Ozone Decreases Biomarkers of Inflamation (C-Reactive Protein and Erytrocyte Sedimentation Rate) and Improves Pain, Function and Quality of Life in Knee Osteoarthrtitis Patients: A Before-and-After Study and Review of the Literature

Abstract

Objectives: The aim of this study was to evaluate if ozone is capable of decreasing biomarkers of inflammation (CRP/ESR) and pain, and to improve function and quality of life in knee osteoarthrtitis (OA) patients. Methods: A prospective quasi experimental (before-and-after study) research was performed to investigate the effect of Ozone therapy protocol. The intervention included 4 sessions (1 session/week) of an intra-articular infiltration of a medical mixture of Oxygen-Ozone (95% to 5%) at 20 ug/mL concentration. Biochemical evaluation (CRP and ESR), pain VAS, and WOMAC scales were evaluated before and after the treatment. Results: Overall, 33 patients were evaluated. Mean age was 68.18 ± 8.43 years. Female patients accounted for 75.7% (n = 25) and male patients corresponded to 24.3% (n = 8). Female: male ratio was 3:1. The most frequent radiological KL grade was 2º (n = 22, 66.7%), followed by 3º (n = 8, 24.2%), and 4º (n = 3, 9.1%). Biomarkers of inflammation decreased significantly. C-reactive protein (CRP) diminished from 0.33 ± 0.32 mg/dL to 0.25 ± 0.23 mg/dL (P = 0.0456). Erythrocyte sedimentation rate (ESR) decreased from 15.06 ± 12.09 mm/h to 11.81 ± 8.32 mm/h (P = 0.01). Before treatment, pain measured by VAS was 7.33 ± 1.31 points and decreased to 2.84 ± 1.76 (P < 0.0001). The WOMAC-pain subscale was 14.84 ± 2.77 points and diminished to 5.96 ± 3.53 (P < 0.0001), WOMAC stiffness subscale was 3.06 ± 1.95 points and ameliorated to 1.15 ± 1.3 (P < 0.0001), WOMAC-function subscale was 41.15 ± 12.58 points and decreased to 22.3 ± 11.64 (P < 0.0001). Conclusions: Ozone is capable of both decreasing pain and stiffness and improving function and quality of life in knee OA patients, yet decreases biomarkers of inflammation, such as CRP and ESR.

Oxygen–Ozone Therapy for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials

“…Ozone (O 3 ), a gas discovered in the mid-19th century, is a molecule consisting of 3 atoms of oxygen in a dynamically unstable structure due to the presence of mesomeric states. 9 Intra-articular administration of an adequate mixture of oxygeneozone is supposed to reduce pain, to have protective immunomodulatory effects on cartilage, and to reduce oxidative stress, thus potentially representing an alternative to other injective methods 10 ; several researchers worldwide and many years of clinical experience have indicated that O 3 has the capacity to modulate inflammation. 2 It is highly reactive and, when injected into a joint capsule, it is able to stimulate fibroblastic joint repair, reduce inflammation, and may promote new cartilage growth.…”

Ozone (O2 - O3) Has SYSADOA (Symptomatic Slow Acting Drug for Osteoarthritis) and DMDOA (Disease Modifying Drug for Osteoarthritis) Effect in Knee Osteoarthritis Patients

“…Secondly pable of decreasing laboratorial biomarkers of inflammation; namely, C-reactive protein, erythrocyte sedimentation rate, and serum uric acid in 33 patients with knee OA (9). Ozone was both capable of decreasing inflammation biomarkers and improving clinical symptoms (pain, function, stiffness, and quality of life) in a two-month follow-up period, and with a level of significance of P < 0.05 (9).…”

“…The arguments of this article are based on three previous quasi-experimental before-and-after studies published by the study group and with a level of evidence 2b (6,9,10). Scientists are encouraged to replicate the current promising findings for the management of knee OA.…”

“…For the management of knee OA, there is the necessity to evaluate biomarkers for diagnosis, monitoring and progression of the disease (9). Those biomarkers should evaluate clinical, biochemical (laboratorial), and radiographic outcomes (9).…”

Symptomatic (Pain and Inflammation) and Disease-Modifying Effect (Minimal Joint Space) of Intra-articular Ozone (O2-O3) in Osteoarthritis of the Knee: a Clinical Case

“…For the management of knee osteoarthritis, it is necessary to use biomarkers for the diagnosis, monitoring, and progression of the disease. These biomarkers should evaluate clinical (pain, stiffness, function), biochemical (C-reactive protein, erythrocyte sedimentation rate, uric acid, interleukins), and radiological (minimal femorotibial joint space) results [6,7].…”