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

Abstract

The objective of the clinical case is to report the symptomatic effect and, for the first time, the disease-modifying effect of ozone in a patient with osteoarthritis of the knee. A 67-year-old woman has been infiltrated with ozone 1 time/week for 4 weeks, using an oxygen-ozone volume of 20 ml, at a 20-µg/ml concentration. Another cycle of ozone treatment was boosted at 6 months follow-up. Clinical outcomes such as pain, function, and quality of life were measured by the Western Ontario and McMaster University Index for Osteoarthritis (WOMAC) scale. Biochemical markers of inflammation such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and uric acid were performed at the beginning and at the end of ozone (O2-O3) treatment protocol. Radiological outcome was evaluated as the change in minimal joint space at the medial compartment of joint space, at the beginning and at 12 months follow-up in both knees. In the first and second ozone cycles, clinical (pain, function, rigidity) and biochemical variables (CRP, ESR, uric acid) improved in our case report. Minimal joint space at medial compartment improved in both knees after 12 months follow-up. Intra-articular ozone (O2-O3) has shown a symptomatic effect and especially a disease-modifying effect in a patient with knee osteoarthritis, improving pain, function, and rigidity; decreasing inflammation biomarkers (CRP, ESR, and uric acid); and increasing the joint space of the medial component evidenced radiologically. The structural effect is reported for the first time in literature. No adverse effects have been observed after intra-articular ozone infiltrations.

Intra Articular Ozone Modulates Inflammation and Has Anabolic Effect on Knee Osteoarthritis: IL-6 and IGF-1 as Pro-Inflammatory and Anabolic Biomarkers

“…In a previous study we observed that O3 improved the minimal joint space narrowing evaluated by X-rays, so an anabolic effect was attributable to O3 therapy 9,12,13 . In clinical reviews on the effect of Ozone, it is accepted that O3 stimulate anti-inflammatory cytokines (IL-4, IL-10, IL-13) and growth factors (IGF-1, TGF-β) 3,5,6 .…”

“…In clinical reviews on the effect of Ozone, it is accepted that O3 stimulate anti-inflammatory cytokines (IL-4, IL-10, IL-13) and growth factors (IGF-1, TGF-β) 3,5,6 . The anabolic effect would explain the improvement on joint space in knee OA patients 13 .…”

“…Our study group had previously observed that O3 was capable of modulating inflammation by decreasing CRP (C-reactive protein), ESR (erythrocyte sedimentation rate) and uric acid, improving pain and function (evaluated by VAS [visual analog scale] and WOMAC [Western Ontario and McMaster Index for OA]), and O3 was also capable of increasing joint narrowing space [9][10][11][12][13] . Those previous observations were confirmed again in this cohort of knee OA patients (n=65).…”

Un nuevo paradigma para el tratamiento de la osteoartritis de rodilla: el papel del ácido hialurónico, el plasma rico en plaquetas (PRP) y el ozono en la modulación de la inflamación: una revisión.

“…Además, el efecto anabólico del ozono (O 2 -O 3 ) podría jugar un papel importante en la modificación de la historia natural de la OA, como se informó recientemente en un caso clínico (39,40).…”

“…Por las investigaciones previas, podría esperarse que el ozono (O 2 -O 3 ) pueda desempeñar un papel en el tratamiento de los pacientes con OA de rodilla (40,43).…”