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Inflammation

Top class magnetic therapy

Inflammation early warning system

 

Background

Inflammation is fundamentally essential for healing processes, since it tries to eliminate harmful stimuli such as bacteria or foreign substances or to create the conditions for repair processes in the sense of an "early warning system". For example, it is the natural side effect of injuries to remove clotted blood and injured or dead tissue by phagocytes of the immune system. It arises from so-called inflammation mediators such as prostaglandin, histamine, bradykinin etc., which lead to increased permeability of the local blood vessels and thus facilitate the escape of blood plasma and the migration of leukocytes. The result is swelling of the tissue or edema. Cytokines such as IL-6 IL-1ß and TNF-alpha are also included in the inflammation scale, since they stimulate the production of inflammation mediators, for example.

 

As important as inflammation and edema are for the healing process, they can be painful or even harmful for those affected. The messenger substances prostaglandin, histamine, bradykinin and serotonin also lower the threshold of irritation at the end branches of sensitive nerve fibers (C fibers), ie the sensation of pain increases significantly. Due to the edema, the blood vessels may subsequently compress, which hinders the subsequent healing process. Edema should therefore be kept to a minimum.

 

Frequency

Typical examples of inflammation are injuries or active interventions such as surgery. Mechanical joint irritation or rheumatism also react with an inflammatory event. For example, over 16.7 million operations are performed in German clinics each year [1] . In addition, there are still 1.9 million outpatient interventions per year [2] . The number of annual sports accidents that require medical care is 1.5 million in Germany [3] - but this corresponds to only 20% of all accidents, so that 7.5 million injuries can be assumed annually.

 

Inflammation musculoskeletal system

Inflammation and the associated pain not only occur with injuries, but are, for example, symptomatic of (rheumatoid) arthritis. Behind this is a malfunction of the immune system, in that T cells are directed against their own tissue, in this case against the inner skin of the joint - with the result that the joint is destroyed. Inflammatory cytokines (TNF-alpha, IL-1) formed by macrophages and, of course, IgM and IgG antibodies targeting collagen and proteoglycans in the connective tissue are included [4] . The prevalence (frequency) of rheumatoid arthritis (eg chronic polyarthritis of the hands) is approx. 1%, ie approx. 800,000 people are affected in Germany [5] .

 

The conditions for osteoarthritis are completely different. This is about joint wear, which can be caused, for example, by an incorrect axis position. Knots on the finger end joints (Heberden arthrosis), the middle finger joints (Bouchard arthrosis) or pain on the base of the thumb / saddle (rhizarthrosis) usually have a genetic cause and, apart from a painful restriction of movement, have no further relevance to the disease.

 

However, it should be noted that for approx. 85% of all pain in the musculoskeletal system (large joints, tendopathies, intervertebral discs) there is no causal joint wear, but mostly a contraction of muscles and ligaments of the joints. The associated crushing of sensitive nerves results in a painful restriction of movement. The result is a nutritional disorder of the articular cartilage, since sufficient oxygen and nutrients can only be supplied in the form of an "articular grease" if there is sufficient movement in the joint.

 

“Osteoarthritis” is one of the most common diseases worldwide. However, there are different data on the frequency (prevalence). They vary between 33% (radiologically diagnosed) in adults [6] and 8.9% of clinically relevant knee, hand and hip arthrosis [7] . Misunderstandings are also inevitable, because osteoarthritis in English means "osteoarthritis" and it is therefore wrong to suggest that it is a fundamentally inflammatory disease. However, this is usually not the cause of the disease, but the possible consequence of a degraded cartilage ("mechanical bone friction").

 

Conventional therapies

While rheumatoid arthritis is treated with cortisone, chemotherapy drugs ("methotrexate") or biologics ("inhibition of inflammatory cytokines"), the standard recommendation for artificial joints is made in arthritis of the large joints. In Germany, 200,000 artificial hip joints, 150,000 artificial knee joints and 12,000 artificial shoulder joints are implanted every year [8] . Accordingly, Germany ranks second in the frequency of hip replacement compared to the OECD countries after Switzerland [9].

PEMF Anti-Inflammation Invitro

The anti-inflammatory effect of PEMF has been known for a long time. In a current cell culture study, for example, it was confirmed that PEMF (4 mT, 5 Hz) leads to down-regulation, for example of the tumor necrosis factor (TNF-alpha) [10] . This is of great importance because TNF-alpha and IL-1 activate the transcription factor Kappa B, which in turn regulates the activation of pro-inflammatory genes. Also the realization that the various adenosine receptors (A 1 , A 2A , A 2B , A 3 ), all of which either reduce the production of cAMP (A 1 and A 3 ) or increase (A 2A and A 2B ) [11 ] and down-regulating the pro-inflammatory cytokines TNF-alpha and IL-ß via the adenosine receptors A 2A and A 3 after PEMF application [12] , [13] , [14] , discloses a complex, but relatively clear explanation model.

 

This can be seen particularly impressively, for example, in bovine cell cultures which have a 5-fold higher proliferation potential than human cells. PEMF reduced the IL-1alpha activity by 10-70% or in human cells by 10-80% [15] . If, for example, mononuclear blood cells from Crohn's disease patients (“inflammatory bowel disease”) are exposed to a PEMF (45 mT, 50 Hz), the pro-inflammatory IFN-gamma decreases and the anti-inflammatory IL-10 increases [16] .

 

In another study with human tendon cells (taken from the semitendinosus and gracilis muscles), PEMF stimulated tendon cell proliferation. At the same time, the anti-inflammatory cytokines decreased significantly after 4 and 12 hours compared to the untreated cells, whereby the pro-inflammatory cytokines were not affected [17] .

 

PEMF in rheumatoid arthritis

In animal experiments, for example, the injection of heat-treated tubercle bacteria into the rear leg of rats caused artificial arthritis (increase in the inflammation mediator prostate aglandin / joint edema). A 90-minute PEMF application (4 µT, 5 Hz, daily) led to the remission of the symptoms [18] .

 

In another animal experiment, artificial inflammation and edema were caused by carrageenan. After three hours of magnetic field treatment, the symptoms weakened considerably [19] .

 

A similar result is achieved by daily PEMF treatment (10 mT, 5 Hz) in rats (artificially caused rheumatoid arthritis). The results of the study are based on changes in acute phase proteins and macroglobulin and their influence on chronic inflammation [20] .

 

In a further animal study with rats, in which rheumatoid arthritis was provoked by heat-treated tubercle bacteria, a PEMF (4 µT, 5 Hz, 90 min, day 14 - 42 after artificial rheumatoid arthritis was produced) led to a decrease in the edema volume and the lysosomal Enzyme both in the blood serum and in the liver. The MPO concentration in the bone also decreased [21] . Since this has already been observed in a similar study [22] , the author concludes that the anti-inflammatory potential of PEMF is related to both enzymes.

Explanation:

In the destruction of the joints (erosive synovitis), which is the basis of rheumatoid arthritis (RA), lysosomal enzymes seem to play a major role [23] . Myeloperoxidase (MPO) is also an important activity indicator for RA and the associated chronic inflammation [24] .

In a human study (randomized, double-blind) [25] , 31 women were divided into two groups with regard to PEMF intensity (200 µT and 400 µT). The test criterion was the change in pain intensity on the basis of the MPQ and VAS test sheets. There was no significant but significant pain reduction in both groups compared to placebo.

 

A study with 50 rheumatism patients showed a comparable result. The pain decreased in 82% of the patients under PEMF - however the pain effect was only moderate [26] . It is noteworthy, however, that the swelling reduced and the morning stiffness of the fingers.

 

In a comparative study (laser versus PEMF), the therapeutic effects on the function of hand mobility (basic joints) and the subjective quality of life were examined [27] . The setting parameters of 3 mT / 5 Hz were gradually increased to 7.5 mT / 23 Hz. As a result, the laser was superior to the PEMF in pain. The laser and PEMF were equally effective in reducing swelling and quality of life.

 

PEMF for knee and hip arthrosis

In a randomized, double-blind pilot study, 27 osteoarthritis patients (mainly knee osteoarthritis) received a total of 18 half-hour PEMF treatments (1 - 2 mT, <30 KHz, rectangular pulse) within one month. A total of 6 symptom parameters were examined. Result: In comparison to placebo treatment, which yielded a 2-18% improvement in the symptom parameters (including pain reduction and improvement in functionality), it was 23-61% under PEMF [28] .

Definitions:

The VAS pain scale (“visual-analogue scale”) measures the patient's subjective pain severity. This marks the perceived pain intensity on a numerical scale of 1 - 10 or on a visual scale of 1 - 100 mm. The error rate when filling in is very low at 4 - 11%. Since it is higher in older or disoriented patients, a verbal rating scale is usually preferred [29] .

 

The WOMAC index (Western Ontario and McMaster Universities Osteoarthritis Index) [30] is intended to assess the effects of osteoarthritis in affected patients. A total of 24 questions are asked about pain (5 questions), stiffness (2 questions) and joint functions (17 questions). The WOMAC score is the most frequently used PRO (Patient Reported Outcome) instrument in clinical studies and is available in over 65 languages

A randomized, double-blind study with 34 knee osteoarthritis patients: The assessment according to the VAS pain scale had to be at least ≥ 4 in the entrance examination. The patients also had to have at least 2 hours of mobility / daily and were not allowed to have had knee surgery or cortisone therapy earlier. Compared to placebo, the pain value after VAS decreased by 50 +/- 11% after one day and persisted until the end of treatment after 42 days. Overall, pain reduction was three times higher with PEMF than with placebo [31] .

 

In a study with 28 elderly patients between 60 and 83 years of age who suffered from bilateral osteoarthritis of the knee, only the right knee was treated over a period of 6 weeks (3 x weekly at 30 minutes), ie the left knee served as a control. Result: In the VAS, the pain in PEMF decreased by 49.8 +/- 2.03 versus 11 +/- in the other leg. The WOMAC test, which also examines stiffness and joint function, also showed a significant improvement [32] .

 

In a Cochrane review, a systematic review that is internationally recognized as the absolute quality standard in evidence-based medicine, 9 studies with a total of 636 osteoarthritis patients were included. Here the PEMF treatment achieved a pain reduction of 15.1 points on a pain scale of 100 compared to placebo. However, no significant effects with regard to improving joint function could be observed [33] .

 

In a randomized, double-blind study with 66 patients (radiologically confirmed knee osteoarthritis) there was a significant reduction in pain (VAS and WOMAC scale) compared to placebo with 1-month PEMF treatment. Pain tolerance with regard to PPT, i.e. tenderness to pressure, also improved. It is also surprising that 26% of the PEMF group could stop taking NSAID pain relievers [34] .

 

Another review [35] , which analyzed and evaluated 36 randomized double-blind studies with a total of 2,434 osteoarthritis patients, achieved 33 or three of the five required methodological criteria. The patients had an average age of 65.1 years and the mean baseline value on the VAS analog scale was 62.9 mm. Result: After 4 weeks, additional short procedures such as manual acupuncture, static magnetic fields and ultrasound did not show any significant short-term pain reduction. In contrast, a slight pain reduction of 6.9 mm was achieved using PEMF (different intensities / frequencies 10 - 200 Hz).

 

A review from 2009 analyzed the study situation on cell cultures, animal and human studies. Overall, the authors come to the conclusion that PEMF can treat pain, inflammation and joint dysfunction in both arthrosis and rheumatoid arthritis. Osteoarthritis not only relieves pain and reduces inflammation, but also cartilage protection and bone remodeling [36] .

 

PEMF in tendopathy and tendinitis

In contrast to tendopathy, which involves a degenerative change in the tendons, the name “tendinitis” suggests a primarily inflammatory disease. However, since inflammation parameters obviously do not play a major role, it is not surprising that the causes of the disease are still largely in the dark. Operative inspections even seem to disprove an inflammatory process [37] . It therefore makes sense to deal with the pain syndromes tennis elbow, golfers arm, shoulder-arm syndrome and fibromyalgia (generalized tendomyopathy) in a separate document.

Conclusion

By inhibiting inflammation, edema removal and improved microcirculation, PEMF lead to a significant reduction in pain in advanced arthrosis and postoperative healing processes, regardless of whether after endoprosthetic implantation, aesthetic breast surgery or a general postoperative wound treatment. Rheumatoid arthritis is also relieved by PEMF (pain, swelling, stiffness), although the results regarding pain symptoms can be described as rather moderate.

swell

[1] Federal health reporting in 2016

[2] German Medical Journal. Number of outpatient operations in Germany increases April 2, 2013

[3] Biener K. Sports accidents. 2nd edition, Bern

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[6] Felson DT. Epidemiology of knee and hip osteoarthritis. Epidemiol Rev 1988; 10: 1-28

[7] Andrianakos AA et al. Prevalence of symptomatic knee, hand and hip osteoarthritis in Greece. The ESORDIG study. J Rheumatol 2006; 33: 2507-13

[8] German Arthrosis Aid eV

[9] Wengler A et al. Hip and Knee Replacement in Germany and the USA. Analysis of individual patient data from German and US hospitals for the Years 2005 to 2011. Deutsch Aerzteblatt Internat 2014; 111: 407-16

[10] Ross CL, Harrison BS. Effect of pulsed electromagnetic field on inflammatory pathway markers in RAW 264.7 murine macrophages. J Inflam Res 2013; 6: 45-51

[11] Borea PA et al. The A 3 adenosine receptor: historry and perspectives. Pharmcol reviews 2015; 67 (1): 74-102

[12] Varani K et al. Effect of low frequency electromagnetic fields on A2A adenosine receptors in human neutrophils. Br J Pharmacol 2002; 136 (1): 57-66

[13] Vincenzi F et al. Pulsed electromagnetic fields increased the anti-inflammatory effect of A2A and A3 adenosine receptors in human T / C-28a2 chondrocytes and hFOB 1.19 osteoblasts. PLOS one 2013; 8 (5): e65561

[14] Varani K et al. Adenosine receptors as a biological pathway to the anti-inflammatory and beneficial effects of low frequency low energy pulsed electromagnetic fields. Review. Mediators Inflamm 2017; 2017: 2740963. doi: 10.1155 / 2017/2740963. Epub 2017 Feb 1

[15] Willardson R et al. Pulsed electromagnetic fields have an acute anti-inflammatory effect on intervertebral disc cells. Orthopedic Research Society. Annual meeting 2013, San Antoni, Texas

[16] Kaszuba-Zwoinska J et al. Magnetic field anti-inflammatory effects in Crohn's disease depends upon viability and cytokine profile of the immune competent cells. J Physiol Pharmacol 2008; 59 (1): 177-87

[17] De Cirolamo L et al. Low frequency pulsed electromagnetic field affects proliferation, tissue specific gene expression, and cytokines release of human tendon cells. Cell Biochen Biophys 2013; 66 (3): 697-708. doi: 10.1007 / s12013-013-9514-y

[18] Selvam R et al. Low frequency and low intensity pulsed electromagnetic field exerts its antiinflammatory effect through restoration of plasm membrane calcium ATPase activity. Life Sci 2007; 80 (26): 2403-10

[19] Mizushima Y et al. Effects of magnetic field on inflammation. Experientia 1975; 31 (12): 1411-2 [20] Dortch AB, Johnson MT. Characterization of pulsed magnetic field therapy in a rat model for rheumatoid arthritis. Biomed Sci Instum 2006; 42: 302-7

[21] Kumar VS et al. Optimization of pulsed electromagnetic field therapy for management of arthritis in rats. Bioelectromagnetics 2005; 26: 431-439

[22] Poornapriya T et al. Preliminary studies on the effect of an electromagnetic field in adjuvant induced arthritis in rats. Med Sci Res 1998; 26: 467-469

[23] Anderson AJ. Lysomsomal enzymes acitivity in rats with adjuvant induced arthritis. Ann Rheum Dis 1986; 29: 307-313

[24] Wang W et al. Increased levels of serum myeloperoxidase in patients with active rheumatoid arthritis. Life Sci 2014; 177 (1): 19-23

[25] Shupak NM et al. Exposure to a specific pulsed low-frequency magnetic field; a double-blind placebo controlled study of effects on pain ratings in rheumatoid arthritis and fibromyaglia patients. Pain Res Manag 2006; 11: 85-90

[26] Krawczyk-Wasielewska A et al. Nova Med 2007; 4: 74-78

[27] Chwiesko-Minarowska S et al. The comparison of multi-waved locked system laser and low-frequency magnetic field therapy on hand function and quality of life in patients with rheumatoid arthritis - preliminary study. Act Balneol 2014; 56; 181-184

[28] Trock DH et al. A double-blind trial of the clinical effects of pulsed electromagnetic fields in osteoarthritis. J Rheumatol 1993; 20 (3): 456-60

[29] Schumacher J. Quality Criteria of the Visual Analogue Scale for Pain Assessment. PhysioSci 2008; 4: 125-133

[30] Bellamy N. WOMAC Osteoarthritis Index User Guide. Version V. Brisbane, Australia 2002

[31] Nelson FR et al. Non-invasive electromagnetic field therapy produces rapid and substantial pain reduction in early knee osteoarthritis: a randomized double-blind pilot study. Rheumatol Int 2013; 33 (8): 2169-73

[32] Iannitti T et al. Pulsed electromagnetic field therapy for management of osteoarthritis-related pain, stiffness and physical function: clinical experience in the elderly. Clin Interv Aging 2013; 8: 1289-93

[33] Li S et al. Electromagnetic fields for treating osteoarthritis. Cochrane Database Syst Rev 2013; 14 (12): CD003523

[34] Bagnato GL et al. Pulsed electromagnetic fields in knee osteoarthritis: a double blind, placebo-controlled, randomized clinical trial. Rheumatolgy (Oxford) 2016; 55 (4): 755-62

[35] Bjordal JM et al. Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomized placebo-controlled trials. BMC Musculoskelet Disord 2007 Jun; 8:51

[36] Ganesan K et al. Low frequency pulsed electromagnetic field - A viable alternative therapy for arthritis. Ind J Exper Biol 2009; 47: 939-948

[37] Regan W et al. Microscopic histopathology of chronic refractory lateral epicondylitis. Am J Sports Med. 1992; 20 (6): 746-9