Molecular and Cellular Mechanisms of Arthritis in Children and Adults: New Perspectives on Applied Photobiomodulation

Abstract

Juvenile idiopathic arthritis and adult rheumatoid arthritis are two major groups with chronic joint pain and inflammation, extra-articular manifestations, and high risk of comorbidities, which can cause physical and ocular disability, as well as create great socio-economic pressure worldwide. The pathogenesis of arthritis manifested in childhood and adulthood is multifactorial, unclear, and overly complex, in which immunity plays an important role. Although there are more and more biological agents with different mechanisms of action for the treatment of arthritis, the results are not as expected, because there are partial responses or non-responsive patients to these compounds, high therapeutic costs, side effects, and so on; therefore, we must turn our attention to other therapeutic modalities. Updating knowledge on molecular and cellular mechanisms in the comparative pathogenesis of chronic arthritis in both children and adults is necessary in the early and correct approach to treatment. Photobiomodulation (PBM) represents a good option, offering cost-effective advantages over drug therapy, with a quicker, more positive response to treatment and no side effects. The successful management of PBM in arthritis is based on the clinician’s ability to evaluate correctly the inflammatory status of the patient, to seek the optimal solution, to choose the best technology with the best physical parameters, and to select the mode of action to target very precisely the immune system and the molecular signaling pathways at the molecular level with the exact amount of quantum light energy in order to obtain the desired immune modulation and the remission of the disease. Light is a very powerful tool in medicine because it can simultaneously target many cascades of immune system activation in comparison with drugs, so PBM can perform very delicate tasks inside our cells to modulate cellular dysfunctions, helping to initiate self-organization phenomena and finally, healing the disease. Interdisciplinary teams should work diligently to meet these needs by also using single-cell imaging devices for multispectral laser photobiomodulation on immune cells.

Photobiomodulation Therapy vs. Corticosteroid for the Management of Erosive/Ulcerative and Painful Oral Lichen Planus. Assessment of Success Rate during One-Year Follow-Up: A Retrospective Study

“…This modulation of ROS production has been shown to mimic the activity of molecular agents that attenuate tissue damage, such as amifostine, N-acetyl cysteine, and superoxide dismutase [ 20 ]. It was also demonstrated that PBM acts on the inflammatory process by causing reduction of inflammation initiators, stimulating the fibroblasts, facilitating the deposition of collagen fibers and rebuilding the extracellular matrix as the wound site occurs [ 19 , 20 , 21 , 22 ].…”

“…Similar studies were conducted using PBM therapy with the aim of treating OLP [ 21 , 22 ]; however, there is no consent on the exact PBM dosimetry or treatment protocol for the management of erosive OLP. In this context, a randomized double-blind study by Rodrigues et al [ 23 ], showed that the use of PBM can be as effective as corticoid therapy in treating oral lichen planus with no adverse side effects noted.…”

Three Inspiring Review Articles on Photobiomodulation: Update 2021

“…PBM has proven a good option here too and offered cost-effective advantages over drug therapy with a faster, more positive response to treatment. The third article addresses this question [4].…”

Review of the Pathophysiology, Diagnosis, and Orthopedic Treatment Options for Juvenile Idiopathic Arthritis

“…Current management falls short due to the limited knowledge of the biological processes of the disease. Biologic agents that target the immune system are expensive, require long-term treatment, and do not treat the disease definitively [5,13]. Eisenstein et al explain that pediatric rheumatologists may need to provide a "more precise biological classification" to specify and improve treatments that target gene expression and new immunological findings that contribute to this disease process [14].…”

“…The occurrence of JIA is most common in Caucasian children and is significantly less common in African-American, Asian, and Hispanic children [4]. Like rheumatoid arthritis (RA), JIA causes chronic joint pain and inflammation that can lead to physical or ocular disability [5]. An early interdisciplinary approach is necessary to improve outcomes and decrease disease activity, which may delay or avoid the need for eventual joint replacement [6].…”