MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

“Unless positive evidence emerges, the risk/benefit balance of ozone therapy for any condition fails to be positive.”  This is the conclusion I recently drew after assessing the evidence for or against this therapy. Now a new review has just been published. Does it change my verdict?

This review evaluated the available literature on the application of oxygen-ozone therapy (OOT) in the treatment of knee osteoarthritis (KOA) to understand its therapeutic potential and to compare it with other conservative treatment options.

Eleven studies involving 858 patients met the inclusion criteria. Patients in the control groups received different treatments:

  • placebo in 1 trial;
  • hyaluronic acid in 2 studies;
  • hyaluronic acid and PRP in 1 trial;
  • corticosteroids in 4;
  • hypertonic dextrose, radiofrequency, or celecoxib + glucosamine in the remaining 3 trials.

The quality of these studies was poor; none of the studies included reached “good quality” standard, 2 were ranked as “fair,” and the rest were considered “poor.” No major complications or serious adverse events were reported following intra-articular OOT, which provided encouraging pain relief at short term. On the basis of the available data, no clear indication emerged from the comparison of OOT with other established treatments for KOA.

The authors concluded that the analysis of the available RCTs on OOT for KOA revealed poor methodologic quality, with most studies flawed by relevant bias, thus severely limiting the possibility of drawing conclusions on the efficacy of OOT compared with other treatments. On the basis of the data available, OOT has, however, proven to be a safe approach with encouraging effects in pain control and functional recovery in the short-middle term.

The use of ozone for treatment of KOA is highly controversial. The mechanism of action of ozone therapy for the treatment of KOA is unclear. Some studies have suggested that ozone injections results in pain relief, reduction of oedema, and improved mobility. The above review might be valuable in summarising the evidence, however, I fing its conclusion odd:

  • The authors write that they cannot arrive at a verdict about efficacy because of the poor quality of the primary studies. I think the conclusion is very clear and should have been expressed bluntly. THE AVAILABLE DATA FAIL TO SHOW EFFICACY; THE THERAPY IS THUS UNPROVEN AND SHOULD THEREFORE NOT BE USED. Simple!
  • I also disagree that OOT was proven to be safe. No treatment can be proven to be safe on the basis of just a few studies. This would require a much, much greater sample size.

This leaves us with the following situation:

  1. OOT is not plausible.
  2. OOT is unproven.
  3. The risks of OOT are unknown.

To me this means that we should stop using it (and I don’t need to change my above-quotes verdict).

4 Responses to Ozone-therapy for osteoarthritis? No, thanks!

  • Ozone is O3 – one more oxygen molecule than O2 (wouldn’t you know!). ‘Trioxygen’.
    It is a pale blue gas.

    It can cause lung damage if inhaled, trigger asthma, cause shortness of breath.
    (CoI: This happened to me when inhaling ozone released from seaweed at Brixham harbour.)

    I’ve no idea how it can be injected, but unless the basic research on animals has been done, and published in reputable journals, we have to assume O3 is harmful to articular membranes and linings just as is the case for lungs.

    Recommendation: Ozone therapy must not be undertaken.
    Those advocating its use know this perfectly well and they are therefore quacks and fraudsters.

  • My thought too was how on earth do you inject a gas? You can buy mercury vapour quartz glass UVC ozone-producing lamps on Ebay, made in China. They have to be used with great care, for sterilising purposes. Ozone is poisonous and smells absolutely foul (to me, anyway). Rooms have to be well ventilated after use of ozone.

  • Here in Italy actually some physiatrists use to infiltrate frozen shoulders with Oxigen-ozone. Probably following the advices of this study: “Shoulder adhesive capsulitis, treatment with oxygen ozone:Technique and results
    G. Peretti SIOOT Italian Oxigen Ozone Therapy Scientific Society, Gorle (BG), Italy”. In my wiew the results are not so fantastic as there shown, but patients still believe in the treatment, which is long, expensive, and often associated with other physical therapy means.

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