Isolated and combined effects of photobiomodulation therapy, topical nonsteroidal anti-inflammatory drugs, and physical activity in the treatment of osteoarthritis induced by papain

Abstract. Osteoarthritis (OA) is a chronic inflammatory disease and is characterized as a degenerative process. This study aimed to evaluate and compare the effects of a topical nonsteroidal anti-inflammatory drug (NSAID), physical activity, and photobiomodulation therapy (PBMT) applied alone and/or in combination between them in an experimental model of knee OA. OA was induced by injection of papain in the knees of rats. After 21 days, the animals started to be treated with the above treatment. Histological analysis shows that the experimental model of OA induction causes morphological changes consistent with the disease, and among treatments, the PBMT is the most effective for reducing these changes. Moreover, the results demonstrate that PBMT and NSAID reduce the total number of cells in the inflammatory infiltrate (p<0.05) and PBMT was the most effective for reducing the activity of myeloperoxidase (p<0.05). Finally, we observed that both NSAID and PBMT were effective for reducing the gene expression of MMP-3 (p<0.05), but in relation to the gene expression of MMP-13, PBMT was the most effective treatment (p<0.05). The results of this study indicate that PBMT is the most effective therapy in stopping disease progression, and improving inflammatory conditions observed in OA.

[1]  Lúcio Frigo,et al.  Infrared (810-nm) low-level laser therapy on rat experimental knee inflammation , 2011, Lasers in Medical Science.

[2]  C. Juhl,et al.  Impact of Exercise Type and Dose on Pain and Disability in Knee Osteoarthritis: A Systematic Review and Meta‐Regression Analysis of Randomized Controlled Trials , 2014, Arthritis & rheumatology.

[3]  J. Bjordal.  Evidence-Based Medicine Turned Upside Down. , 2015, Photomedicine and laser surgery.

[4]  Kaelen C. Dunican,et al.  Treatment Options for Osteoarthritis: Considerations for Older Adults , 2011, Hospital practice.

[5]  S. Abramson,et al.  Osteoarthritis in 2007. , 2007, Bulletin of the NYU hospital for joint diseases.

[6]  E. M. Bacchi,et al.  Lipid metabolism in trained rats: effect of guarana (Paullinia cupana Mart.) supplementation. , 2005, Clinical nutrition.

[7]  A. Renno,et al.  Effectiveness of an aquatic exercise program and low-level laser therapy on articular cartilage in an experimental model of osteoarthritis in rats , 2016, Connective tissue research.

[8]  A. Klovning,et al.  Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials , 2004, BMJ : British Medical Journal.

[9]  V. Garcia,et al.  A histologic assessment of the influence of low-intensity laser therapy on wound healing in steroid-treated animals. , 2004, Photomedicine and laser surgery.

[10]  S. Roth,et al.  Diclofenac sodium topical solution with dimethyl sulfoxide, a viable alternative to oral nonsteroidal anti-inflammatories in osteoarthritis: review of current evidence , 2011, Journal of multidisciplinary healthcare.

[11]  R. Vieira,et al.  Effect of low-level laser therapy on the expression of inflammatory mediators and on neutrophils and macrophages in acute joint inflammation , 2013, Arthritis Research & Therapy.

[12]  A. Woolf,et al.  Burden of major musculoskeletal conditions. , 2003, Bulletin of the World Health Organization.

[13]  V. Karatosun,et al.  [Quantification of papain-induced rat osteoarthritis in relation to time with the Mankin score]. , 2007, Acta orthopaedica et traumatologica turcica.

[14]  C. Bombardier,et al.  An evidence-based approach to prescribing nonsteroidal antiinflammatory drugs. Third Canadian Consensus Conference. , 2006, The Journal of rheumatology.

[15]  A. Renno,et al.  Aerobic exercise training and low-level laser therapy modulate inflammatory response and degenerative process in an experimental model of knee osteoarthritis in rats. , 2016, Osteoarthritis and cartilage.

[16]  J. Parvizi,et al.  Myeloperoxidase and chlorinated peptides in osteoarthritis: potential biomarkers of the disease , 2007, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[17]  R. Albertini,et al.  Effect of low-level laser therapy on metalloproteinase MMP-2 and MMP-9 production and percentage of collagen types I and III in a papain cartilage injury model , 2014, Lasers in Medical Science.

[18]  R. Vieira,et al.  Comparative analysis of two low-level laser doses on the expression of inflammatory mediators and on neutrophils and macrophages in acute joint inflammation , 2013, Lasers in Medical Science.

[19]  J. Mentes,et al.  Benefits of physical activity for knee osteoarthritis: a brief review. , 2010, Journal of gerontological nursing.

[20]  P. D. T. D. de Carvalho,et al.  Effects of Low‐level Laser Therapy at Wavelengths of 660 and 808 nm in Experimental Model of Osteoarthritis , 2012, Photochemistry and photobiology.

[21]  D. Hendrick,et al.  Introduction , 1998, Thorax.

[22]  Jianglin Fan,et al.  Overexpression of human matrix metalloproteinase-12 enhances the development of inflammatory arthritis in transgenic rabbits. , 2004, The American journal of pathology.

[23]  C. Helmick,et al.  Physical activity levels among the general US adult population and in adults with and without arthritis. , 2003, Arthritis and rheumatism.

[24]  T. Barbosa,et al.  Physical exercise and reduction of pain in adults with lower limb osteoarthritis: a systematic review. , 2010, Journal of back and musculoskeletal rehabilitation.

[25]  T. Kubo,et al.  Effect of light-emitting diode (LED) therapy on the development of osteoarthritis (OA) in a rabbit model. , 2011, Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie.

[26]  M. Doherty,et al.  Does paracetamol (acetaminophen) reduce the pain of osteoarthritis?: a meta-analysis of randomised controlled trials , 2004, Annals of the rheumatic diseases.