Terapia Laser de Baixa Intensidade para a redução da dor em artrite reumatoide e osteoatrite: uma revisão sistemática

Fangel, Renan; Vendrusculo-Fangel, Leticia Meda; Albuquerque, Cleandro Pires de; Parizotto, Nivaldo Antônio; Paz, Clarissa Cardoso dos Santos C.; Matheus, João Paulo Chieregato

doi:10.1590/1980-5918.032.AO29

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REVIEW ARTICLE • Fisioter. mov. 32 • 2019 • https://doi.org/10.1590/1980-5918.032.AO29 linkcopiar

Terapia Laser de Baixa Intensidade para a redução da dor em artrite reumatoide e osteoatrite: uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

Introdução: Os tratamentos para artrite reumatoide (AR) e osteoartrite (OA) devem diminuir dor, modular inflamação e diminuir deformidades. O LLLT é um biomodulador e pode auxiliar no quadro clínico destas.

Objetivo: Analisar os parâmetros mais comumente utilizados para a diminuição das respostas de dor em pacientes com AR e OA em ensaios clínicos controlados e não controlados.

Método: Trata-se de uma revisão sistemática com busca de artigos em inglês, português e espanhol na: PUBMED, SCOPUS, LILACS e Web of SCIENCE, entre 2006 a 2018. Foram utilizados os descritores MESH. Critérios de inclusão: avaliação da eficácia do LLLT nestas populações, verificação da dor antes e depois do tratamento, ensaios clínicos controlados e não controlados, publicados integralmente. Foi realizado o cálculo da dosimetria do laser e análise de média, mediana e moda da energia por ponto e energia por tratamento.

Resultados: Incluídos neste estudo 3 artigos de AR e 16 de OA. Em relação à dosimetria, apenas um AR apresentou redução da dor, sendo este com a maior dose de energia. Já na OA, a maioria dos artigos apresentou diminuição da dor, e com variabilidade na dosagem aplicada. Alguns tiveram poucos parâmetros apresentados, tornando impossível calcular a dosimetria.

Conclusão: há evidências científicas para reduzir a dor relatada em pacientes com OA de joelho, principalmente com doses de 6 J por ponto e 48 J aplicadas no tratamento diário. Para as outras articulações afetadas com OA e AR, seria importante a publicação de mais artigos científicos com melhor qualidade metodológica e descrição da dosimetria.

Palavras-chave:
Terapia com Luz de Baixa Intensidade; Dosimetria; Artrite Reumatoide; Osteoartrite; Dor

	Group	Pain´s evalution	Sessions	Application's form	Application´s site	N	PEDro
Rheumatoid arthritis
Ekim et al. ²¹	Group I - LLLT	VAS	10 sessions (2 weeks)	Skin contact	Region volar in the direction of median nerve	19 patients with carpal tunnel syndrome caused by RA	6
Ekim et al. ²¹	Group II- placebo	VAS	10 sessions (2 weeks)	Skin contact	Region volar in the direction of median nerve	19 patients with carpal tunnel syndrome caused by RA	6
Silva, Noravett, Baldan ³¹	Study Group- LLLT	Br-MPQ Pain Questionnaire, Brazilian Version.	10 sessions (5 weeks)	Skin contact	Region of pain´s reported.	10 participants with RA	7
Silva, Noravett, Baldan ³¹	Control Group	Br-MPQ Pain Questionnaire, Brazilian Version.	10 sessions (5 weeks)	Skin contact	Region of pain´s reported.	10 participants with RA	7
Meireles et al. ²⁷	Group I - LLLT	VAS	16 sessions (8weeks)	Skin contact	joint lines of wrist and fingers	82 patients with RA.	10
Meireles et al. ²⁷	Group II - Placebo	VAS	16 sessions (8weeks)	Skin contact
Hands´ osteoarthritis
Baltzer, Ostapczuk Stosch ²⁵	No group	VAS	5 a 10 sessions (2,5 a 5 weeks)	Skin contact				Several points in the intra-articular space.	34 patients with hand OA with Bouchard and Heberden signs.	3
Knee´s osteoarthritis
Yurtkuran et al. ¹⁴	Group Laser	VAS; WOMAC	10 sessions (2 weeks)	Skin contact	Lateral side of knee at acupuncture point Sp9	52 patients with knee OA.	8
Yurtkuran et al. ¹⁴	Group Placebo	VAS; WOMAC	10 sessions (2 weeks)	Skin contact	Lateral side of knee at acupuncture point Sp9	52 patients with knee OA.	8
Hegedús et al. ³²	Group Laser	VAS	8 sessions (4 weeks)	Skin contact	femoral and tibial condyles, articular line and fibular head	27 patients with knee OA	6
Hegedús et al. ³²	Group Placebo	VAS	8 sessions (4 weeks)	Skin contact		27 patients with knee OA	6
Zhao et al. ³³	Group Laser	WOMAC	12 sessions (4 weeks)	2 cm above skin	joint line at the acupuncture point ST35	40 patients with knee OA	8
Zhao et al. ³³	Group Placebo	WOMAC	12 sessions (4 weeks)	2 cm above skin	joint line at the acupuncture point ST35	40 patients with knee OA	8
Fukuda et al. ³⁴	Group Laser	VAS; Lequesne Scale	9 sessions (3 weeks)	Skin contact	femoral and tibial condyles, articular line and fibular head	47 patients with knee OA	10
Fukuda et al. ³⁴	Group Placebo	VAS; Lequesne Scale	9 sessions (3 weeks)	Skin contact		47 patients with knee OA	10
Štiglić-Rogoznica et al. ³⁵	No group	VAS	10 sessions (10 days)	Skin contact	not supplied	96 patients with knee OA	3
Gworys et al. ³⁶	Group 1 laser irradiation Group 2 (MSL irradiation) Group 3 (MSL irradiation) Group 4 placebo	Lequesne scale, VAS; Modified Laitinen questionnaire	10 sessions (2 weeks)	Skin contact	femoral and tibial condyles, articular line and fibular head	125 patients with knee OA	9
Kedzierski et al. ³⁷	Group A - MSL laser therapy Group B - low frequency TENS.	VAS; Modified Laitinen questionnaire.	10 sessions (2 weeks)	Skin contact	Joint space, popliteal fossa and base of patella	50 patients with knee OA	5
Rayegani et al. ³⁸	Group 1 LLLT, Group 2 LLLT placebo; Group 3 Ultrasound.	VAS; WOMAC	10 sessions (2 weeks)	Skin contact	femoral and tibial condyles, articular line and fibular head	37 patients with knee OA	7
Alghadir et al. ¹⁶	Group Laser	VAS; WOMAC.	8 sessions (4 weeks)	Skin contact	femoral and tibial condyles, articular line and fibular head	40 patients with knee OA	10
Alghadir et al. ¹⁶	Group Placebo	VAS; WOMAC.	8 sessions (4 weeks)	Skin contact		40 patients with knee OA	10
Nakamura et al. ³⁹	No group	VAS	8 sessions (4 weeks)	Skin contact	Articular line	35 patients with knee OA	3
Soleimanpour et al. ⁴⁰	No group	VAS	12 sessions (4 weeks)	Skin contact	LASER I- around patella; LASER II- bellow patella.	18 patients with knee OA	3
Hinman et al. ²⁸	Control group, Group Needle acupuncture, Group laser	VAS; WOMAC	12 sessions (4 weeks)	Skin contact	Various acupuncture points	282 patients with knee OA	7
Hinman et al. ²⁸	Group placebo laser .	VAS; WOMAC	12 sessions (4 weeks)	Skin contact	Various acupuncture points	282 patients with knee OA	7
Nambi et al. ⁴¹	Group Laser	VAS, joint space width, collagen-II telopeptide and MMP-3, 8, and 13	12 sessions (4 weeks)	Skin contact	Medial and lateral epicondyle of tibia and femur, tendon of the biceps femoris muscle and semitendinosus muscle	34 patients with knee OA	9
Nambi et al. ⁴¹	Group Placebo		12 sessions (4 weeks)	Skin contact		34 patients with knee OA	9
Nazari et al. ⁴²	High-intensity laser therapy (HILT) group, conventional physical therapy (CPT) group, and exercise therapy (ET) group	VAS, knee flexion range of motion, timed up and go test,6-min walk test, WOMAC	12 sessions (4 weeks)	Skin contact	Articular line	93 patients with knee OA	7
Temporomandibular´s osteoarthritis
Madani et al. ⁴³	Group Laser	VAS	12 sessions (4 weeks)	Skin contact	Points around the temporomandibular joint, mandibular muscles and condyles.	20 patients with temporomandibular OA	8
Madani et al. ⁴³	Group Placebo	VAS	12 sessions (4 weeks)	Skin contact		20 patients with temporomandibular OA	8

	Laser	P	T	A	NP	PD	ED	EP	ET	Effect
Rheumatoid arthritis
Ekim et al. ²¹	Ga-Al-As (780 nm)	50 mW continuous	120 s	0.0078 cm²	5	6410.25 mW/cm²	192.3 J/cm²	6 J	30 J	Yes
Silva, Noravett, Baldan ³¹	As-Ga (904 nm)	8mW (peak power of 45 W and pulsed emission at 1000 Hz)	194 s	not supplied	not supplied	Cannot be calculate	Cannot be calculate	1.55 J	Cannot be calculate	No
Meireles et al. ²⁷	Ga-Al-As (785 nm)	70 mW continuous	2.57 s	0.06 cm²	20	1166.66 mW/cm²	3 J/cm²	0.18 J	7.56 J	No
Hands´ osteoarthritis
Baltzer, Ostapczuk, Stosch ²⁵	Diode laser	400 mW continuous	1200 s	0.0016 cm²	several points at the same time	25000 mW/cm2	cannot be calculated	Cannot be calculate	480 J	Yes
	6-fiber 658 nm
	4-fiber 785 nm
Knee´S Osteoarthritis
Yurtkuran et al. ¹⁴	As-Ga (904 nm)	4 mW pulsed	120 s	0.4 cm²	1 (Sp9)	10 mW/cm²	1.2 J/cm²	0.48 J	0.48 J	No
Hegedús et al. ³²	As-Ga-Al (830 nm)	50 mW continuous	120 s	0.005 cm²	8	10000 mW/cm²	1200 J/cm²	6 J	48 J	Yes Intergroup
Zhao et al. ³³	Laser (650 nm) + CO2 laser (10.6 µm)	36 mW + 200 mW (40 hz)	1200 s	0.0314 cm²	1 (ST35)	1146.5 mW/cm² + 6369.4 mW/cm²	1375,8 J/cm² + 3821,65 J/cm²	43.2 J + 120 J	43.2 J + 120 J	Yes With 2 weeks
Fukuda et al. ³⁴	As-Ga (904 nm)	60 mW pulsed	50 s	0.5 cm²	9	120 mW/cm²	6 J/cm²	3 J	27 J	Yes
Štiglić-Rogoznica et al. ³⁵	YAG laser (1064 nm)	3 kW	1200 s total	not supplied	not supplied	Cannot be calculate	Cannot be calculate	Cannot be calculate	Cannot be calculate	Yes
Gworys et al. ³⁶	Laser (810 nm)	400 mW continuous	20 s	0.63 cm²	12	634.9 mW/cm²	12.7 J/cm²	8 J	96 J	Yes
Group I	Laser (810 nm)	400 mW continuous	20 s	0.63 cm²	12	634.9 mW/cm²	12.7 J/cm²	8 J	96 J	Yes
Gworys et al. ³⁶	Laser MSL	1100 mW (2000Hz)	11.27 s	2 cm²	12	550 mW/cm²	6.2 J/cm²	12.4 J	148.8 J	Yes
Group II	Laser MSL	1100 mW (2000Hz)	11.27 s	2 cm²	12	550 mW/cm²	6.2 J/cm²	12.4 J	148.8 J	Yes
Gworys et al. ³⁶	Laser MSL	1100 mW (2000Hz)	6 s	2 cm²	12	550 mW/cm²	3.28 J/cm²	6.6 J	79.2 J	Yes
Group III	Laser MSL	1100 mW (2000Hz)	6 s	2 cm²	12	550 mW/cm²	3.28 J/cm²	6.6 J	79.2 J	Yes
Kedzierski et al. ³⁷	Laser 10 MSL M1 (808 nm) + (905 nm)	1250 mW Continuous + Pulsed	600 s	not supplied	not supplied	Cannot be calculate	Cannot be calculate	36 J	Cannot be calculate	Yes
Rayegani et al. ³⁸	Laser (880 nm)	50 mW continuous	120 s	0.01 cm²	8	5000 mW/cm²	600 J/cm²	6 J	48 J	Yes
Alghadir et al. ¹⁶	As-Ga (850 nm)	100 mW	60 s	0.00785 cm²	8	12738.8 mW/cm²	764.33 J/cm²	6 J	48 J	Yes
Nakamura et al. ³⁹	Ga-Al-AS (830 nm)	1000 mW	30 s	1.5 cm²	4	666.67 mW/cm²	20.1 J/cm²	30 J	120 J	Yes
Soleimanpour et al. ⁴⁰	Laser (810 nm)	50mW (F = 3,000, peak power = 80W, Δt =200 ns)	120 s	1 cm²	6	50 mW/cm²	6 J/cm²	6 J	36 J	Yes
Laser I	Laser (810 nm)	50mW (F = 3,000, peak power = 80W, Δt =200 ns)	120 s	1 cm²	6	50 mW/cm²	6 J/cm²	6 J	36 J	Yes
Soleimanpour et al. ⁴⁰	Laser (890 nm)	30mW (F = 3,000Hz, peak power = 50W, Δt = 200 ns	588 s	1.765 cm²	1	17 mW/cm²	10 J/cm²	17.6 J	53.6 J	Yes
Laser II	Laser (890 nm)	30mW (F = 3,000Hz, peak power = 50W, Δt = 200 ns	588 s	1.765 cm²	1	17 mW/cm²	10 J/cm²	17.6 J	53.6 J	Yes
Hinman et al. ²⁸	Red Laser (not specify)	10 mW	not supplied	not supplied	Varied	Cannot be calculated	Cannot be calculated.	0.2 J	Cannot be calculated.	No
Nambi et al. ⁴¹	AS-Ga (905 nm)	25 mW, (pulsed)	60 s	1 cm²	8	25 mW/cm²	1,5 J/cm²	1.5 J	12 J	Yes
Nazari et al. ⁴²	YAG (1064 nm)	5 W, (30 Hz)	8 min	not supplied	not supplied	Cannot be calculate	60 J/cm2	Cannot be calculate	2400 J	Yes
Temporomandibular´s osteoarthritis
Madani et al. ⁴³	810 nm Laser	50 mW	120 s	1.76 cm²	variable	28.41 mW/cm²	3.4 J/cm²	6 J	Cannot be calculate	No

	EP	ET
Knee´s osteoarthritis
Mean	18.94 J	218.70 J
Median	6.3 J	48 J
Mode	6 J	48 J

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[TFN1] Note: LLLT: Low Intensity Laser Therapy; RA: Rheumatoid Arthritis; VAS: Visual Analog Pain Scale; HILT: High Intensity Laser Therapy; HAQ: Health Assessment Questionnarie; DASH: Disabilities of the Arm, Shoulder and Hand Questionnaire; AlGaAs: aluminum, gallium, arsenide; OA: osteoarthritis; n: number of subjects; MSL: Multisession Semiconductor Laser; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; TMJ: Temporomandibular Joint; Br-MPQ: Pain Questionnaire, Brazilian Version; SP9/ST35: acupuncture point.