The effect of intra-articular ozone injection on pain and physical function in knee osteoarthritis: A prospective study

Gülçin Gazioğlu Türkyılmaz 1 * , Mesut Bakır 2, Şebnem Rumeli Atıcı 1
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1 Division of Algology, Mersin University School of Medicine, Mersin, Turkey
2 Division of Algology, Mersin City Education and Research Hospital, Mersin, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 6, Issue 60, pp. 68-72. https://doi.org/10.23950/jcmk/9265
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ABSTRACT

Introduction: This study aims to evaluate the effect of intra-articular ozone treatment on pain and physical functionality by measuring Numerical Pain Rating Scale (NRS), WOMAC Osteoarthritis Index (WOMAC-OI), and Active Joint Range of Motion (AROM) in patients diagnosed with osteoarthritis.
Material and methods: A total of 30 patients diagnosed with stage 2-3 osteoarthritis according to the Kellgren-Lawrence Classification System (K-L) were included in the study. Ozone gas was administered (10 ml of 10 mcg/ml per session) twice weekly for a total of four sessions. AROM examination was performed at pre-treatment baseline (BL), post-treatment (PT), and two weeks after treatment (PT2). During these periods, NRS was assessed and WOMAC-OI questionnaire was administered.
Results: Significant improvement in NRS and WOMAC-OI total index scores were observed at PT and PT2 periods compared to BL (6.9±1.2; 2.1±1.3; 3.3±1.1; WOMAC-OI total index: 48.1±10.1; 25.5±10.4; 29.1±11.1 respectively; p˂0.001 for all). However, in both of these evaluation methods, the recovery at PT2 had decreased compared to the PT period (NRS p˂0.001; WOMAC-OI p˂0.05). Significant improvement was observed in the AROM values measured during the PT and PT2 periods, compared to baseline (105.6 ± 10.4°; 118.8 ± 8.1°; 117.5 ± 9.2°, respectively) (p˂0.001). There was no difference between the PT and PT2 periods in terms of AROM measurements (p˃0.05).
Conclusion: Our study demonstrates that intra-articular ozone injection treatment provides improvement in pain and physical functionality in osteoarthritis patients. In our two-month follow-up assessment, although evaluation methods indicated that there was regression in recovery, AROM measurements showed that there was no regression in function. Therefore, we believe that future studies may include AROM as an objective measurement among evaluation methods.

CITATION

Türkyılmaz GG, Bakır M, Atıcı ŞR. The effect of intra-articular ozone injection on pain and physical function in knee osteoarthritis: A prospective study. J Clin Med Kaz. 2020;6(60):68-72. https://doi.org/10.23950/jcmk/9265

REFERENCES

  • Barbour KE, Helmick CG, Boring M, Brady TJ. Vital Signs: Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation - United States, 2013-2015. MMWR Morbidity and mortality weekly report. 2017; 66(9):246-253.https://doi.org/10.15585/mmwr.mm6609e1
  • Maricar N, Callaghan MJ, Felson DT, O'Neill TW. Predictors of response to intra-articular steroid injections in knee osteoarthritis--a systematic review. Rheumatology (Oxford). 2013; 52(6):1022-1032. https://doi.org/10.1093/rheumatology/kes368
  • Raeissadat SA, Rayegani SM, Forogh B, Hassan Abadi P, Moridnia M, Rahimi Dehgolan S. Intra-articular ozone or hyaluronic acid injection: Which one is superior in patients with knee osteoarthritis? A 6-month randomized clinical trial. Journal of pain research. 2018; 11:111-117. https://doi.org/10.2147/JPR.S142755
  • Raeissadat SA, Rayegani SM, Ahangar AG, Abadi PH, Mojgani P, Ahangar OG. Efficacy of Intra-articular Injection of a Newly Developed Plasma Rich in Growth Factor (PRGF) Versus Hyaluronic Acid on Pain and Function of Patients with Knee Osteoarthritis: A Single-Blinded Randomized Clinical Trial. Clin Med Insights Arthritis Musculoskelet Disord. 2017; 10:1179544117733452. https://doi.org/10.1177/1179544117733452
  • Manoto SL, Maepa MJ, Motaung SK. Medical ozone therapy as a potential treatment modality for regeneration of damaged articular cartilage in osteoarthritis. Saudi journal of biological sciences. 2018; 25(4):672-679.https://doi.org/10.1016/j.sjbs.2016.02.002
  • Karouzakis E, Neidhart M, Gay RE, Gay S. Molecular and cellular basis of rheumatoid joint destruction. Immunology letters. 2006; 106(1):8-13. https://doi.org/10.1016/j.imlet.2006.04.011
  • Vaillant JD, Fraga A, Diaz MT, Mallok A, Viebahn Hansler R, Fahmy Z et al. 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. 2013; 714(1-3):318-324. https://doi.org/10.1016/j.ejphar.2013.07.034
  • Lopes de Jesus CC, Dos Santos FC, de Jesus L, Monteiro I, Sant'Ana M, Trevisani VFM. 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. https://doi.org/10.1371/journal.pone.0179185
  • Arias-Vazquez PI, Tovilla-Zarate CA, Hernandez-Diaz Y, Gonzalez-Castro TB, Juarez-Rojop IE, Lopez-Narvaez ML et al. Short-Term Therapeutic Effects of Ozone in the Management of Pain in Knee Osteoarthritis: A Meta-Analysis. PM & R: the journal of injury, function, and rehabilitation. 2019; 11(8):879-887. https://doi.org/10.1002/pmrj.12088
  • Noori-Zadeh A, Bakhtiyari S, Khooz R, Haghani K, Darabi S. Intra-articular ozone therapy efficiently attenuates pain in knee osteoarthritic subjects: A systematic review and meta-analysis. Complementary therapies in medicine. 2019; 42:240-247. https://doi.org/10.1016/j.ctim.2018.11.023
  • Dernek B, Kesiktas FN. Efficacy of combined ozone and platelet-rich-plasma treatment versus platelet-rich-plasma treatment alone in early stage knee osteoarthritis. Journal of back and musculoskeletal rehabilitation. 2019; 32(2):305-311. https://doi.org/10.3233/BMR-181301
  • Duymus TM, Mutlu S, Dernek B, Komur B, Aydogmus S, Kesiktas FN. Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options. Knee Surg Sports Traumatol Arthrosc. 2017; 25(2):485-492. https://doi.org/10.1007/s00167-016-4110-5
  • Kohn MD, Sassoon AA, Fernando ND. Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clin Orthop Relat Res. 2016; 474(8):1886-1893. https://doi.org/10.1007/s11999-016-4732-4
  • Madrid Declaration On Ozone Therapy. https://www.drsozone.com/wp-content/uploads/2014/02/Madrid-Declaration-updated-July-30.pdf. Accessed.
  • Basaran S, Guzel R, Seydaoglu G, Guler-Uysal F. Validity, reliability, and comparison of the WOMAC osteoarthritis index and Lequesne algofunctional index in Turkish patients with hip or knee osteoarthritis. Clin Rheumatol. 2010; 29(7):749-756. https://doi.org/10.1007/s10067-010-1398-2
  • Xing D, Xu Y, Liu Q, Ke Y, Wang B, Li Z et al. Osteoarthritis and all-cause mortality in worldwide populations: grading the evidence from a meta-analysis. Scientific reports. 2016; 6:24393. https://doi.org/10.1038/srep24393
  • Chang KV, Hung CY, Aliwarga F, Wang TG, Han DS, Chen WS. Comparative effectiveness of platelet-rich plasma injections for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation. 2014; 95(3):562-575. https://doi.org/10.1016/j.apmr.2013.11.006