Ozone Decreases Biomarkers of Inflamation (C-Reactive Protein and Erytrocyte Sedimentation Rate) and Improves Pain, Function and Quality of Life in Knee Osteoarthrtitis Patients: A Before-and-After Study and Review of the Literature

Objectives: Theaimof thisstudywastoevaluateif ozoneiscapableof decreasingbiomarkersof inflammation(CRP/ESR)andpain, and to improve function and quality of life in knee osteoarthrtitis (OA) patients. Methods: Aprospectivequasiexperimental(before-and-afterstudy)researchwasperformedtoinvestigatetheeffectof Ozonether-apyprotocol. Theinterventionincluded4sessions(1session/week)of anintra-articularinfiltrationof amedicalmixtureof Oxygen-Ozone (95% to 5%) at 20 ug/mL concentration. Biochemical evaluation (CRP and ESR), pain VAS, and WOMAC scales were evaluated before and after the treatment. Results: Overall, 33 patients were evaluated. Mean age was 68.18 ± 8.43 years. Female patients accounted for 75.7% (n = 25) and male patients corresponded to 24.3% (n = 8). Female: male ratio was 3:1. The most frequent radiological KL grade was 2º (n = 22, 66.7%), followed by3º (n = 8, 24.2%), and 4º (n = 3, 9.1%). Biomarkersof inflammation decreased significantly. C-reactive protein (CRP) diminished from 0.33 ± 0.32 mg/dL to 0.25 ± 0.23 mg/dL (P = 0.0456). Erythrocyte sedimentation rate (ESR) decreased from 15.06 ± 12.09 mm/h to 11.81 ± 8.32 mm/h (P = 0.01). Before treatment, pain measured by VAS was 7.33 ± 1.31 points and decreased to 2.84 ± 1.76(P=0.0000). TheWOMAC-painsubscalewas14.84 ± 2.77pointsanddiminishedto5.96 ± 3.53(P=0.0000), WOMACstiffness subscale was 3.06 ± 1.95 points and ameliorated to 1.15 ± 1.3 (P = 0.0000), WOMAC-function subscale was 41.15 ± 12.58 points and decreased to 22.3 ± 11.64 (P = 0.000). Conclusions: Ozoneiscapableof bothdecreasingpainandstiffnessandimprovingfunctionandqualityof lifeinkneeOApatients, yet decreases biomarkers of inflammation, such as CRP and ESR. inflammation hypothesized stiff-nessandQoL,andmanystudiessuggestthatozoneiscapa- bleof amelioratinginflammation(5). Therationaletoeval-uateCRP/ESRisthatinflammationbiomarkersmaypredict outcomes in OA. Elevated hs-CRP predicts loss of cartilage in knee OA and poor results after total knee arthroplasty. acute phase