An  investigation into the  efficacy of intra-articular  ozone (O&lt;sub&gt;2&lt;/sub&gt;&amp;ndash;O&lt;sub&gt;3&lt;/sub&gt;)&amp;nbsp;injection in patients with knee osteoarthritis: a systematic review and meta-analysis

Raeissadat, Seyed Ahmad; Tabibian, Elnaz; Rayegani, Seyed Mansoor; Rahimi‐Dehgolan, Shahram; Babaei-Ghazani, Arash

doi:10.2147/jpr.s175441

Cited by 42 publications

(45 citation statements)

References 29 publications

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“…Hyaluronic acid, ozone, laser, botulinum toxin A, and other medical treatments have been suggested. [2][3][4][5][6] One of the more recent modalities currently gaining attention is the various growth factor products. These include platelet rich plasma and plasma rich in growth factors; which because of having more platelet content compared to standard plasma, contains more growth factors.…”

Section: Introductionmentioning

confidence: 99%

<p>MRI Changes After Platelet Rich Plasma Injection in Knee Osteoarthritis (Randomized Clinical Trial)</p>

Raeissadat

Ghorbani

Taheri

et al. 2020

JPR

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Purpose: Few papers have studied the objective effects of PRP on cartilage. In this study, we investigated the effect of PRP on cartilage characteristics by special MRI sequencing in knee osteoarthritis (IRCT registration number: 2014020413442N6). Patients and methods: In this double blind randomized clinical trial, patients with bilateral knees osteoarthritis-grade 1, 2, and 3 were included in the study. Each patient's knees were randomly allocated to either control or treatment groups. PRP was injected in two sessions with 4 week intervals in PRP group. The VAS (visual analog scale) and WOMAC (Western Ontario and McMaster Universities Arthritis Index) were utilized and MRI was performed for all patients, before, and 8 months after treatment. The MRI sequences taken were transverse 3D TRUFISP and coronal and sagittal fat saturated proton-density. Imaging was scored according to four cartilage characteristics. Results: 46 knees (from 23 patients) were included in this study. 23 knees in the case group and 23 knees in control group were studied. All patients were female with mean age of 57.57±5.9 years. Mean total WOMAC and VAS changes before and after treatment in control group were 11.61±8.5 and 1.3±1.1 respectively. In PRP group, mean total WOMAC and VAS changes showed better improvement with 20±12.3 and 3.2±1.6 respectively (P-value <0.05). In PRP group, all of the radiologic variables (patellofemoral cartilage volume, synovitis and medial and lateral meniscal disintegrity), with the exception of subarticular bone marrow abnormality, had significant improvement (P-value <0.05). In a comparison between the two groups, patellofemoral cartilage volume and synovitis had significantly changed in the PRP group (P-value <0.05). Conclusion: In this study, in addition to the effect of PRP on VAS and WOMAC, there was a significant effect on radiologic characteristics (patellofemoral cartilage volume and synovitis). For further evaluation, a longer study with a larger sample size is recommended.

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Section: Introductionmentioning

confidence: 99%

<p>MRI Changes After Platelet Rich Plasma Injection in Knee Osteoarthritis (Randomized Clinical Trial)</p>

Raeissadat

Ghorbani

Taheri

et al. 2020

JPR

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“…LULIN MA 1 , SONG WEN 1 , JIE YUAN 1,2 , DEXIN ZHANG 1 , YAN-LIU LU 3 , YOU ZHANG 4 , YING LI 1 and SONG CAO 1,2 oxidative and anti-pathogenic effects and immune regulation ability, as well as the increase of oxygen supply and reduction of oxidative stress (12,(20)(21)(22)(23)(24)(25)(26)(27). For instance, ozone was proven to relieve pain by causing the following effects: i) Release of endorphins (26); ii) inhibition of the activation of microglia via adenosine monophosphate (AMP)-dependent protein kinase signaling (28); iii) inhibition of the expression of purinergic receptors P2X3 and P2X7 in the spinal dorsal horn (29); iv) promoting phosphodiesterase 2A-cyclic guanosine monophosphate/cyclic AMP/NFκB-p65 signaling (30); v) inhibition of autophagy (31,32); vi) reduction of the expression of pro-inflammatory/pro-apoptotic caspases (33); and vii) increase of oxygen supply in tissues and cells (22).…”

Section: Detection Of Chlorite Chlorate and Perchlorate In Ozonated mentioning

confidence: 99%

Detection of chlorite, chlorate and perchlorate in ozonated saline

Wen

Yuan

et al. 2020

Exp Ther Med

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Medical ozone is used to treat various diseases, including numerous pathologies associated with chronic pain. Chronic pain may be treated by systemic administration of ozone, with ozonated autohemotherapy (OAH) being the commonly used method. In the clinic, intravenous infusion of ozonized saline has been used to treat various diseases. Compared with OAH, ozonized saline infusion is less technically demanding and causes minimal damage to veins. However, it has been indicated that ozone may oxidize saline and generate toxic substances, and therefore, the safety of ozone treatment has been questioned. In the present study, the potential chemical compounds produced from ozone and saline, including chlorite, chlorate and perchlorate, were examined at various time-points with ion chromatography-mass spectrometry (IC-MS). A control group (pure oxygen group) and an ozone group were included in the present study. Two subgroups were included within each group: A saline bottle (made from polypropylene) subgroup and an ozone-resistant blood transfusion bag [made from medical polyvinyl chloride, di(2-ethyl) hexyl phthalate plasticized] subgroup. For the ozone group, 100 ml saline and 100 ml medical ozone at various concentrations (20, 40 or 60 µg/ml in pure oxygen) were injected into the saline bottle or blood bag, and for the control group, 100 ml of pure oxygen was injected into the saline bottle or blood bag. The presence and the content of chlorite, chlorate and perchlorate were determined at different time-points (3, 6 and 15 days after mixing) by IC-MS. Chlorate was detected in the ozone groups at three time-points and its content increased as the ozone concentration and the reaction time increased. Under the same conditions (the same ozone concentration and the same incubation time), the chlorate content (0.90±0.14-7.69±0.48 µg/l) in the blood bag subgroup was significantly lower than that in the saline bottle subgroup (45.23±6.14-207.6±15.63 µg/l). However, chlorite and perchlorate were not detected at any time-point in the two groups. In addition, in the control group (pure oxygen group), chlorite, chlorate and perchlorate were not detected at any time-point. These results indicate that ozone reacts with saline to produce chlorate. Ozone may also react with the polypropylene saline bottle to increase the chlorate content in the bottled solution. Due to a lack of toxicology studies of chlorate in blood, it remains elusive whether ozonated saline and chlorate at the range of 0.90±0.14-7.69±0.48 µg/l has any toxic effects. The potential toxicity of chlorate should be considered when ozonated saline is used for clinical infusions.

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“…medications including nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, duloxetine, opioids, topical NSAIDs and capsaicin are effective in reducing symptoms [5]. Intra-articular injection, can be carried out using corticosteroid [6], hyaluronic acid (HA) [7], ozone [8], plasma rich in growth factor (PRGF) [9], and Platelet-rich plasma (PRP) [10]. Physical agent modalities have also been investigated regarding knee OA [11,12].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of single high-molecular-weight versus triple low-molecular-weight hyaluronic acid intra-articular injection among knee osteoarthritis patients

Bahrami

Raeissadat

Cheraghi

et al. 2020

BMC Musculoskelet Disord

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Background: To compare intra-articular (IA) knee injections of a cross-linked high-molecular-weight hyaluronic acid (HMW-HA) with a linear low-molecular weight HA (LMW-HA) in terms of pain and functional improvement among knee osteoarthritis (OA) patients. Methods: In this single-blinded RCT, the patients were randomly divided into two groups for HA injections. The first group received an HMW-HA (Arthromac) injection, while the other received three weekly LMW-HA (Hyalgan) injections. Pain and function were assessed using the outcome measures including WOMAC, Lequesne and VAS indices, once prior to injection, as well as 2 and 6 months after injections. Results: A total of 90 patients were included. There was no significant difference in baseline characteristics including age and sex between the two groups. Our analysis showed that total WOMAC, Lequesne and VAS mean scores remarkably improved at both follow-up time-points compared to the baseline measurements (p < 0.001). There was no significant superiority between the two therapeutic protocols according to our outcome measures at any time-point of follow-up. The only except was about the improvement in WOMAC stiffness subscale that was significantly higher in LMW-HA group compared to HMW-HA (p = 0.021). Moreover, no significant difference was observed in minor complications and injection-induced pain scores between the two groups. Conclusion: This study proved that a single HMW-HA injection is as effective as multiple injections of LMW-HA counterparts in periods of 2 and 6 months follow-up. This study protocol was registered in Iranian database of RCTs (IRCT; www.irct.ir) with the trial registration number IRCT20130523013442N24 and registration date 2018-07-13.

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An investigation into the efficacy of intra-articular ozone (O<sub>2</sub>–O<sub>3</sub>) injection in patients with knee osteoarthritis: a systematic review and meta-analysis

Cited by 42 publications

References 29 publications

<p>MRI Changes After Platelet Rich Plasma Injection in Knee Osteoarthritis (Randomized Clinical Trial)</p>

<p>MRI Changes After Platelet Rich Plasma Injection in Knee Osteoarthritis (Randomized Clinical Trial)</p>

Detection of chlorite, chlorate and perchlorate in ozonated saline

Efficacy of single high-molecular-weight versus triple low-molecular-weight hyaluronic acid intra-articular injection among knee osteoarthritis patients

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