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Low level laser therapy (Classes I, II and III) for treating rheumatoid arthritis

  • Review
  • Intervention




Rheumatoid arthritis (RA) affects a large proportion of the population. Low Level Laser Therapy (LLLT) was introduced as an alternative non-invasive treatment for RA about ten years ago. LLLT is a light source that generates extremely pure light, of a single wavelength. The effect is not thermal, but rather related to photochemical reactions in the cells. The effectiveness of LLLT for rheumatoid arthritis is still controversial. This review is an update of the original review published in October 1998.


To assess the effectiveness of LLLT in the treatment of RA.

Search methods

We initially searched MEDLINE, EMBASE (from 1998), the registries of the Cochrane Musculoskeletal Group and the field of Rehabilitation and Related Therapies as well as the Cochrane Central Register of Controlled Trials (CENTRAL) up to June 2001. This search has now been updated to include articles published up to June 2005.

Selection criteria

Following an a priori protocol, only randomized controlled trials of LLLT for the treatment of patients with a clinical diagnosis of RA were eligible. Abstracts were excluded unless further data could be obtained from the authors.

Data collection and analysis

Two reviewers independently selected trials for inclusion, then extracted data and assessed quality using predetermined forms. Heterogeneity was tested using chi-squared. A fixed effects model was used throughout for continuous variables, except where heterogeneity existed, in which case, a random effects model was used. Results were analyzed as weighted mean differences (WMD) with 95% confidence intervals (CI), where the difference between the treated and control groups was weighted by the inverse of the variance. Dichotomous outcomes were analyzed with relative risks.

Main results

A total of 222 patients were included in the five placebo-controlled trials, with 130 randomized to laser therapy. Relative to a separate control group, LLLT reduced pain by 1.10 points (95% CI: 1.82, 0.39) on visual analogue scale relative to placebo, reduced morning stiffness duration by 27.5 minutes (95%CI: 2.9 to 52 minutes) and increased tip to palm flexibility by 1.3 cm (95% CI: 0.8 to 1.7). Other outcomes such as functional assessment, range of motion and local swelling did not differ between groups. There were no significant differences between subgroups based on LLLT dosage, wavelength, site of application or treatment length. For RA, relative to a control group using the opposite hand, there was no difference observed between the control and treatment hand for morning stiffness duration, and also no significant improvement in pain relief RR 13.00 (95% CI: 0.79 to 214.06). However, only one study was included as using the contralateral limb as control. .

Authors' conclusions

LLLT could be considered for short-term treatment for relief of pain and morning stiffness for RA patients, particularly since it has few side-effects. Clinicians and researchers should consistently report the characteristics of the LLLT device and the application techniques used. New trials on LLLT should make use of standardized, validated outcomes. Despite some positive findings, this meta-analysis lacked data on how LLLT effectiveness is affected by four important factors: wavelength, treatment duration of LLLT, dosage and site of application over nerves instead of joints. There is clearly a need to investigate the effects of these factors on LLLT effectiveness for RA in randomized controlled clinical trials.



低階雷射(Classes I, II and III)治療類風濕性關節炎

低階雷射(Low Level Laser Therapy, LLLT)是一個非侵入性治療類風濕性關節炎替代方法。低階雷射治療(LLLT)是過濾光源使其產生純淨的單一特定波長。低階雷射治療類風濕性關節炎尚有爭議,本文為1998年10月回顧文獻的更新版本。




搜尋包括MEDLINE, EMBASE (自1998), Cochrane Musculoskeletal Group、Rehabilitation and Related Therapies及Cochrane Central Register of Controlled Trials (CENTRAL) 到 001年6月,目前搜尋到2005年6月)。




兩位作者獨立進行資料摘錄。每篇試驗研究的品質由兩位作者獨立使用驗證過的品質評估工具進行評估。本文使用卡方檢定各試驗間異質性,並用固定效應模型(fixedeffects model)分析;若有異質性則使用隨機效應模型(randomeffects model)分析。連續變數以變異數倒數之加權平均差異(WMD)分析。二分資料則使用勝算比(OR)分析。


5個研究包含222例病患於分析中,130例病患使用低階雷射。低階雷射比安慰劑組降低疼痛1.10點VAS (95% CI: 1.82, 0.39),降低晨僵27.5分 (95% CI: 2.9 to 52),增加手掌屈曲度1.3公分 (95% CI: 0.8 to 1.7)。其他如功能評估,活動角度及局部腫脹在兩組並無差異。次群組分析顯示低階雷射使用之劑量、波長、位置、時間並無影響。有一篇使用另一隻手當控制對照的研究,在晨僵時間、疼痛減緩上相對風險13.00 (95% CI: 0.79 to 214.06),兩組並無差異。


低階雷射可短期治療類風濕性關節炎患者降低疼痛及晨僵,特別是它的副作用很少。 臨床人員與研究人員應該持續調查低階雷射設備特性及其使用技巧。 關於低階雷射的新試驗應該利用標準化並且具效度的結果指標。 儘管有一些正面積極的結論(positive findings), 不過這個統合分析缺乏低階雷射的效用是如何受到4個主要的因素影響的數據:波長、低階雷射療程長短、劑量,以及神經的應用治療(而不是對關節的應用治療)。很明確需要以隨機對照試驗,調查這些因素對於低階雷射用於類風濕性關節炎效果的影響。



此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。


■低階雷射是否對於類風濕性關節炎有效?回顧6篇品質中等的研究,並且提供了目前我們所知的最佳證據。這些研究測試超過220名類風濕性關節炎患者,比較接受低階雷射或是安慰劑(假的)雷射治療對於病人的效用。雷射治療多施作於手部,並且多數每週進行2 – 3次,並進行4週。所施予的波長與劑量有所不同。 ■什麼是類風濕性關節炎與低階雷射?類風濕性關節炎(RA)是一種免疫系統攻擊自身健康組織的疾病。它最常侵犯手、腳關節,並且造成關節周圍發紅、疼痛、腫脹以及發熱。藥物及非藥物治療被用來緩解疼痛及或腫脹。低階雷射治療是一種用來減少腫脹與疼痛的非藥物治療。在不產生熱的情況下,該雷射發射出非常單純的光線,並且在所侵犯的目標,產生光與化學反應。 ■這些研究呈現出甚麼?研究顯示雷射治療相較於安慰劑雷射治療可以減少疼痛及早晨僵直。雷射治療相較於安慰劑治療,增進了手部的活動力。在1 – 10分的評估尺度中,疼痛減少了1.10分,晨間僵直的時間減少了28分鐘。研究也顯示雷射治療僅有在改善移動範圍、腫脹與握力上與安慰劑治療相同。只有兩個研究在治療結束3個月後評估雷射治療效果。研究結果指出,在第三個月時雷射治療與安慰劑治療效用相同。儘管有一些證據指出較長的治療時間與較短的波長所產生的效果較好,不過劑量、雷射治療時間長短、以及雷射治療的波長似乎沒有顯著的差異。 ■臨床的重要結論為何?銀級證據顯示以低階雷射治療類風濕性關節炎4周確實可以減少疼痛與晨間僵直。不過似乎沒有帶來長期持續的效果。多數研究測試於手部使用雷射治療,因此並不清楚以雷射治療是否能夠一樣對於身體其他的關節有影響。

Plain language summary

Low level laser therapy for rheumatoid arthritis

Does low level laser therapy work for treating rheumatoid arthritis?
Six studies of medium quality were reviewed and provide the best evidence we have today. Collectively, these studies tested over 220 people with rheumatoid arthritis. The studies compared how well people did while receiving either laser therapy or a 'placebo' (fake) laser therapy. Laser therapy was given mostly on the hands and generally for two to three times a week for four weeks. There were also many different wavelengths and dosages given.

What is rheumatoid arthritis and low level laser therapy?
Rheumatoid arthritis (RA) is a disease in which the body's immune system attacks its own healthy tissues. The attack happens mostly in the joints of the hands and feet and causes redness, pain, swelling and heat around the joints. Drug and non-drug treatments are used to relieve pain and/or swelling. Low level laser therapy, is a non-drug treatment used to decrease swelling and pain. Without producing heat, the laser emits very pure light that causes light and chemical reactions in cells where it is targeted.

What did the studies show?
Studies showed that laser therapy decreased pain and morning stiffness more than 'placebo' laser therapy. Laser therapy also increased hand flexibility more than placebo therapy.
Pain decreased by 1.10 points on a scale of 1-10. The length of time for morning stiffness decreased by 28 minutes.

Studies also showed that laser therapy worked just as well as 'placebo' laser therapy to improve range of motion, function, swelling and grip strength.
Only two of the studies measured the effect of laser therapy three months after the end of treatment. The results from these studies indicated that laser therapy worked just as well as 'placebo' therapy after three months times.

Dose, length of laser administration time and wavelength of the laser therapies did not appear to make a significant difference, though there was some evidence indicating that longer administration times and shorter wavelengths produced better effects.

Were there any side effects?
No side effects were reported in the studies.

What is the bottom line?
There is 'silver' level evidence that low level laser therapy in people with rheumatoid arthritis for up to four weeks does decrease pain and morning stiffness. It does not appear, however, to have long-lasting effects.
Most of the studies tested laser therapy on the hand, so it is not clear whether laser therapy would affect other joints of the body the same way.

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