenlaser mit einer Wellenlänge von 692.6 nm auf den Verlauf der Arthrose wurde nach gleichen Parametern evaluiert. 30 Tage nach einer Gelenkinstabilitätsoperation wurden während einer zweiten Operation die Femurkondylen mit unterschiedlichen Energiedichten bestrahlt. Sieben Tage nach der zweiten Operation wurden sowohl makroskopische Befunde erhoben als auch der Proteoglykangehalt auf Basis der quantitativen

Bestimmung nach Taylor & Jeffre bestimmt. Dieses Verfahren beruht auf den unterschiedlichen spektrophotometrischen Absorptionsverhalten der verschiedenen Konzentrationen von sulfatierten Glykosaminoglykanen in Anwesenheit von Dimethylmethylenblau.

Makroskopisch fand sich eine progrediente Zunahme der Schwere der Knorpelveränderungen im Verlauf der Arthrose, ebenso konnte eine Abnahme des Proteoglykangehaltes nachgewiesen werden. Des Weiteren fanden sich bei den bestrahlten Gelenken mildere Veränderungen, wobei hier die höhere Energiedichte einen größeren positiven Einfluss mit statistischer Signifikanz hatte.

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Pain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LPL) therapy has been claimed to reduce pain in musculoskeletal pathologies, but there have been concerns about this point. The aim of this study was to evaluate the analgesic efficacy of LPL therapy and related functional changes in COA. Sixty patients between 20 and 65 years of age with clinically and radiologically diagnosed COA were included in the study. They were randomised into two equal groups according to the therapies applied, either with LPL or placebo laser. Patients in each group were investigated blindly in terms of pain and pain-related physical findings, such as increased paravertebral muscle spasm, loss of lordosis and range of neck motion restriction before and after therapy.

Functional improvements were also evaluated. Pain, paravertebral muscle spasm, lordosis angle, the range of neck motion and function were observed to improve significantly in the LPL group, but no improvement was found in the placebo group. LPL seems to be successful in relieving pain and improving function in osteoarthritic diseases.

The Effect Of Low Power Laser Therapy On Osteoarthritis Of The Knee
Basirnia A., Sadeghipoor G., Esmaeeli Djavid G. et al.

Treatment was performed on 20 patients, aging from 42 to 60 years. All patients had
received conservative treatment with poor results. Laser device used for this treatment was pulsed IR diode laser; 810 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval .The total number of applications was 12 sessions.
Irradiation was performed on 5 periarticular tender points, each for 2 min. The treatment outcome (pain relief and functional ability) was observed and measured according to the following methods: 1) Numerical rating scales (NRS), 2) Self assessment by the patient, 3) Index of severity for osteoarthritis of the knee (ISK), 4) Analgesic requirements. We achieved significant improvement in pain relief and quality of life in 70% of patients,
comparing to their previous status (p<0.05). There was no significant change in range of motion of the knee.

Improvement Of Pain And Disability In Elderly Patients With Degenerative Osteoarthritis Of The Knee Treated With Narrow-Band Light Therapy
Stelian J, Gil I, Habot B et al. J Am Geriatr Soc. 1992; 40: 23-26.

In an Israeli study the effect of laser therapy in degenerative osteoarthritis (DOA) of the knee was investigated in a double blind study among 50 patients. One group received
infrared (GaAlAs) and one red (HeNe) laser. Only the first group could be blinded, while the latter was open. Patients were treated twice daily, 15 minutes each time, for 10 days.
The patients treated themselves after instruction. Total dose for each session was 10.3 J for red and 11.1 for infrared. Continuous mode was used for 7.5 minutes, pulsed for 7.5 minutes, rationale not stated. There was a significant pain reduction in the laser groups as compared to the placebo groups. There was no significant difference between the red and the infrared group. The Disability Index Questionnaire also revealed an improvement in the laser groups. All patients in the placebo group required analgesics within two months after laser therapy while the patients in the laser group were pain free ranging from 2
months to 1 year.