What is the role of intra-articular oxygen-ozone injections in treating joint pain?

From the Guidelines

Intra-articular oxygen-ozone injections are not recommended as a first-line treatment for joint pain due to limited high-quality evidence, and their use should be considered on a case-by-case basis, taking into account the patient's specific condition and medical history. The available evidence suggests that intra-articular oxygen-ozone injections may provide temporary relief for joint pain, particularly in osteoarthritis, but the quality of the evidence is generally low, and more research is needed to fully understand their efficacy and safety 1.

Key Considerations

• The typical protocol involves injecting 5-15 ml of an oxygen-ozone gas mixture (concentration 10-30 μg/ml) directly into the affected joint, usually administered as a series of 3-5 weekly injections.
• Patients may experience mild discomfort during injection and temporary pain flare-up afterward.
• The proposed mechanism involves ozone's anti-inflammatory and antioxidant properties, which may reduce inflammatory cytokines and oxidative stress within the joint while potentially stimulating cartilage repair mechanisms.
• Ozone therapy appears to have a good safety profile with minimal side effects when properly administered, though it should be performed only by trained healthcare providers using medical-grade ozone generators.

Clinical Context

The use of intra-articular oxygen-ozone injections should be considered in the context of the patient's overall treatment plan, taking into account their medical history, current symptoms, and other treatment options. The EULAR recommendations for intra-articular therapies provide guidance on the use of intra-articular injections, including the importance of patient information, procedure and setting, accuracy, routine and special antiseptic care, safety and precautions in special populations, efficacy and safety of repeated joint injections, and the use of local anaesthetics and aftercare 1.

Patient-Centered Outcomes

The aim of intra-articular oxygen-ozone injections should be to improve patient-centered outcomes, such as reducing pain and improving function, while minimizing potential harms and considering patient preferences and values. Contextual factors, such as effective communication and patient expectations, can also influence the outcome of intra-articular oxygen-ozone injections, and should be taken into account when making treatment decisions 1.

From the Research

Intra-Articular Oxygen-Ozone Injections for Joint Pain

• Intra-articular oxygen-ozone injections have been studied as a treatment for joint pain, particularly in cases of osteoarthritis and other musculoskeletal disorders 2, 3, 4, 5, 6.
• The mechanism of action of oxygen-ozone therapy involves reducing inflammation, relieving pain, promoting tissue regeneration, and activating antioxidant defense systems 2.
• Studies have compared the efficacy of intra-articular oxygen-ozone injections with other treatments, such as hyaluronic acid injections, in patients with knee osteoarthritis 3, 4, 5, 6.
• The results of these studies suggest that intra-articular oxygen-ozone injections can be effective in reducing pain and improving function in patients with knee osteoarthritis, although the evidence is not always consistent and more research is needed to fully understand the benefits and limitations of this treatment 3, 4, 5, 6.
• A meta-analysis of randomized controlled trials found that intra-articular oxygen-ozone injections achieved similar pain control to hyaluronic acid injections in patients with knee osteoarthritis, with no significant difference in adverse events 5.
• Another study found that intra-articular oxygen-ozone injections were associated with significant reductions in pain and improvements in function, although the benefits were not always sustained over time 4.
• The current evidence suggests that intra-articular oxygen-ozone injections may be a useful treatment option for patients with joint pain, particularly those with knee osteoarthritis, although further research is needed to fully establish the efficacy and safety of this treatment 2, 3, 4, 5, 6.

Comparison with Other Treatments

• Intra-articular oxygen-ozone injections have been compared with other treatments, such as hyaluronic acid injections and steroid injections, in patients with knee osteoarthritis and other musculoskeletal disorders 2, 3, 4, 5, 6.
• The results of these studies suggest that intra-articular oxygen-ozone injections can be as effective as other treatments in reducing pain and improving function, although the evidence is not always consistent and more research is needed to fully understand the benefits and limitations of this treatment 3, 4, 5, 6.
• A systematic review and meta-analysis found that intra-articular ozone injection was slightly better than control injections during the first month, but the benefits declined over time 6.

Safety and Adverse Events

• The safety and adverse event profile of intra-articular oxygen-ozone injections has been studied in several trials, with most studies finding no significant difference in adverse events between oxygen-ozone injections and other treatments 3, 4, 5, 6.
• However, more research is needed to fully establish the safety and adverse event profile of intra-articular oxygen-ozone injections, particularly in the long term 2, 3, 4, 5, 6.