Ozone injections reduce pain in knee osteoarthritis: a systematic review and meta-analysis

Arias-Vázquez, Pedro Iván1,*; Castillo-Avila, Rosa Giannina1; Hernández-Gil, Karen1; Guzzardo, Mauro Nicolás2; Guzzardo, Duilio Román2

Author Information

1Department of Rehabilitation, Juárez Autonomous University of Tabasco, Tabasco, Mexico

2Pain Training and Research Team (EFID, for its acronym in Spanish), National University of Rosario, Rosario, Argentina

*Correspondence to: Pedro Iván Arias Vázquez, MD, pivanav@gmail.com

Abstract

The only intra-articular injections recommended by international guidelines for the treatment of knee osteoarthritis are injections of corticosteroids and hyaluronic acid; nonetheless, other substances including ozone, dextrose and platelet-rich plasma are also used in clinical. Intra-articular injections of ozone have been reported to have anti-inflammatory mechanisms and clinical benefits similar to intra-articular injections of corticosteroids in patients with knee osteoarthritis; however, this treatment has not been evaluated in a meta-analysis. The objective of this review is to evaluate the effectiveness of intra-articular injections of ozone for reducing pain and improving function in individuals with knee osteoarthritis when compared with intra-articular injections of corticosteroids. An online search was performed using the electronic databases PubMed, EMBASE, Central Cochrane and Web of Science, for controlled clinical trials that compared intra-articular injections of ozone and intra-articular injections of corticosteroid in the treatment of knee osteoarthritis. Seven clinical trials were included in this review, gathering 409 individuals with knee osteoarthritis. In the pooled analysis, ozone injections were found to be more effective in reducing pain in the short and medium terms than corticosteroids injections. Similarly, function improvement in the medium term was observed in favor of ozone injections. Our results suggest that ozone injections represent a good alternative to corticosteroids injections for reducing pain in the short and medium terms in individuals with knee osteoarthritis. Nonetheless, definitive conclusions could not be drawn due to the limited quality of the included studies. Better quality clinical trials are needed to strengthen the evidence and confirm these results.

摘要

目前国际指南推荐的用于治疗膝骨关节炎的唯一关节内注射剂是皮质类固醇和透明质酸；然而，临床上也在使用其他物质，包括臭氧、葡萄糖和富血小板血浆。据报道，对于膝骨关节炎患者，关节内注射臭氧具有与关节内注射皮质类固醇相似的抗炎机制和临床获益；然而，这种治疗方法尚未经过荟萃分析评估。本综述旨在评估与关节内注射皮质类固醇相比，关节内注射臭氧在减轻膝骨关节炎患者疼痛和改善功能方面的有效性。使用电子数据库PubMed、EMBASE、Cochrane对照试验中心数据库和Web of Science进行在线检索，查找比较关节内注射臭氧与关节内注射皮质类固醇治疗膝骨关节炎的对照临床试验。本综述共纳入7项临床试验，包含409名膝骨关节炎患者。荟萃分析发现，臭氧注射在短期和中期减轻疼痛方面比皮质类固醇注射更有效。同样，在中期功能改善方面也观察到臭氧注射更有优势。我们的研究结果表明，对于膝骨关节炎患者，臭氧注射在短期和中期减轻疼痛方面是皮质类固醇注射的一个良好替代方案。然而，由于纳入研究的质量有限，尚不能得出确切结论。需要更高质量的临床试验来加强证据并证实这些结果。