Ozoniotherapy: adjuvant therapy in the treatment of knee osteoarthritis

Authors

DOI:

https://doi.org/10.33448/rsd-v11i4.27417

Keywords:

Knee osteoarthritis; Ozone; Pain; Physical capacity; Quality of life.

Abstract

Knee osteoarthritis (KOA) is one of the degenerative joint diseases that causes pain, functional impairment and quality of life that is associated with a significant economic impact. Ozone therapy (OT) has been suggested in clinical practice as a promising therapy and adjunct to clinical rehabilitation due to favorable results in the treatment of joint diseases such as KOA. Thus, the purpose of this study is to present, through a narrative review, an understanding of the current evidence available on the clinical importance of including OT in the treatment of KOA. The bibliographic databases of PubMed/MEDLINE, Virtual Health Library (VHL), Web of Science and SciELO were used. Based on peer-reviewed studies, the studies analyzed demonstrate that OT exerts positive effects in reducing the level of pain, improving functionality and quality of life in patients with KOA due to its ability to modulate the joint inflammatory process and act on pathways. endogenous inhibition of pain control. Furthermore, the authors support that OT therapy may be particularly important for patients experiencing adverse drug therapy effects and/or who are not candidates for surgery. Thus, OT can be suggested as an adjuvant method for rehabilitation and effective in the treatment of chronic degenerative inflammatory joint diseases, as it is a minimally invasive method and has relatively low costs. However, it is necessary to carry out controlled and randomized clinical studies in order to elucidate ideal treatment protocols to be used safely in clinical practice.

References

Akkawi, I. (2020). Ozone therapy for musculoskeletal disorders: Current concepts. Acta Bio Medica: Atenei Parmensis, 91(4).

Ariani, A., Manara, M., Fioravanti, A., Iannone, F., Salaffi, F., Ughi, N., . . . Scire, C. (2019). The Italian Society for Rheumatology clinical practice guidelines for the diagnosis and management of knee, hip and hand osteoarthritis. Reumatismo, 71(S1), 5-21.

Babaei-Ghazani, A., Fadavi, H. R., Eftekharsadat, B., Ebadi, S., Ahadi, T., Ghazaei, F., & Khabbaz, M. S. (2019). A randomized control trial of comparing ultrasound-guided ozone (O2-O3) vs corticosteroid injection in patients with shoulder impingement. American journal of physical medicine & rehabilitation, 98(11), 1018-1025.

Bannuru, R. R., Osani, M., Vaysbrot, E., Arden, N., Bennell, K., Bierma-Zeinstra, S., . . . Bhandari, M. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and cartilage, 27(11), 1578-1589.

Barragán-Mejı́a, M. G., Castilla-Serna, L., Calderón-Guzmán, D., Hernández-Islas, J. L., Labra-Ruiz, N. A., Rodrı́guez-Pérez, R. A., & Santamarı́a-Del Angel, D. (2002). Effect of nutritional status and ozone exposure on rat brain serotonin. Archives of medical research, 33(1), 15-19.

Benner, R. W., Shelbourne, K. D., Bauman, S. N., Norris, A., & Gray, T. (2019). Knee Osteoarthritis: Alternative Range of Motion Treatment. The Orthopedic clinics of North America, 50(4), 425–432. https://doi.org/10.1016/j.ocl.2019.05.001

Bhatia, A., Munk, P., Lee, D., Elias, G., & Murphy, K. (2019). Percutaneous ozone treatment for herniated lumbar discs: 1-year follow-up of a multicenter pilot study of a handheld disposable ozone-generating device. Journal of Vascular and Interventional Radiology, 30(5), 752-760.

Bocci, V., Borrelli, E., Travagli, V., & Zanardi, I. (2009). The ozone paradox: ozone is a strong oxidant as well as a medical drug. Medicinal research reviews, 29(4), 646-682.

Bocci, V., & Valacchi, G. (2013). Free radicals and antioxidants: how to reestablish redox homeostasis in chronic diseases? Current Medicinal Chemistry, 20(27), 3397-3415.

Bocci, V., Zanardi, I., & Travagli, V. (2011). Ozone: a new therapeutic agent in vascular diseases. American Journal of Cardiovascular Drugs, 11(2), 73-82.

Bocci, V. A. (2006). Scientific and medical aspects of ozone therapy. State of the art. Archives of medical research, 37(4), 425-435.

Borrelli, E., Alexandre, A., Iliakis, E., Alexandre, A., & Bocci, V. (2015). Disc herniation and knee arthritis as chronic oxidative stress diseases: the therapeutic role of oxygen ozone therapy. J Arthritis, 4(3), 161.

Chirumbolo, S., Valdenassi, L., Simonetti, V., Bertossi, D., Ricevuti, G., Franzini, M., & Pandolfi, S. (2021). Insights on the mechanisms of action of ozone in the medical therapy against COVID-19. International immunopharmacology, 96, 107777.

Conaghan, P. G. (2013). Parallel evolution of OA phenotypes and therapies. Nature Reviews Rheumatology, 9(2), 68-70.

de Sire, A., Agostini, F., Lippi, L., Mangone, M., Marchese, S., Cisari, C., . . . Invernizzi, M. (2021). Oxygen–ozone therapy in the rehabilitation field: State of the art on mechanisms of action, safety and effectiveness in patients with musculoskeletal disorders. Biomolecules, 11(3), 356.

Di Filippo, C., Marfella, R., Capodanno, P., Ferraraccio, F., Coppola, L., Luongo, M., . . . Rossi, F. (2008). Acute oxygen-ozone administration to rats protects the heart from ischemia reperfusion infarct. Inflammation Research, 57(10), 445-449.

Di Paolo, N., Bocci, V., & Gaggiotti, E. (2004). Ozone therapy. The International journal of artificial organs, 27(3), 168-175.

Driban, J. B., Harkey, M. S., Barbe, M. F., Ward, R. J., MacKay, J. W., Davis, J. E., . . . Lo, G. H. (2020). Risk factors and the natural history of accelerated knee osteoarthritis: a narrative review. BMC musculoskeletal disorders, 21(1), 1-11.

Duymus, T. M., Mutlu, S., Dernek, B., Komur, B., Aydogmus, S., & Kesiktas, F. N. (2017). Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options. Knee surgery, sports traumatology, arthroscopy, 25(2), 485-492.

Feng, X., & Beiping, L. (2017). Therapeutic efficacy of ozone injection into the knee for the osteoarthritis patient along with oral celecoxib and glucosamine. Journal of clinical and diagnostic research: JCDR, 11(9), UC01.

Fernández-Cuadros, M. E. (2016). Ozone fundamentals and effectiveness on Knee pain: Chondromalacia and Knee Osteoarthritis. LAP LAMBERT Academic Publishing.

Goh, S. L., Persson, M., Stocks, J., Hou, Y., Welton, N. J., Lin, J., Hall, M. C., Doherty, M., & Zhang, W. (2019). Relative Efficacy of Different Exercises for Pain, Function, Performance and Quality of Life in Knee and Hip Osteoarthritis: Systematic Review and Network Meta-Analysis. Sports medicine (Auckland, N.Z.), 49(5), 743–761. https://doi.org/10.1007/s40279-019-01082-0

Goldring, S. R., & Goldring, M. B. (2004). The role of cytokines in cartilage matrix degeneration in osteoarthritis. Clinical Orthopaedics and Related Research®, 427, S27-S36.

Hafez, A. R., Al-Johani, A. H., Zakaria, A. R., Al-Ahaideb, A., Buragadda, S., Melam, G. R., & Kachanathu, S. J. (2013). Treatment of knee osteoarthritis in relation to hamstring and quadriceps strength. Journal of physical therapy science, 25(11), 1401–1405. https://doi.org/10.1589/jpts.25.1401

Hashemi, M., Khameneh, S. M. H., Dadkhah, P., & Mohajerani, S. A. (2017). Effect of intraarticular injection of ozone on inflammatory cytokines in knee osteoarthritis. Journal of Cellular and Molecular Anesthesia, 2(2), 37-42.

Hinman, R. S., Campbell, P. K., Lawford, B. J., Briggs, A. M., Gale, J., Bills, C., Kasza, J., Harris, A., French, S. D., Bunker, S. J., Forbes, A., & Bennell, K. L. (2020). Does telephone-delivered exercise advice and support by physiotherapists improve pain and/or function in people with knee osteoarthritis? Telecare randomised controlled trial. British journal of sports medicine, 54(13), 790–797. https://doi.org/10.1136/bjsports-2019-101183

Hawker, G. A. (2019). Osteoarthritis is a serious disease. Clin Exp Rheumatol, 37(Suppl 120), 3-6.

Huang, Z., Ding, C., Li, T., & Yu, S. P.-C. (2018). Current status and future prospects for disease modification in osteoarthritis. Rheumatology.

Hulshof, C. T., Colosio, C., Daams, J. G., Ivanov, I. D., Prakash, K., Kuijer, P. P., . . . van der Molen, H. F. (2019). WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of exposure to occupational ergonomic risk factors and of the effect of exposure to occupational ergonomic risk factors on osteoarthritis of hip or knee and selected other musculoskeletal diseases. Environment international, 125, 554-566.

Jones, A., Silva, P., Silva, A., Colucci, M., Tuffanin, A., Jardim, J., & Natour, J. (2012). Impact of cane use on pain, function, general health and energy expenditure during gait in patients with knee osteoarthritis: a randomised controlled trial. Annals of the rheumatic diseases, 71(2), 172-179.

Juhl, C., Christensen, R., Roos, E. M., Zhang, W., & Lund, H. (2014). Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta‐regression analysis of randomized controlled trials. Arthritis & rheumatology, 66(3), 622-636.

Kuru Çolak, T., Kavlak, B., Aydoğdu, O., Şahin, E., Acar, G., Demirbüken, İ., . . . Polat, M. G. (2017). The effects of therapeutic exercises on pain, muscle strength, functional capacity, balance and hemodynamic parameters in knee osteoarthritis patients: a randomized controlled study of supervised versus home exercises. Rheumatology international, 37(3), 399-407.

Laires, P. A., Canhão, H., Rodrigues, A. M., Eusébio, M., Gouveia, M., & Branco, J. C. (2018). The impact of osteoarthritis on early exit from work: results from a population-based study. BMC Public Health, 18(1), 1-12.

Le Graverand-Gastineau, M.-P. H. (2009). OA clinical trials: current targets and trials for OA. Choosing molecular targets: what have we learned and where we are headed? Osteoarthritis and cartilage, 17(11), 1393-1401.

Li, J.-S., Tsai, T.-Y., Clancy, M. M., Li, G., Lewis, C. L., & Felson, D. T. (2019). Weight loss changed gait kinematics in individuals with obesity and knee pain. Gait & posture, 68, 461-465.

Liu-Bryan, R., & Terkeltaub, R. (2015). Emerging regulators of the inflammatory process in osteoarthritis. Nature reviews. Rheumatology, 11(1), 35–44. https://doi.org/10.1038/nrrheum.2014.162

Lopes de Jesus, C. C., Dos Santos, F. C., de Jesus, L. M. O. B., Monteiro, I., Sant’Ana, M. S. S. C., & Trevisani, V. F. M. (2017). Comparison between intra-articular ozone and placebo in the treatment of knee osteoarthritis: A randomized, double-blinded, placebo-controlled study. PloS one, 12(7), e0179185.

Magnusson, K., Turkiewicz, A., & Englund, M. (2019). Nature vs nurture in knee osteoarthritis–the importance of age, sex and body mass index. Osteoarthritis and cartilage, 27(4), 586-592.

Manoto, S. L., Maepa, M. J., & Motaung, S. K. (2018). Medical ozone therapy as a potential treatment modality for regeneration of damaged articular cartilage in osteoarthritis. Saudi journal of biological sciences, 25(4), 672-679.

Messier, S. P., Mihalko, S. L., Beavers, D. P., Nicklas, B. J., DeVita, P., Carr, J. J., . . . Bennell, K. L. (2021). Effect of high-intensity strength training on knee pain and knee joint compressive forces among adults with knee osteoarthritis: the start randomized clinical trial. Jama, 325(7), 646-657.

Mishra, S. K., Pramanik, R., Das, P., Das, P. P., Palit, A. K., Roy, J., & Halder, R. N. (2011). Role of intra-articular ozone in osteo-arthritis of knee for functional and symptomatic improvement. Ind J Phys Med Rehabilit, 22(2), 65-69.

Mobasheri, A., & Batt, M. (2016). An update on the pathophysiology of osteoarthritis. Annals of physical and rehabilitation medicine, 59(5-6), 333-339.

Moreno Fernández, A. M., Macías García, L., Valverde Moreno, R., Ortiz, T., Fernández Rodríguez, A., Moliní Estrada, A., & De-Miguel, M. (2019). Autohemotherapy with ozone as a possible effective treatment for Fibromyalgia. Acta Reumatologica Portuguesa, 44 (3), 244-249.

Nelligan, R. K., Hinman, R. S., Kasza, J., Crofts, S. J., & Bennell, K. L. (2021). Effects of a self-directed web-based strengthening exercise and physical activity program supported by automated text messages for people with knee osteoarthritis: A randomized clinical trial. JAMA Internal Medicine, 181(6), 776-785.

Noori-Zadeh, A., Bakhtiyari, S., Khooz, R., Haghani, K., & Darabi, S. (2019). Intra-articular ozone therapy efficiently attenuates pain in knee osteoarthritic subjects: A systematic review and meta-analysis. Complementary therapies in medicine, 42, 240-247.

Otero, M., Favero, M., Dragomir, C., Hachem, K. E., Hashimoto, K., Plumb, D. A., & Goldring, M. B. (2012). Human chondrocyte cultures as models of cartilage-specific gene regulation. Methods in molecular biology (Clifton, N.J.), 806, 301–336. https://doi.org/10.1007/978-1-61779-367-7_21

Paolucci, T., Agostini, F., Bernetti, A., Paoloni, M., Mangone, M., Santilli, V., . . . Saggini, R. (2021). Integration of focal vibration and intra-articular oxygen–ozone therapy in rehabilitation of painful knee osteoarthritis. Journal of International Medical Research, 49(2), 0300060520986705.

Paredes-Carnero, X., Escobar, J., Galdo, J., & Babé, J. (2018). Total knee arthroplasty for treatment of osteoarthritis associated with extra-articular deformity. Journal of clinical orthopaedics and trauma, 9(2), 125-132.

Peralta, C., Xaus, C., Bartrons, R., Leon, O. S., Gelpí, E., & Roselló-Catafau, J. (2000). Effect of ozone treatment on reactive oxygen species and adenosine production during hepatic ischemia-reperfusion. Free radical research, 33(5), 595-605.

Rice, D., Nijs, J., Kosek, E., Wideman, T., Hasenbring, M. I., Koltyn, K., . . . Polli, A. (2019). Exercise-induced hypoalgesia in pain-free and chronic pain populations: state of the art and future directions. The Journal of Pain, 20(11), 1249-1266.

Sagai, M., & Bocci, V. (2011). Mechanisms of action involved in ozone therapy: is healing induced via a mild oxidative stress? Medical gas research, 1(1), 1-18.

Schwartz, A., Martínez Sánchez, G., Sabbah, F., & Avilés, M.H. (2020). International Scientific Comittee of Ozone Therapy (ISCO3). Madrid Declaration on Ozone Therapy. 3 ed. Madrid (SPA): ISCO3, 103.

Sconza, C., Respizzi, S., Virelli, L., Vandenbulcke, F., Iacono, F., Kon, E., & Di Matteo, B. (2020). Oxygen–ozone therapy for the treatment of knee osteoarthritis: a systematic review of randomized controlled trials. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 36(1), 277-286.

Seyam, O., Smith, N. L., Reid, I., Gandhi, J., Jiang, W., & Khan, S. A. (2018). Clinical utility of ozone therapy for musculoskeletal disorders. Medical gas research, 8(3), 103.

Silverwood, V., Blagojevic-Bucknall, M., Jinks, C., Jordan, J., Protheroe, J., & Jordan, K. (2015). Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthritis and cartilage, 23(4), 507-515.

Smith, N. L., Wilson, A. L., Gandhi, J., Vatsia, S., & Khan, S. A. (2017). Ozone therapy: an overview of pharmacodynamics, current research, and clinical utility. Medical gas research, 7(3), 212.

Sophia Fox, A. J., Bedi, A., & Rodeo, S. A. (2009). The basic science of articular cartilage: structure, composition, and function. Sports health, 1(6), 461-468.

Ulusoy, G. R., Bilge, A., & Öztürk, Ö. (2019). Comparison of corticosteroid injection and ozone injection for relief of pain in chronic lateral epicondylitis. Acta orthopaedica Belgica, 85(3), 317–324.

Vaillant, J. D., Fraga, A., Díaz, M. T., Mallok, A., Viebahn-Hänsler, R., Fahmy, Z., . . . Fernández, O. S. L. (2013). Ozone oxidative postconditioning ameliorates joint damage and decreases pro-inflammatory cytokine levels and oxidative stress in PG/PS-induced arthritis in rats. European journal of pharmacology, 714(1-3), 318-324.

Van der Esch, M., Steultjens, M., Harlaar, J., Knol, D., Lems, W., & Dekker, J. (2007). Joint proprioception, muscle strength, and functional ability in patients with osteoarthritis of the knee. Arthritis Care & Research: Official Journal of the American College of Rheumatology, 57(5), 787-793.

Vélez, B. P. L. (2014). Ozone therapy, a supplement for patients with fibromyalgia. Ozone Therapy Global Journal, 4(1), 39-49.

Visuri, T., Mäkelä, K., Pulkkinen, P., Artama, M., & Pukkala, E. (2016). Long-term mortality and causes of death among patients with a total knee prosthesis in primary osteoarthritis. The Knee, 23(1), 162-166.

Whittaker, J., Truong, L., Dhiman, K., & Beck, C. (2021). Osteoarthritis year in review 2020: Rehabilitation and outcomes. Osteoarthritis and cartilage, 29(2), 190-207.

Wylde, V., Hewlett, S., Learmonth, I. D., & Dieppe, P. (2011). Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. PAIN®, 152(3), 566-572.

Xiang, A., Deng, H., Cheng, K., Liu, H., Lin, L., Qu, X., . . . Shen, X. (2020). Laser photobiomodulation for cartilage defect in animal models of knee osteoarthritis: a systematic review and meta-analysis. Lasers in medical science, 35(4), 789-796.

Zhang, W., Nuki, G., Moskowitz, R., Abramson, S., Altman, R., Arden, N., . . . Doherty, M. (2010). OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis and cartilage, 18(4), 476-499.

Published

21/03/2022

How to Cite

REZZO, T. C. da S.; SILVA, Y. V. B. . . .; TIM, C. R.; MARTIGNAGO, C. C. S.; SILVA, R. B.; GARCIA, L. A. Ozoniotherapy: adjuvant therapy in the treatment of knee osteoarthritis. Research, Society and Development, [S. l.], v. 11, n. 4, p. e38911427417, 2022. DOI: 10.33448/rsd-v11i4.27417. Disponível em: https://www.rsdjournal.org/index.php/rsd/article/view/27417. Acesso em: 18 apr. 2024.

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Section

Health Sciences