The impact of ex vivo ozone injection into the synovial fluid in patients with knee osteoarthritis: A controlled clinical trial
Emre Ata1
, Semiha Özgüç1, Mustafa Hüseyin Temel2, Hakan Beyaztaş3, Selman Aktaş4, Eray Metin Güler5
1Department of Physical Medicine and Rehabilitation, Sultan 2. Abdulhamid Han Training and Research Hospital, İstanbul, Türkiye
2Department of Physical Medicine and Rehabilitation, Üsküdar State Hospital, İstanbul, Türkiye
3Department of Medical Biochemistry, University of Health Sciences Türkiye, İstanbul, Türkiye
4Department of Biostatistics, University of Health Sciences Türkiye, İstanbul, Türkiye
5Haydarpasa Numune Health Application And Research Center, Medical Biochemistry, İstanbul, Türkiye
Keywords: Knee osteoarthritis, ozone therapy, proinflammatory cytokines.
Abstract
Objectives: This study aimed to examine the effect of varying ozone doses on proinflammatory cytokine levels in the synovial fluid collected from individuals with knee osteoarthritis.
Patients and methods: The controlled clinical trial was conducted with 82 patients (61 females, 21 males; mean age: 63.1±10.0 years; range, 40 to 73 years) between 21 April 2023 and 20 May 2023. Synovial fluid samples were collected from the patients under ultrasound guidance and divided into three tubes, one of which was not injected with ozone, and the other two were injected with 10 and 30 gamma (γ) ozone, respectively. The total antioxidant status, total oxidant status, oxidative stress index, interleukin (IL)-1 beta (β), IL-6, and tumor necrosis factor-alpha (TNF-α) in the joint fluids were measured.
Results: The oxidative stress index and IL-1 β, IL-6, and TNF-α levels in the synovial fluid were lower at 10 and 30 γ compared to 0 and 10 γ, respectively. In vitro ozone injection at 30 gamma was more effective in reducing proinflammatory cytokines in the synovial fluid than that at 10 and 0 γ. Ozone injection into the pathological joint fluid was more effective in terms of total antioxidant status at 10 and 30 γ compared to 0 and 10 γ, respectively. No significant difference in total oxidant status was observed between the groups.
Conclusion: This study showed that in vitro ozone injection at 30 γ was more effective in reducing proinflammatory cytokines in the synovial fluid and in improving total antioxidant status than that at 10 and 0 γ. The results showed the potential significance of the ozone injection dosage in treating knee osteoarthritis.
Citation: Ata E, Özgüç S, Temel MH, Beyaztaş H, Aktaş S, Güler EM. The impact of ex vivo ozone injection into the synovial fluid in patients with knee osteoarthritis: A controlled clinical trial. Arch Rheumatol 2024;39(3):459-466. doi: 10.46497/ ArchRheumatol.2024.10375.
The study protocol was approved by the Health Sciences University Hamidiye Scientific Research Ethics Committee (date: 22.04.2022, no: 22/248). To ensure transparency, accountability, and scientific rigor, the clinical trial was duly registered with Clinical Trials under trial number NCT05824052. The study was conducted in accordance with the principles of the Declaration of Helsinki.
A written informed consent was obtained from each patient.
Idea/concept, design, critical review: E.A., H.B.; Control/supervision, writing the article: E.A., M.H.T., H.B.; Data collection and/ or processing: S.A., E.M.G., S.Ö.; Analysis and/or interpretation: S.A., E.A., H.B.; Literature review: E.M.G., S.Ö.; References and fundings: M.H.T., S.Ö.; Materials: H.B., S.Ö., E.M.G.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
The data that support the findings of this study are available from the corresponding author upon reasonable request.