Ozone Therapy Improves Joint Pain and Function in Patients with Knee Osteoarthritis

by | Oct 22, 2018 | 2017, Alternative Therapies, Joint Health

Written by Angeline A. De Leon, Staff Writer. Ozone therapy significantly reduced pain and improved joint function and quality of life in the participating subjects with a confirmed diagnosis of osteoarthritis.

joint healthOsteoarthritis (OA) is a degenerative bone disease characterized by the wearing away of cartilage between joints. Caused by aging, injury, and obesity, OA typically involves pain, stiffness, loss of flexibility, and tenderness of the joint 1. Knee OA, specifically, constitutes the leading cause of disability in the U.S., affecting almost 10 million individuals annually 2. Existing clinical treatments remain incapable of slowing down or reversing knee OA, and as an incurable disease, progression of the condition inevitably requires a total knee replacement 3. Ozone therapy, an alternative therapy designed to stimulate the immune system by enhancing the body’s use of oxygen, has been used in the treatment of various chronic diseases, including rheumatic diseases 4. Inactivation of bacteria, viruses, fungi, and yeast is possible with ozone therapy due to its anti-inflammatory, antioxidant, and vasodilatory effects 5-7. While studies offer support for the clinical efficacy of ozone therapy in the treatment of osteoarthritis, the majority of data are sourced from observational studies and prospective case reports 8-10. Moreover, research on the impact of ozone therapy on knee OA is very limited. Therefore, researchers in Brazil sought to evaluate whether ozone therapy could reduce pain, improve joint mobility, and enhance quality of life in patients with OA of the knee.

A total of 98 patients (aged 60 to 85 years) with confirmed diagnosis of knee OA (based on knee X-ray) were enrolled as participants in a randomized, double-blind, placebo-controlled trial. Subjects were randomly assigned to one of two groups, an ozone group receiving one intra-articular injection of 20 µg/ml of ozone (produced from an ozone generator connected to a pure oxygen source) or a placebo group receiving an intra-articular injection of 10 ml of air once weekly for eight consecutive weeks. At baseline, Week 4, Week 8, and 8 weeks following the end of the treatment period, participants completed the Visual Analogue Scale (VAS, measure of pain), Lequesne Index (LEQ, measure of pain and function in knee OA), Timed Up and Go Test (TUG, test of balance and walking stability), SF-36 Health Survey Instrument (SF-36, measure of quality of life), Western Ontario and McMaster University Index (WOAC, assessment of pain, stiffness, and physical function during daily life activities), and Geriatric Pain Measure (GPM, measure of impact of pain on functionality and quality of life in older individuals).

At the end of 8 weeks, patients treated with ozone therapy demonstrated greater improvement on almost all measures of interest, compared to placebo: VAS [Mean Difference = 2.16, p < 0.003 (95% Confidence Interval = 0.42 to 3.89)], GPM [MD = 18.94, p < 0.004 (95% CI = 3.43 to 34.44)], and LEQ [MD = 4.05, p < 0.001 (95% CI = 1.10 to 7.00)]. The ozone group also showed greater improvement than placebo on specific subtests of the WOMAC [pain: median of diff = 9.999, p = 0.019 (95% CI = 0.000-15.000); joint stiffness: median of diff = 12.499, p < 0.001 (95% CI = 0.000-12.500); functional deficit: median of diff = 11.760, p = 0.003 (95% CI = 4.409 to 19.119)] and SF-36 [functional capacity: MD = -25.82, p < 0.001 (95% CI = 33.65 to 17.99); physical health: MD = -40.82, p < 0.001 (95% CI = -54.48 to 27.17); general state of health: MD = -3.38, p < 0.001 (95% CI = -4.83 to 1.93); social aspect: MD = 2.17, p < 0.001 (95% CI = -19.67 to 8.24); emotional aspect: MD = -35.37, p < 0.001 (95% CI: -48.86 to 21.89).

Overall, findings speak to the capacity of ozone therapy to relieve pain and enhance joint function and quality of life in patients with knee OA. As one of the few randomized clinical trials on the use of intra-articular ozone injections for knee OA 11,12, the present study corroborates the clinical efficacy of ozone therapy reported from previous research 9,10. The use of a comprehensive range of survey tools was valuable in verifying treatment response of patients in this study, however, the use of objective imaging techniques to evaluate disease progression in relation to patient reports may be beneficial for future studies. Additional studies using a longer treatment and follow-up period are also warranted.

Source: Lopes de Jesus CC, dos Santos FC, Oliveira LM, et al. Comparison between intra-articular ozone and placebo in the treatment of knee osteoarthritis: a randomized, double-blinded, placebo-controlled study. Plos ONE. 2017; 12(7): e0179185. DOI: 10.1371/journal.pone.179185.

© 2017 Lopes de Jesus et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Posted October 22, 2018.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

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