UVA1 Phototherapy, though unknown to most, has been around for quite some time.
According to nobelprize.org, the Nobel Prize in Physiology (Medicine) was awarded to Niels Ryberg Finsen in 1903 "in recognition of his contribution to the treatment of diseases, especially lupus vulgaris, with concentrated light radiation, whereby he has opened a new avenue for medical science". Lupus vulgaris is also known as tuberculosis luposa, which is one type of lupus. Unfortunately, this "new avenue for medical science" then dropped off the map and didn't surface again in the medical field until a doctor in New Orleans published a study in 1987 showing that UVA1 phototherapy was effective in mediating lupus disease activity in hybrid mice.
In this study, "Ultraviolet-A Light Prolongs Survival and Improves Immune Function in (New Zealand Black x New Zealand White)F1 Hybrid Mice" published in Arthritis and Rheumatism, Vol. 30, No. 5, May 1987, Wiley-Liss, Inc., McGrath, et al. suggested that
"...a relatively small dose of UV-A exerts significant therapeutic action in murine lupus, perhaps through an effect on immunologic regulation."
Further, McGrath states the following:
"Ultraviolet (UV) light is a well-documented contributory factor in the induction or exacerbation of systemic lupus erythematosus (SLE) (1). Most of the harmful effects of UV light have been attributed to UV-B, and it is primarily this band of wavelengths that is absorbed by DNA. UV-A (320-400 nm) is negligibly absorbed by DNA (2). Moreover, UV-A is far more abundant in terrestrial sunlight than is UV-B (3), and it penetrates the epidermis more effectively than does UV-B (4), and reaches the dermis with its circulating mononuclear cells. Although the effects of UV-A on immune function are not precisely understood, it may exert immunostimulatory action in experimental models in which UV-B is immunosuppressive (5,6)."
In other words, UVA1 appears to be less damaging because it is not absorbed into your DNA like its shorter friend, UVB. UVA goes through the skin and deeper into the body so that it can irradiate circulating blood; this irradiation process, much like photosynthesis, is how the light wavelength induces apoptosis in fragmented white blood cells of the immune system without damaging the skin. In addition, UVA appears to be less toxic and has different immunologic actions. A lot more research has been done since this study (which I cover below and provide links to on my Research page). However, much more research is needed to fully explore the illustrated and further potential benefits of UVA1 phototherapy in regard to treating lupus and other chronic illness. I am working on getting full text links and permission to share these studies in their entirety on this site, but for now, for the abstract of this study, go here.
I want to stop for a moment to clarify something important about UVA. When I (or others) are talking about UVA in regard to treating lupus, we are talking about the longer wavelength portion of UVA, which is 340-400 nm ONLY. This longer portion of UVA is referred to specifically as UVA1. I do not recommend or support any exposure to light of shorter wavelengths including shortwave UVA (320-340 nm) or UVB (280-320 nm) unless prescribed by a qualified physician, especially if one is photosensitive. UVA1 works a bit differently and has shown to be well tolerated even by persons with photosensitivity to other light wavelengths. From this point forward, when I mention UVA1, know that I am speaking only on 340-400 nm longwave UVA, otherwise known simply as UVA1.
UVA1 is a part of the sun's natural light spectrum, or visible light. You see it every day, it is all around you. In fact, 80% of morning sunlight during the summer months is mostly UVA1. Isolated or filtered out from the sun's shorter and more damaging wavelengths, UVA1 has an opposite effect on tissue than the shorter wavelengths. UVB causes the skin to tan and/or burn and can cause skin cancer, and UVA (shortwave) has been linked to premature aging. UVA1 is much different; while it could still be shown to contribute to premature aging in the future the jury is still out on its possible long term side effects. Studies have shown UVA1 to be much safer and less damaging than its shorter cousins. UVA1 doesn't stop at your skin where the other wavelengths are absorbed, but goes through the skin into the sub-dermal layers where it does its work systemically.
Image source: http://images.tutorvista.com/cms/images/95/electromagnetic-spectrum1.jpeg
If you would like to read more about visible light and how UV is broken down by wavelength check out some easy to read info here, and of course, some wiki information here.
Because many lupus patients are extremely photosensitive or do become photosensitive at some point throughout their illness, a treatment or therapy involving a wavelength of light can seem counter-intuitive. It is definitely outside of the box. The very reason I stumbled upon this therapy is because of this light sensitivity. My boyfriend couldn't understand how in the world I could suddenly have a light allergy. How can anyone be allergic to the sun? Being as stubborn as he is, and as incredibly gifted as he is in the research department, he set out to find out more about lupus and light. What did he find?? An answer. Not an answer to why lupus patients usually become photosensitive, but even better, he found the answer to 'fixing' my light allergy altogether. What he found changed my life, has helped others change theirs, and has the potential to change a whole lot more. He found Dr. Hugh McGrath's research on UVA1 phototherapy and this launched us into an incredible journey back 'into the light'! Read more about my story here.
McGrath's 1994 Pilot Study:
In 1996, McGrath published his findings from another clinical trial studying UVA1 and Systemic Lupus. The study results were also quite remarkable. "Ultraviolet-A1 (340-400NM) Irradiation Therapy in Systemic Lupus Erythematosus" found that
"All patients decreased their drug use. Anti-double-stranded DNA antibodies (andi-dsDNA) decreased significantly (P<0.05) and anti-nuclear antibodies non-significantly. Side effects were negligible. Visible light had no significant effect. In conclusion, low-dose UV-A1 irradiation effectively, comfortably, and without apparent toxicity diminished signs and symptoms of disease activity in SLE."
While McGrath stated that anti-nuclear antibodies (ANA) were not significantly affected, it is interesting to note that my ANA was completely normal after 3 months of light therapy. In addition, other patients I know who have used UVA1 also had their elevated ANA return to normal after a few months, along with most of their other inflammation markers. I am no doctor, and I make no claims here, but I do think that because the clinical trials are of limited duration, so too are the 'clinical' findings on how UVA1 affects the serology of patients over time. But more importantly, this study confirmed that UVA1 does effectively reduce disease activity in patients with SLE (systemic lupus) without toxic side effects. McGrath continued this very important research and this link will take you to a list of subsequent findings on UVA1 and lupus for further reading.
But how does it work on lupus and other diseases??
In plain language (this is NOT an exact description, nor is it a medical opinion): UVA1 fixes a broken cell death process with lupus and certain other autoimmune disease. It is like walking into a room and hitting a light switch, but the light is your body's white blood cells (particularly, B-cells). With lupus, the immune system breaks down and begins to create antibodies (ANA, etc.) which signal your warrior cells to fight your body's own tissue. You essentially become allergic to yourself. Once this happens, anything and everything that may have provoked a mild immune response before now invites a full out battle. A battle not just between your warrior cells and the invader, but a war between everything in your body. So what might have been a slight reaction to an allergy before, a stressful situation, or a virus perhaps, now becomes much more compounded and severe. Instead of a sneeze or a mild headache, one experiences joint pain, rashes, chronic fatigue and organ failure.
Inflammation is your immune system doing its job-just like a fever signals an immune response and your body's fight to expel a pathogen-but with lupus, your whole body can become chronically inflamed and that is bad. Chronic inflammation leads to permanent damage. Lupus can and does affect every organ system in the body. (Please go to my Lupus page for more information and resources on this disease, or the Other Diseases tab to check out other conditions UVA1 has been shown to effectively treat). The usual medications used to control lupus disease activity include corticosteroids, NSAIDs, anti-malarials, and certain types of chemotherapy. These drugs usually treat the symptoms of the disease by dialing down the immune system in order to help mediate the immune response and the inflammation that it causes. This does reduce inflammation but leaves you wide open to chronic infection because your immune system is suppressed and cannot fight off other 'normal' everyday threats effectively. In more severe cases of lupus where disease activity cannot be effectively controlled by medication alone, stem cell transplants, dialysis and organ removal and/or transplant are needed.
In contrast, UVA1 signals the immune system to cease and desist attacking its own tissue. However, UVA1 allows the immune system to remain intact in order to fight off invaders, rather than simply shutting it down. So it does the work of steroids, for example, but without the associated dangers like pneumonia, infection, or bone loss, and without the other toxic side effects that come with many of these drugs.
Our white blood cells (WBC) are designed to be activated when the immune system receives the signal that a pathogen or virus has entered the body. Once signaled, WBC flood to the site of the invader and attack. Once the attack is over, those WBC are suppose to die off and leave the body along with the conquered invaders in a process known as apoptosis, or programmed cell death. When lupus is involved, your WBC do not die off properly and are not flushed out of the body. Instead of dying off and being carried out of the body, they are reprogrammed with anti-DNA (bits of your own DNA) and begin to attack your body's healthy tissue, thus causing a state of chronic inflammation. This type of autoimmune response is similar across the board with other immune and connective tissue disease--your body attacks itself.
The subject of UVA1 phototherapy is very complex and I have simplified it greatly in the above summary. The processes involved are much more complex and there are plenty of scientifically worded speculations, studies and findings on how UVA1 does its work in the links I have posted on my Research page and other places throughout this site. The short and easy-to-read version is this: UVA1 signals the body's immune system to resume its normal cell death processes. It stops the body from attacking itself thus putting an end to chronic inflammation, giving your body the chance to heal with the immune system still intact. While a lot of research has been done, much more is needed in order to better understand exactly what the functioning mechanisms of UVA1 are and why it works so well in mediating disease activity.