Ozone therapy as an integrating therapeutic in osteoartrosis treatment: a systematic review

Abstract

BACKGROUND AND OBJECTIVES: Osteoarthrosis affects 85% of the population over 75 years of age. It is divided into primary and secondary, however despite the knowledge at the molecular level the treatments are not yet fully effective. However, ozone therapy emerges as an alternative therapy, which is low cost and seems effective in the treatment of chronic pain. The objective of this study was to evaluate the current evidence to support or to refute the use of ozone therapy in the treatment of patients with osteoarthritis. CONTENTS: Systematic review using the keywords "ozone therapy", "ozone", "osteoarthritis", "arthritis", "randomized", "controlled" and "meta-analysis". The selection of publications was based on inclusion and exclusion criteria. In total, 9 articles were used. Among the 9 articles found regarding ozone therapy in osteoarthritis, 7 of them clearly show the benefits of ozone. The concentrations of ozone used in the studies ranged from 20μg/mL to 15g/mL. The route of administration was intra-articular and rectal insufflation. The frequency of use was, on average, 1 to 3 times a week and the treatment time was between 3 to 4 months in most of the studies. CONCLUSION: The use of ozone produces clinically relevant benefits in patients with osteoarthrosis. Therefore, ozone therapy in osteoarthrosis represents a low-cost, efficient therapeutic alternative that should be implemented in the country's Public Health, considering the prevalence of the disease.

Clinical Uses and Molecular Aspects of Ozone Therapy: A Review

“…Ozone therapy has been used to treat different conditions as summarized in Table 1, seen in different Randomized Clinical Trial (RCT) and reviewed by many authors. The conditions already studied includes: Tissue healing from inflammatory processes showed by a systematic review that included only RCT for chronic wounds (Fitzpatrick et al, 2018) and revised by Travagli et al (2010) and Valacchi et al (2005); for back pain revised by Braidy et al, 2018 and also showed by Andrade et al (2019) in a RCT; osteoarthritis showed in a systematic reviews (Anzolin and Bertol, 2018;Noori-Zadeh et al, 2019) and seeing in an RCT (Babaei-Ghazani et al, 2018; Lopes de Jesus et al, 2017) and in a clinical trial phase 2 (Calunga et al, 2012); diabetic foot ulcers as showed by a RCT (Zhang et al, 2014) and revised by others (Braidy et al, 2018); dental problems such as caries and periodontitis summarized in a review (Almaz and Sönmez, 2015); in the treatment of systemic sclerosis, as seeing in a RCT (Hassanien et al, 2018); multiple sclerosis, seeing in a clinical trial phase 1 (Delgado-Roche et al, 2017; Nowicka, 2017); among other conditions showed in clinical trials (Vanni et al, 2016). Increase in vessel numbers, collagen deposition and myofibroblasts numbers; Stimulation of the growth factors and peroxide releases; Improvement in oxygenation of the affected area.…”

“…To treat disc herniated low back pain and acute back pain, patients received for five consecutive weeks, three intramuscular injections of an oxygen and ozone mixture at an average concentration of 20 µg/mL (Paoloni et al, 2009). Protocols that perform rectal insufflation, generally indicated for the treatment of low back pain, osteoarthritis, arthritis, multiple sclerosis, among others, use an ozone concentration of approximately 20 µg/mL during approximately 2-3 times per week for 3 months (Anzolin and Bertol, 2018;Delgado-Roche et al, 2017) and also 20 applications for 4 weeks in the case of rheumatoid arthritis (León Fernández et al, 2016). In the case of coronary artery disease, a concentration of 40 µg/mL once a day for 20 days was effective in decreasing oxidative biomarkers generally present in this condition (Martínez-Sánchez et al, 2012).…”

Use of Reticulated Hyaluronic Acid Alone or Associated With Ozone Gas in the Treatment of Osteoarthritis Due to Hip Dysplasia in Dogs

“…In turn, intra-articular ozone has been used in human patients with osteoarthritis to reduce pain, relieve of physical disability and stiffness, in order to promote the reduction of joint inflammation and to improve quality of life (16)(17)(18)(19)(20)(21). The action mechanism is not fully understood (20), but a hypothesis it that ozone injected into synovial fluid produces form reactive oxygen species and lipid oxidative products (17).…”

“…In turn, intra-articular ozone has been used in human patients with osteoarthritis to reduce pain, relieve of physical disability and stiffness, in order to promote the reduction of joint inflammation and to improve quality of life (16)(17)(18)(19)(20)(21). The action mechanism is not fully understood (20), but a hypothesis it that ozone injected into synovial fluid produces form reactive oxygen species and lipid oxidative products (17). Thus, the ozone in osteoarthritis may be responsible for cell metabolism activation, to reduce prostaglandin synthesis and oxidative stress, and to induce antioxidant enzyme synthesis, as well as to augment oxygen supply to tissues, promoting immunomodulatory effect and improving vascularization, among others (17,20).…”

“…The action mechanism is not fully understood (20), but a hypothesis it that ozone injected into synovial fluid produces form reactive oxygen species and lipid oxidative products (17). Thus, the ozone in osteoarthritis may be responsible for cell metabolism activation, to reduce prostaglandin synthesis and oxidative stress, and to induce antioxidant enzyme synthesis, as well as to augment oxygen supply to tissues, promoting immunomodulatory effect and improving vascularization, among others (17,20).…”