Intra-Articular Laser Therapy May Be a Feasible Option in Treating Knee Osteoarthritis in Elderly Patients

Abstract

Knee osteoarthritis (OA) is a common problem in elderly patients. They are often troubled with altered knee function, such as pain and weakness. However, not all these patients are able to receive autologous platelet-rich plasma (PRP) injections as they may be taking antiplatelet or anticoagulant medications. Their physical condition may not allow them to receive total knee replacement surgery as well. Long-term oral intake of nonsteroidal anti-inflammatory drugs may be detrimental to the gastrointestinal tract. As a result, it is crucial to discover new treatment options that can alleviate painful knee symptoms in elderly knee OA patients. In this study, 19 elderly patients diagnosed with moderate degree of knee OA as well as suprapatellar bursitis were recruited. They received low-level laser therapy (LLLT) to their affected knees. Under ultrasound guidance, flexible fiber optic wire was inserted intra-articularly into the knee joint. Red laser followed by infrared irradiation was performed once every 2 weeks for a total of 3 times. The Lequesne index for knee OA and the volume of suprapatellar synovial fluid (SF) were measured. SF proteomic analyses were also performed up to a period of 6 months. The results revealed that after 3 LLLT, the Lequesne index significantly decreased, signifying improvement in the knee joint functional status. The volume of suprapatellar SF and SF proteins associated with inflammation also decreased significantly in the SF. These findings lasted up to a period of at least 3 months. Therefore, LLLT may be considered as a feasible option in treating elderly patients with knee OA who are not suitable for surgical interventions or intra-articular PRP injections.

Introducing Matrix Metalloproteinases as Crucial Targets for Intra-articular Laser Therapy in Patients with Synovial Fluid of Knee Osteoarthritis

“…Chen et al investigation led to the introduction of intra-articular laser therapy as a possible useful therapeutic method to treat knee OA. Proteomics as a valuable technique is performed in the Chen et al assessment to confirm the validity of knee laser therapy ( 1 ). In the present examination, 3 sets of data—including ORPs, LRPs, PPI network finding (the results related to the queried DEPs and the added first neighbors)—can be integrated to find a clear prospective from molecular events in patients after laser therapy.…”

“…Comparison between LRPs and the hub bottlenecks of ORPs indicates that MMP2 is common between the compared proteins. Based on the study by Chen et al, MMP2 is downregulated after laser therapy ( 1 ). The results provide a clear understanding of the involvement of MMP2 in knee OA; patients have overexpressed MMP2, which is downregulated following laser therapy and appears to be a crucial protein in the progression of knee OA.…”

“…The inverse role of APOA1 and TTR has a coexpression change with IL6; thus, its upregulation increases level of IL6. The beneficial effects of laser therapy in treating knee OA are correlated with favorable clinical outcomes ( 1 ).…”

“…In this study, the gene expression profile of patients with OA was analyzed using bioinformatics. The set of proteins that were dysregulated after laser treatment in the study by Chen et al ( 1 ) are called “laser related proteins” (LRPs) and were pointed out for analysis. The OA related proteins were selected from Neserin et al report ( 18 ).…”

“…As it is reported in this investigation, 19 patients with moderate degree of knee OA received low-level laser therapy (red laser followed by infrared irradiation) under ultrasound guidance via intra-articularly mode. They found that after laser therapy, the concentrations of matrilin, transthyretin (TTR), complement 5, osteoprotegerin (OPG), and immunoglobulin kappa chain were changed 2-fold (FC >2) as upregulated proteins and apolipoprotein A-1 (APOA1), cartilage acidic protein 1, immunoglobulin kappa chain, and matrix metalloproteinase (MMP) as downregulated proteins, respectively ( 1 ). According to Neserin et al, 7 patients—four men and 4 women—had early-stage OA synovial fluid proteome profiling compared to 13 controls (5 men and 8 women).…”