INTRODUCTION:

Osteoarthritis (OA) or degenerative joint disease is characterized by progressive degeneration of the articular cartilage or the entire joint including the articular cartilage, the synovium, the ligaments, and the subchondral bone. Although the prevalence of the disorder varies according to the geographical positions and race, it is about 10 percent for men and 18 percent for women over 60 years old. OA is asymptomatic, particularly during early stage of the disorder. However, along with the progression of the disorder, pain, stiffness, and a limitation in movement develop. Different treatments, depending on the site and severity of the disease are used for the OA. The main treatment options for OA are pain-relieving medications, corticosteroid injections, weight reduction, periodic rest, and physical therapy or exercise. In cases with moderate

symptoms a combination of the aforementioned methods is used. For those patients suffer severe pain, surgical procedures such as hip or knee replacement or joint debridement are necessary. During recent decades non-medication techniques have been developed for the treatment of musculoskeletal and soft tissue disorders including ultrasound stimulation (1, 2), electromagnetic fields (EMFs) (3-5), and photostimulation electromagnetic (6-8). Accordingly, several non-medication techniques have shown promising therapeutic outcomes in different OA . In line with research to develop new medications for treatment of OA, efforts to develop non-medication techniques have been initiated during last decade. Among new non-medication The common medications prescribed for treatment of OA are cyclooxygenase-2 inhibitors and tetracycline derivatives. In addition to the medications several supplements are used for the management of these patients including visco and oral chondroitin sulfate/glucosamine supplements. Although medications and supplements may provide symptomatic benefits, no significant improvement has been yet reported as the outcome in OA disease. Several clinical trials have demonstrated that PEMF exposure in human osteoarthritis has symptomatic benefits (9, 10). In addition, the results have shown that exposure to PEMF enhances chondrogenic differentiation and the synthesis of cartilage extracellular matrix proteins. They suggested that PEMFs trigger cartilage growth and improve knee OA (11, 12). The therapeutic outcomes were dependent on the parameters of method vary considerably but in all trials examined knee OA, there were no reported side effects (13, 14). Researchers are trying to shed more light on the mechanisms of actions of the effects of EMFs on clinical symptoms and hip joint structure in order to establish an appropriate method as an establish treatment on hip and knee OA (12, 15-18). The objective of this study is to comprehensively review the recent advances in PEMF based treatment for OA, their effectiveness as alternative or adjunctive treatment for OA, and finally the mechanism of actions of these fields in exerting therapeutic effects on OA.

Therapeutic Effects of EMFs in OA

Medications used conventionally for management of OA are associated with different side effects. In addition, considering the chronic nature of the disorder, long term consumption of medications is usually resulted in medication-resistant or adaptation and consequently low treatment response. As a result, during the recent decade the main focus in treatment of OA has been shifted to non-medication techniques. Different types of electric and magnetic fields have been developed for a variety of musculoskeletal disorders (3, 4, 19). Findings of different clinical and preclinical studies have shown that PEMF therapy is effective on different musculoskeletal disorders ranging from fracture healing to chronic pain (20-23). Several preclinical and clinical studies have investigated the therapeutic efficacy of PEMFs on different OA (24-26). Despite of controversial findings, these studies have shown promising therapeutic effects including tissue healing, cartilage recovery, and pain relieving in the patients with knee OA (26, 27). Some individuals are more prone to osteoarthritis such as young people who have had arthroscopic anterior cruciate ligament reconstruction (ACLR), and are therefore highly susceptible to OA. Therefore the main focus of research is prevention of hip and knee OA (28, 29). The findings of several studies were reported a significant effect of PEMF on scores of activities of daily living (ADL) and stiffness after treatment (26, 30). Application of PEMFs has shown beneficial effects to reduce pain and ameliorate disability associated with OA (27). In addition, PEMF therapy has shown improvement functional performance in the patients with OA knee and cervical spine (9, 31, 32). Interestingly, none of the patients has reported any significant side-effects of PEMF therapy or initial pain increase during treatments (25).

Mechanisms of Action

Several studies have been conducted to reveal the mechanisms of actions of PEMFs on treatment of musculoskeletal disorders in cellular, tissues, and organism levels. To determine the cellular level mechanisms of actions, several studies have investigated the responses of chondrocytes to PEMFs and indicated that these fields can trigger and enhance the growth of chondrocytes. In addition, PEMFs have shown positive effects on bioactivity and glycosaminoglycan metabolism (33, 34). In the patients with a larger growth potential for osteoblasts and chondrocytes, PEMFs usually result in more therapeutic effects. Exposure to PEMFs triggers growth and differentiation of living tissue, while preserves the morphology of articular cartilage and retards the treatment of osteoarthritic lesions (26, 35).

The measurement of arthritis severity or activity is estimated by the proteoglycan neoepitope and 3B3(−) in osteoarthritic cartilage. The cartilage neoepitopes, 3B3(−) and BC-13, and suppression of the matrix-degrading enzymes, collagenase and stromelysin decrease in this condition (36). The stimulation of aggrecan and collagen synthesis is highly dependent on TGFβ. TGFβ has important role on the suppression of the pro-enzyme forms of stromelysin and collagenase, and the suppression of interleukin (IL)-1 (37, 38). PEMF has been shown to increase members of the TGFβ super gene family, synthesis of type II collagen and also increase the number of cells immunopositive to TGFβ (11, 12, 15, 39-41). These observed changes by PEMF may be a mechanism of action of PEMF on the biology of osteoarthritic joints. Results of several studies have shown significant different and stronger effects compared with placebo for intra-articular corticosteroids at 6 weeks (42-44). Despite the controversial findings of the previous studies, the mechanisms of PEMF and its biological effects are still vague and more research is needed to be certain.

CONCLUSION:

Beneficial therapeutic effects of PEMFs have been proven on musculoskeletal disorders such as osteoporosis, osteoarthritis, bone allografts, ligament injury, tendon and joints injuries, and ligaments (45-48). Randomized controlled studies investigating the positive clinical effects of PEMF to improve clinical scores and function in patients with OA knee and they suggested that this method can be considered as adjuvant therapies in future management of OA (9, 24, 31, 32, 49). In addition, the researcher suggested urgent and large-scale studies of pulsed electromagnetic stimulation with a focus on OA to establish the clinical relevance of treatment (49-51).

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Received on 01.02.2017 Modified on 16.02.2017

Research J. Pharm. and Tech. 2017; 10(2): 641-644.

DOI: 10.5958/0974-360X.2017.00122.6