Laser Therapy on Arthritis Induced by Urate Crystals

Acute effects of photobiomodulation applied on the dorsal root ganglion in gout model-induced rats

Gouty arthritis is an inflammatory disease that triggers symptoms such as pain, swelling, and joint stiffness. Since its main therapy is medication, research on other forms of treatment that do not generate side effects is necessary. Given this, the objective of this research was to evaluate the effects of combined photobiomodulation (LASER and LED) applied on the dorsal root ganglion (DRG) in an experimental model of gouty arthritis. For this, 40 Wistar rats were randomized into 4 groups: simulation of the model with saline injection, without treatment (CTL; n = 10); gout simulation with photobiomodulation treatment (CTL-PBM; n = 10); gout model with the injection of monosodium urate crystals (1.25 mg) in the femorotibial joint, without treatment (GOT; n = 10); or gout model with photobiomodulation treatment (GOT-PBM; n = 10). After 7 h of gout induction, photobiomodulation was performed with a cluster of 4 diodes applied to the GRD region in animals from the CTL-PBM and GOT-PBM groups. After analysing the results, it was concluded that the therapy favored the reduction of edema and joint incapacity, as well as the increase in the nociceptive threshold and plantar grip strength. Furthermore, PBM stimulated an increase in the inflammatory response (with increased levels of IL-1β and greater recruitment of leukocytes) and greater activation of the antioxidant system. Therefore, PBM can be considered an effective therapeutic alternative to improve the functional status in this model of joint disease.

Photobiomodulation Therapy Partially Restores Cartilage Integrity and Reduces Chronic Pain Behavior in a Rat Model of Osteoarthritis: Involvement of Spinal Glial Modulation

OBJECTIVE

Chronic pain associated with osteoarthritis (OA) often leads to reduced function and engagement in activities of daily living. Current pharmacological treatments remain relatively ineffective. This study investigated the efficacy of photobiomodulation therapy (PBMT) on cartilage integrity and central pain biomarkers in adult male Wistar rats.

DESIGN

We evaluated the cartilage degradation and spinal cord sensitization using the monoiodoacetate (MIA) model of OA following 2 weeks of delayed PBMT treatment (i.e., 15 days post-MIA). Multiple behavioral tests and knee joint histology were used to assess deficits related to OA. Immunohistochemistry was performed to assess chronic pain sensitization in spinal cord dorsal horn regions. Furthermore, we analyzed the principal components related to pain-like behavior and cartilage integrity.

RESULTS

MIA induced chronic pain-like behavior with respective cartilage degradation. PBMT had no effects on overall locomotor activity, but positive effects on weight support (P = 0.001; effect size [ES] = 1.01) and mechanical allodynia (P = 0.032; ES = 0.51). Greater optical densitometry of PBMT-treated cartilage was evident in superficial layers (P = 0.020; ES = 1.34), likely reflecting the increase of proteoglycan and chondrocyte contents. In addition, PBMT effects were associated to decreased contribution of spinal glial cells to pain-like behavior (P = 0.001; ES = 0.38).

CONCLUSION

PBMT during the chronic phase of MIA-induced OA promoted cartilage recovery and reduced the progression or maintenance of spinal cord sensitization. Our data suggest a potential role of PBMT in reducing cartilage degradation and long-term central sensitization associated with chronic OA.

Laser treatment of synovial inflammatory process in experimentally induced microcrystalline arthritis in Wistar rats

The presence of intra-articular crystals is detected in different articular pathologies of acute or chronic nature. The aim of this work was to analyze the action of the indium gallium aluminum and phosphorus (InGaAlP) (λ = 670 nm) laser on the synovial membrane present in the knee joint in experimentally induced microcrystalline arthritis in male adult Wistar rats. The animals were divided into three experimental groups (n = 24): control (A), experimentally induced arthritis (B), experimentally induced arthritis+InGaAlP laser therapy (C). The laser treatment was made daily in the patellar region of the right knee after 48 h of the experimental induction. After 7, 14, and 21 days of therapy, the rats were euthanized and the right knees were removed and processed for histomorphometric, immunohistochemical, ultrastructural, and biochemical investigation of the synovium. The number of granulocytes on the 14th and 21st days was higher in B and lower in C and, lastly, in A. The number of fibroblasts on the 14th and 21st days was similar between A and C and below B. The number of blood vessels on the 21st day was higher in B than in the other groups. The positive number of cells for the TUNEL test was higher on the 14th and 21st days in B compared to the others. The percentage of tissue area occupied by birefringent collagen fibers was higher in B on the 21st day than in the others. The ultrastructure of cells showed fibroblast-like morphology in all groups and periods evaluated. The quantification of glycosaminoglycans did not present significant differences between the groups in all the experimental periods. The amount of hydroxyproline was higher in B compared to the other groups on the 14th and 21st days. The content of non-collagen proteins was higher in B on the 21st day in relation to the other groups. Quantification of TNF-α on the 21st day was higher in A and B than in C. For TGF-β on the 21st day, groups B and C presented similar and higher values than A. For MMP-13, groups A and B presented data similar to and above C. In relation to ADAMT-S4, on the 21st day, groups B and C presented data similar to and lower than A. InGaAlP-670 nm therapy reduced the inflammatory process and tissue injuries of the synovial membrane in comparison to the untreated group, indicating its potential utilization in clinical studies aiming in the recovery of acute arthritis in patients.

Effectiveness of Low-Intensity Laser Therapy on Tissue Repair Following Saphenectomy in Patients Who Underwent Coronary Artery Bypass Graft: A Randomized, Double-Blind Study

OBJECTIVE

To verify the effectiveness of low-intensity laser therapy (LLLT) on tissue repair following saphenectomy during postoperative period in patients having undergone coronary artery bypass graft (CABG).

MATERIALS AND METHODS

A randomized clinical trial, controlled and double-blind study was conducted with 40 volunteers, divided into 2 groups: a placebo group (PG, n = 20) and a laser group (LG, n = 20). The patients in the LG group were irradiated with laser during saphenectomy (InGaAlP, λ 660 nm, energy density 6 J/cm²) daily from the first to the fourth postoperative day. The surgical incision was clinically evaluated and imaged at the beginning and at the end of the treatment. The areas of hematoma and hyperemia were evaluated using the software ImageJ 1.4^©, and border closure was evaluated by three researchers, who were blinded concerning the allocation of the participants.

RESULTS

The LG group presented a reduction of the areas of hematoma and hyperemia (p = 0.0003) and better border closure (p = 0.009), when compared with the PG group.

CONCLUSIONS

The proposed LLLT protocol improved the tissue repair following saphenectomy in CABG patients.

The Antinociceptive Effect of Light-Emitting Diode Irradiation on Incised Wounds Is Correlated with Changes in Cyclooxygenase 2 Activity, Prostaglandin E2, and Proinflammatory Cytokines

Background. Light-emitting diode (LED) phototherapy has been reported to relieve pain and enhance tissue repair through several mechanisms. However, the analgesic effect of LED on incised wounds has never been examined. Objectives. We examined the analgesic effect of LED therapy on incision pain and the changes in cyclooxygenase 2 (COX-2), prostaglandin E2 (PGE2), and the proinflammatory cytokines interleukin 6 (IL-6), IL-1β, and tumor necrosis factor α (TNF-α). Methods. Rats received LED therapy on incised skin 6 days before incision (L-I group) or 6 days after incision (I-L group) or from 3 days before incision to 3 days after incision (L-I-L group). Behavioral tests and analysis of skin tissue were performed after LED therapy. Results. LED therapy attenuated the decrease in thermal withdrawal latency in all the irradiated groups and the decrease in the mechanical withdrawal threshold in the L-I group only. The expression levels of COX-2, PGE2, and IL-6 were significantly decreased in the three LED-treated groups, whereas IL-1β and TNF-α were significantly decreased only in the L-I group compared with their levels in the I groups (p < 0.05). Conclusions. LED therapy provides an analgesic effect and modifies the expression of COX-2, PGE2, and proinflammatory cytokines in incised skin.

Effect of IR laser on myoblasts: a proteomic study

Laser therapy is used in physical medicine and rehabilitation to accelerate muscle recovery and in sports medicine to prevent damages produced by metabolic disturbances and inflammatory reactions after heavy exercise. The aim of this research was to get insight into possible benefits deriving from the application of an advanced IR laser system to counteract deficits of muscle energy metabolism and stimulate the recovery of hypotrophic tissue. We studied the effect of IR laser treatment on proliferation, differentiation, cytoskeleton organization and global protein expression in C2C12 myoblasts. We found that laser treatment induced a decrease in the cell proliferation rate without affecting cell viability, while leading to cytoskeletal rearrangement and expression of the early differentiation marker MyoD. The differential proteome analysis revealed the up-regulation and/or modulation of many proteins known to be involved in cell cycle regulation, cytoskeleton organization and differentiation.

Low level laser therapy on experimental myopathy

PURPOSE

The aim of the present work was to study the effect of Helium-Neon (HeNe) and Gallium Arsenide (GaAs) laser upon nitric oxide (NO) plasma levels, an inflammatory biomarker associated with oxidative stress, in rats with experimental myopathy. These were evaluated through histological assessment.

MATERIALS AND METHODS

The groups studied were: (A) control (intact rats that received LLLT sham exposures), (B) rats with myopathy and sacrificed at 24 h later, (C) rats with myopathy and sacrificed 8 days later, (D) rats with myopathy and treated with HeNe laser, (E) rats with myopathy and treated with GaAs laser, (F) intact rats treated with HeNe laser and (G) intact rats treated with GaAs laser. Myopathy was induced by injecting 50μl of 1% carrageenan λ (type IV) in the left gastrocnemius muscle. Low Level Laser Therapy (LLLT) was applied with 9.5 J.cm(-2) daily for 10 consecutive days with each laser. The determination of the NO was made by spectrophotometry. The muscles were stained with Hematoxylin-Eosin and examined by optic microscopy. Quantitative variables were statistically analyzed by the Fisher test, and categorical by applying Pearson's Chi Squared test at p <0.05 for all cases.

RESULTS

In groups B and C, NO was significantly increased compared to groups A, D, E, F and G (p<0.05). In group C, the percentage of area with inflammatory infiltration was significantly increased compared to the other groups (p<0.001).

CONCLUSIONS

LLLT decreased plasma levels of NO in rats with experimental myopathies and significant muscle recovery.

Low-level infrared laser effect on plasmid DNA

Low-level laser therapy is used in the treatment of many diseases based on its biostimulative effect. However, the photobiological basis for its mechanism of action and adverse effects are not well understood. The aim of this study, using experimental models, was to evaluate the effects of laser on bacterial plasmids in alkaline agarose gel electrophoresis and Escherichia coli cultures. The electrophoretic profile of bacterial plasmids in alkaline agarose gels were used for studying lesions in DNA exposed to infrared laser. Transformation efficiency and survival of Escherichia coli AB1157 (wild-type), BH20 (fpg/mutM(-)), BW9091 (xth(-)), and DH5αF'Iq (recA(-)) cells harboring pBSK plasmids were used as experimental models to assess the effect of laser on plasmid DNA outside and inside of cells. Data indicate low-level laser: (1) altered the electrophoretic profile of plasmids in alkaline gels at 2,500-Hz pulsed-emission mode but did not alter at continuous wave, 2.5- and 250-Hz pulsed-emission mode; (2) altered the transformation efficiency of plasmids in wild-type and fpg/mutM(-) E. coli cells; (3) altered the survival fpg/mutM(-), xthA(-) and recA(-) E. coli cultures harboring pBSK plasmids. Low-level infrared laser with therapeutic fluencies at high frequency in pulsed-emission modes have effects on bacterial plasmids. Infrared laser action can differently affect the survival of plasmids in E. coli cells proficient and deficient in DNA repair mechanisms, therefore, laser therapy protocol should take into account fluencies, frequencies and wavelength of laser, as well as tissue conditions and genetic characteristics of cells before beginning treatment.

Avaliação funcional da nocicepção do joelho de ratos tratada com laser de baixa potência e natação

O objetivo deste estudo foi avaliar e comparar os efeitos do laser de baixa potência e da natação forçada em modelo de nocicepção articular, de ratos Wistar, avaliando a dor de forma funcional, pelo tempo de elevação da pata (TEP) durante marcha em cilindro metálico. Foram utilizados 32 ratos Wistar, divididos em quatro grupos: GC - animais submetidos à indução de nocicepção no joelho direito e não tratados; GL - nocicepção e tratados com laser de baixa potência 670nm, 8J/cm²; GN - nocicepção e natação por 10 minutos em água a 30-32ºC; GNL - nocicepção e tratados com natação e laser. Para realizar a nocicepção foi injetado, no espaço tibiofemoral medial direito, 50µL de formalina 5%. A avaliação funcional da dor foi realizada com o teste de incapacidade funcional, que avalia o tempo de pata no ar (TEP) da marcha durante um minuto sobre um cilindro metálico, as avaliações ocorreram antes da indução da nocicepção (AV1), após 15 (AV2) e 30 minutos (AV3) da mesma, sendo que após a AV2, ocorreram os protocolos de tratamento. Os resultados mostraram que o grupo laser foi o único a apresentar restauração dos valores na AV3, comparando com AV1. GN foi o único a não apresentar redução ao comparar AV3 com AV2. Conclui-se que, pela avaliação funcional, o laser de baixa potência apresentou efeitos analgésicos, enquanto a natação produziu aumento do quadro de dor, o qual foi parcialmente revertido com o uso do laser associado

Anti-inflammatory effects of low-level light emitting diode therapy on Achilles tendinitis in rats

BACKGROUND AND OBJECTIVES

The present study investigated the effects of low-level light emitting diode (LED) therapy (880 +/- 10 nm) on inflammatory process in a experimental model of Achilles tendinitis induced by collagenase.

STUDY DESIGN/MATERIALS AND METHODS

Fifty-six male Wistar were separated into seven groups (n = 8), three groups in the experimental period of 7 days and four groups in the experimental period of 14 days, the control group (CONT), tendinitis group (TEND), LED therapy group (LEDT) for both experimental periods, and LED therapy group 7th to 14th day (LEDT delay) for 14 days experimental period. The LED parameters was 22 mW CW of optical output power, distributed in an irradiation area of 0.5 cm(2), with an irradiation time of 170 seconds, the applied energy density was 7.5 J/cm(2) in contact. The therapy was initiated 12 hours after the tendinitis induction, with a 48-hour interval between the irradiations. The histological analysis and inflammatory mediators were quantified.

RESULTS

Our results showed that LED decreases the inflammatory cells influx and mRNA expression to IL-1 beta, IL-6, tumor necrosis factor-alpha (TNF-alpha) in both phase, and cyclooxygenase-2 (COX-2) just in initial phase (P < 0.05).

CONCLUSION

Our results suggest that the anti-inflammatory therapy with low-power LED (880 nm) enhanced the tissue response in all groups. We can conclude that the LED was able to reduce signs of inflammation in collagenase-induced tendinitis in rats by reducing the number of inflammatory cells and decrease mRNA expression of cytokines.

Evaluation of inflammatory biomarkers associated with oxidative stress and histological assessment of low-level laser therapy in experimental myopathy

The objective of the present work was to study the effect of helium-neon (He-Ne) and gallium-arsenide (Ga-As) laser upon inflammatory biomarkers associated with oxidative stress: fibrinogen, nitric oxide (NO), L-citrulline, and superoxide dismutase (SOD). These were evaluated through histological assessment, in rats with experimental myopathy.

MATERIALS AND METHODS

The groups studied were: (A) control, (B) injured, (C) injured and treated with He-Ne laser, (D) injured and treated with Ga-As laser, (E) irradiated with He-Ne; and (F) irradiated with Ga-As laser. Myopathy was induced by injecting 0.05 mg/rat/day of adrenaline in the left posterior limb muscle at the same point on 5 consecutive days, in groups B, C, and D. Low-level laser therapy (LLLT) was applied with 9.5 J/cm(2) daily for 7 consecutive days with each laser. The determination of the biomarkers was made by spectrophotometry. The muscles (5/8, single blinded) were stained with Gomori Trichrome and examined by optic microscopy. The quantitative variables were statistically analyzed by the Fisher's test and categorical data by the Axionvision 4.8 program. Pearson's chi-squared test was applied, setting significant difference at P < 0.05 for all cases.

RESULTS

In group B, the biomarkers were significantly increased compared to the other groups (P < 0.001), except for NO which in group B decreased significantly (P < 0.001). In group B, there was a higher inflammatory infiltration level (80.67%) in relation to destroyed fibers.

CONCLUSIONS

LLLT caused significant changes in inflammatory biomarkers and oxidative stress: decreased levels of fibrinogen, L-citrulline and SOD as opposed to the increase of NO in rats with experimental myopathies and significant muscle recovery.

Inflammatory and oxidative stress markers in experimental crystalopathy: their modification by photostimulation

Crystalopathies are inflammatory pathologies caused by cellular reactions to the deposition of crystals in the joints. The anti-inflammatory effect of the helium-neon (He-Ne) laser and that of the nonsteroidal anti-inflammatory drugs (NSAIDs) diclofenac, meloxicam, celecoxib, and rofecoxib was studied in acute and chronic arthritis produced by hydroxyapatite and calcium pyrophosphate in rats. The presence of the markers fibrinogen, L-citrulline, nitric oxide, and nitrotyrosine was determined. Crystals were injected into the posterior limb joints of the rats. A dose of 8 J/cm(2) of energy from an He-Ne laser was applied for 3 d in some groups and for 5 d in other groups. The levels of some of the biomarkers were determined by spectrophotometry, and that of nitrotyrosine was determined by ELISA. For statistical analysis, Fisher's exact test was used, and p +/- 0.05 was considered significant. In arthritic rats, the fibrinogen, L-citrulline, nitric oxide, and nitrotyrosine levels increased in comparison to controls and to the laser-treated arthritic groups (p +/- 0.001), (p +/- 0.001), (p +/- 0.02), and (p +/- 0.01), respectively. When comparing fibrinogen from arthritic rats with disease induced by hydroxyapatite with undiseased and arthritic rats treated with NSAIDs, the He-Ne laser decreased levels to values similar to those seen in controls (p +/- 0.01). Inflammatory and oxidative stress markers in experimental crystalopathy are positively modified by photobiostimulation.

Helium-neon laser reduces the inflammatory process of arthritis

OBJECTIVE

A histological study of the anti-inflammatory effect of helium-neon laser in models of arthropathies induced by hydroxyapatite and calcium pyrophosphate in rats.

BACKGROUND

Crystal deposition diseases are inflammatory pathologies induced by cellular reaction to the deposit of crystals in the joints.

METHODS

Fifty-six Suquia strain rats were distributed in seven groups. Two mg of each crystal diluted in 0.05 ml physiologic solution were injected six times in each back limb joint, during two weeks on alternate days. Eight J/cm(2) were applied daily to the crystal-injected joints on five consecutive days. The joints were cut and put in 10% formaldehyde, stained with hematoxylin-eosin and observed by light microscopy. The percentage of area with inflammatory infiltrates was determined in five optical microscopy photographs (100X) for each group and analyzed using the Axionvision 4.6 program. A Pearson's Chi Squared test was applied, with significance level set at p < 0.05.

RESULTS

Both crystals produced an inflammatory process in the osteoarticular structures, consisting of predominantly mononuclear infiltration, fibrosis, and granulomas of foreign body-type giant cells containing phagocytosed remains of crystals. In the arthritic joints treated with laser, a marked decrease (p < 0.0001) was found in the percentage of area with inflammatory infiltrates, although the granulomas remained in a less ostensible form, with adipose tissue cells, fibrosis bands with light residual inflammation, and an absence of or very few crystals. Laser alone or physiologic solution injection did not produce histological changes.

CONCLUSIONS

Helium-neon laser reduced the intensity of the inflammatory process in the arthritis model induced by hydroxyapatite and calcium pyrophosphate crystals.

Ablation of articular cartilage with an erbium:YAG laser: an ex vivo study using porcine models under real conditions-ablation measurement and histological examination

BACKGROUND AND OBJECTIVES

The use of an erbium:YAG laser in arthroscopic surgery has the advantage of a precise treatment of soft tissue. Due to the high absorption in water, the laser energy is perfectly matched to smoothing the hydrous, fibrillated articular cartilage surface. In minimal invasive surgery, the workspace is filled with aqueous liquids for enlargement. This appears contrary to the absorption characteristics of erbium:YAG laser radiation in water. The purpose of this study was to evaluate the ablated volume per pulse of cartilage lesions and the potential side effects including thermal damage and tissue necrosis.

STUDY DESIGN/MATERIALS AND METHODS

Twenty-four osteochondral specimens of porcine knee joints were irradiated with an Er:YAG laser completely submerged in water, with distances to the cartilage surface of 1, 3 and 5 mm and pulse durations of 75 and 100 microseconds. To keep a constant peak power of approximately 6 kW, pulse energies of 450 and 580 mJ were used at a pulse repetition rate of 15 Hz. After a histological preparation, ablated volumes, depths, and widths of the cuts were investigated. Additionally, laser protocols were correlated with different markers of cartilage tissue damage and apoptosis.

RESULTS

Ablation could be observed for every measurement. The influence of the distance showed a statistical significance (P < 0.001) for the volume, depth, and width of the cuts. For the pulse duration, statistical significance (P < 0.001) was found only for the volume and the depth. We observed no loss of proteoglycan or collagen type II. The total cell number, cell morphology, and number of apoptotic cells in an area close to the cutting edge and in a corresponding unaffected area of the same specimens revealed no differences regardless of the applied protocol.

CONCLUSION

The use of an Er:YAG laser demonstrates the successful application in liquid environments for cartilage removal without any damage of the surrounding tissue.

Aplicação do laser 808nm na dor articular crônica de ratos Wistar

Durante o processo inflamatório, alguns tipos de células predominam e estão envolvidos com a produção de dor. O laser de baixa potência mostra-se útil no controle de mediadores inflamatórios, mas a ampla divergência nos parâmetros dosimétricos, conduz a variações nos resultados positivos. O objetivo deste estudo foi analisar o uso do laser 808nm, na dor articular crônica e edema de ratos Wistar submetidos a sinovite. Foram utilizados 10 ratos Wistar, divididos em dois grupos: GC - indução de sinovite em joelho direito e tratamento placebo; GT - indução de sinovite e irradiado com laser 10J/cm². Para a produção de sinovite foram injetados 100µl de formalina a 5%, no espaço articular tibiofemoral direito. A avaliação da dor ocorreu pelo tempo de elevação da pata (TEP). No 10º dia após a indução de sinovite, iniciou-se o tratamento com laser sobre a face articular medial do joelho, procedimento mantido no decorrer de 10 dias. Os resultados mostraram que o laser apresentou efeitos analgésicos, visto que, para o grupo tratado, houve redução significativa nos valores de TEP, indicando redução da dor, quando comparados os valores pós-tratamento com os pré-tratamento, o que não ocorreu para o grupo que recebeu tratamento placebo; para o edema, o laser também mostrou redução significativa do mesmo. Concluiu-se que o laser 808nm, com 10J/cm², é eficaz na redução da dor articular crônica e edema, em animais submetidos a sinovite experimental.

Photobiomodulation of Pain and Inflammation in Microcrystalline Arthropathies: Experimental and Clinical Results

OBJECTIVE

This article presents the results of laser therapy in crystal (hydroxyapatite, calcium pyrophosphate, and urates) deposition-induced arthritis in rats and the clinical applications in humans.

BACKGROUND DATA

Microcrystalline arthropathies are prevalent among geriatric patients, who are more vulnerable to the side effects of drugs. The effectiveness of laser therapy for pain relief, free of side effects, has been reported in painful conditions.

METHODS

Two milligrams of each of the above-mentioned crystals was injected in both joints of the back limbs in three groups of rats; these groups were then treated with laser irradiation. Three other groups received no treatment after the injections. We determined the plasmatic levels of inflammatory markers (fibrinogen, prostaglandin E2, and TNF(alpha)), tissues (prostaglandin E(2)) and conducted anatomopathological studies. Twenty-five patients with acute gout arthritis were randomized into two groups and treated over 5 days: group A, diclofenac 75 mg orally, twice a day; and group B, laser irradiation once a day. Forty-nine patients with knee chronic pyrophosphate arthropathy were randomized into two groups and treated over 21 days; group A, diclofenac 50 mg orally, twice a day; and group B, laser irradiation once a day. Thirty patients with shoulder chronic hydroxyapatite arthropathy were randomized into two groups and treated over 21 days; group A, diclofenac 50 mg orally, twice a day; and group B, laser irradiation once a day.

RESULTS

Fibrinogen, prostaglandin E(2), and TNF(alpha) concentrations in the rats injected with crystals and treated with laser decreased significantly as compared with the groups injected with crystals without treatment. Both laser therapy and diclofenac achieved rapid pain relief in patients with acute gouty arthritis without significant differences in efficacy. Laser therapy was more effective than diclofenac in patients with chronic pyrophosphate arthropathy and in patients with chronic apatite deposition disease.

CONCLUSION

Laser therapy represents an effective treatment in the therapeutic arsenal of microcrystalline arthropathies.