Role of Hyperbaric Oxygen Therapy in Rheumatological Diseases
Hyperbaric oxygen therapy (HBOT) is not currently recommended as a primary treatment for rheumatological diseases due to insufficient high-quality evidence supporting its efficacy and safety in this context. While some preliminary research shows potential benefits, the available guidelines do not endorse HBOT as a standard treatment option for rheumatological conditions.
Current Evidence for HBOT in Rheumatological Diseases
Limited Research Base
- The most recent (2023) pilot study showed that 9 rheumatoid arthritis patients who received 30 HBOT treatments over 6-10 weeks demonstrated no radiologic progression of erosions, synovitis, or bone marrow edema at 3 and 6-month follow-up MRIs 1
- A small 1991 study reported good clinical results in 35 out of 50 rheumatoid arthritis patients who underwent 21 sessions of HBOT, noting improvements in immune function 2
- Despite these promising findings, there is a notable absence of large-scale randomized controlled trials specifically evaluating HBOT for rheumatological diseases
Mechanism of Action in Rheumatological Context
- HBOT may provide anti-inflammatory effects and prooxygenatory benefits in musculoskeletal conditions 3
- The therapy potentially enhances tissue oxygenation, reduces inflammation, and modulates oxidative stress 4
- In rheumatoid arthritis specifically, HBOT has been observed to potentially intensify suppressive function of T-lymphocytes and normalize cell-bound immunity 2
Guidelines and Approved Indications
Current Approved Uses
The Underseas and Hyperbaric Medical Society has approved HBOT for specific conditions including:
- Carbon monoxide poisoning
- Necrotizing soft tissue infections
- Certain wound healing applications (particularly diabetic foot ulcers)
- Sudden sensorineural hearing loss (as adjunctive therapy)
- Decompression sickness 5
Notably, rheumatological diseases are not included among the approved indications for HBOT 5
Evidence from Related Guidelines
- For necrotizing soft tissue infections, HBOT has shown a statistically significant reduction in mortality (RR = 0.47; 95% CI, 0.30–0.74) 6
- In diabetic foot ulcers, HBOT may be considered as an adjunctive treatment in non-healing ischemic ulcers despite best standard of care (weak recommendation; moderate evidence) 6
- For mucormycosis, there is insufficient evidence to support HBOT as an adjunctive treatment 6
Risks and Limitations of HBOT
Potential Adverse Effects
- Barotrauma to ears and sinuses (reported in 17% of patients in one study) 6
- Eustachian tube dysfunction (reported in up to 45% of patients) 6
- Oxygen toxicity
- Claustrophobia
- Temporary worsening of short-sightedness 6, 5
Practical Considerations
- HBOT is expensive and time-consuming, typically involving multiple 1-2 hour sessions over days to weeks 6
- Limited availability in many healthcare settings 6
- Significant patient burden in terms of treatment commitment 5
Clinical Decision Algorithm for HBOT in Rheumatological Diseases
First-line approach: Standard disease-modifying treatments for rheumatological diseases should be optimized before considering experimental approaches like HBOT
Consider HBOT only if:
- Patient has failed conventional therapies
- Patient has no contraindications to HBOT (e.g., untreated pneumothorax, certain chemotherapy agents)
- Patient understands the experimental nature of this treatment for rheumatological conditions
- Patient can commit to the intensive treatment schedule (typically 20-30 sessions)
- Treatment is available as part of a clinical trial or research protocol
Monitoring if HBOT is used:
- Assess disease activity using validated measures before and after treatment
- Consider MRI evaluation before and after treatment to assess structural changes 1
- Monitor for adverse effects, particularly barotrauma
Conclusion
While preliminary research suggests potential benefits of HBOT in rheumatological diseases, particularly rheumatoid arthritis, the current evidence base is insufficient to recommend its routine use. Large-scale randomized controlled trials are needed to establish its efficacy, optimal protocols, and safety profile specifically for rheumatological conditions 3. Patients interested in HBOT for rheumatological diseases should be encouraged to participate in clinical trials when available.