Middle East Journal of Rehabilitation and Health

Published by: Kowsar

Intra Articular Ozone Reduces Serum Uric Acid and Improves Pain, Function and Quality of Life in Knee Osteoarthritis Patients: A Before-and-After Study

Marcos Edgar Fernandez-Cuadros 1 , 2 , * , Olga Susana Perez-Moro 1 , Maria Jesus Albaladejo-Florin 1 and Ruben Algarra-Lopez 1
Authors Information
1 Hospital Universitario Santa Cristina, Madrid, Spain
2 Fundacion Hospital General Santísima Trinidad, Salamanca, Spain
Article information
  • Middle East Journal of Rehabilitation and Health: July 2018, 5 (3); e68599
  • Published Online: July 1, 2018
  • Article Type: Research Article
  • Received: March 12, 2018
  • Revised: May 6, 2018
  • Accepted: May 10, 2018
  • DOI: 10.5812/mejrh.68599

To Cite: Fernandez-Cuadros M E, Perez-Moro O S, Albaladejo-Florin M J, Algarra-Lopez R. Intra Articular Ozone Reduces Serum Uric Acid and Improves Pain, Function and Quality of Life in Knee Osteoarthritis Patients: A Before-and-After Study, Middle East J Rehabil Health Stud. 2018 ; 5(3):e68599. doi: 10.5812/mejrh.68599.

Copyright © 2018, Middle East Journal of Rehabilitation and Health Studies. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited
1. Background
2. Methods
3. Results
4. Discussion
  • 1. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012;64(4):465-74. [PubMed: 22563589].
  • 2. Meneses SR, Goode AP, Nelson AE, Lin J, Jordan JM, Allen KD, et al. Clinical algorithms to aid osteoarthritis guideline dissemination. Osteoarthritis Cartilage. 2016;24(9):1487-99. doi: 10.1016/j.joca.2016.04.004. [PubMed: 27095418].
  • 3. Fernandez-Cuadros ME, Perez-Moro OS, Albaladejo-Florin MJ; Miron-Canelo. Ozone fundamentals and effectiveness on knee pain: Chondromalacia and knee Osteoarthritis. Germany: Lambert Academic Publishing; 2016.
  • 4. Tonge DP, Pearson MJ, Jones SW. The hallmarks of osteoarthritis and the potential to develop personalised disease-modifying pharmacological therapeutics. Osteoarthritis Cartilage. 2014;22(5):609-21. doi: 10.1016/j.joca.2014.03.004. [PubMed: 24632293].
  • 5. McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014;22(3):363-88. doi: 10.1016/j.joca.2014.01.003. [PubMed: 24462672].
  • 6. Fernandez-Cuadros ME. Analisis de la calidad de vida en pacientes con prótesis total de rodilla. Spain: Universidad de Salamanca; 2013.
  • 7. Pearson MJ, Herndler-Brandstetter D, Tariq MA, Nicholson TA, Philp AM, Smith HL, et al. IL-6 secretion in osteoarthritis patients is mediated by chondrocyte-synovial fibroblast cross-talk and is enhanced by obesity. Sci Rep. 2017;7(1):3451. doi: 10.1038/s41598-017-03759-w. [PubMed: 28615667]. [PubMed Central: PMC5471184].
  • 8. Deligne C, Casulli S, Pigenet A, Bougault C, Campillo-Gimenez L, Nourissat G, et al. Differential expression of interleukin-17 and interleukin-22 in inflamed and non-inflamed synovium from osteoarthritis patients. Osteoarthritis Cartilage. 2015;23(11):1843-52. doi: 10.1016/j.joca.2014.12.007. [PubMed: 26521730].
  • 9. Moradi B, Rosshirt N, Tripel E, Kirsch J, Barie A, Zeifang F, et al. Unicompartmental and bicompartmental knee osteoarthritis show different patterns of mononuclear cell infiltration and cytokine release in the affected joints. Clin Exp Immunol. 2015;180(1):143-54. doi: 10.1111/cei.12486. [PubMed: 25393692]. [PubMed Central: PMC4367102].
  • 10. Parera IM, Gharbi M, Serrano HM, Barbero MH, Milano JV, Henrotin Y. Effect of chondroitin sulfate on soluble biomarkers of osteoarthritis: How to analyze and interpret the results from an open-label trial in unilateral knee osteoarthritis patients. Basic & Clinical Pharmacology & Toxicology. 2015;117.
  • 11. Saxne T, Lindell M, Mansson B, Petersson IF, Heinegard D. Inflammation is a feature of the disease process in early knee joint osteoarthritis. Rheumatology (Oxford). 2003;42(7):903-4. doi: 10.1093/rheumatology/keg214. [PubMed: 12826709].
  • 12. Sowers M, Jannausch M, Stein E, Jamadar D, Hochberg M, Lachance L. C-reactive protein as a biomarker of emergent osteoarthritis. Osteoarthritis Cartilage. 2002;10(8):595-601. [PubMed: 12479380].
  • 13. Malathi R. Raised serum IL 6 and CRP in radiographic knee osteoarthritis in Eastern India. J Med Sci clin Res. 2017;5(5):21687-92. doi: 10.18535/jmscr/v5i5.73.
  • 14. Ma CA, Leung YY. Exploring the Link between Uric Acid and Osteoarthritis. Front Med (Lausanne). 2017;4:225. doi: 10.3389/fmed.2017.00225. [PubMed: 29326934]. [PubMed Central: PMC5733531].
  • 15. Roddy E, Doherty M. Gout and osteoarthritis: a pathogenetic link? Joint Bone Spine. 2012;79(5):425-7. doi: 10.1016/j.jbspin.2012.03.013. [PubMed: 22867976].
  • 16. Martinon F, Petrilli V, Mayor A, Tardivel A, Tschopp J. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature. 2006;440(7081):237-41. doi: 10.1038/nature04516. [PubMed: 16407889].
  • 17. Denoble AE, Huffman KM, Stabler TV, Kelly SJ, Hershfield MS, McDaniel GE, et al. Uric acid is a danger signal of increasing risk for osteoarthritis through inflammasome activation. Proc Natl Acad Sci U S A. 2011;108(5):2088-93. doi: 10.1073/pnas.1012743108. [PubMed: 21245324]. [PubMed Central: PMC3033282].
  • 18. Perruccio AV, Chandran V, Power JD, Kapoor M, Mahomed NN, Gandhi R. Systemic inflammation and painful joint burden in osteoarthritis: a matter of sex? Osteoarthritis Cartilage. 2017;25(1):53-9. doi: 10.1016/j.joca.2016.08.001. [PubMed: 27546883].
  • 19. Larsson S, Englund M, Struglics A, Lohmander LS. Interleukin-6 and tumor necrosis factor alpha in synovial fluid are associated with progression of radiographic knee osteoarthritis in subjects with previous meniscectomy. Osteoarthritis Cartilage. 2015;23(11):1906-14. doi: 10.1016/j.joca.2015.05.035. [PubMed: 26521736].
  • 20. Ling SM, Patel DD, Garnero P, Zhan M, Vaduganathan M, Muller D, et al. Serum protein signatures detect early radiographic osteoarthritis. Osteoarthritis Cartilage. 2009;17(1):43-8. doi: 10.1016/j.joca.2008.05.004. [PubMed: 18571442]. [PubMed Central: PMC2667202].
  • 21. Pelletier JP, Raynauld JP, Caron J, Mineau F, Abram F, Dorais M, et al. Decrease in serum level of matrix metalloproteinases is predictive of the disease-modifying effect of osteoarthritis drugs assessed by quantitative MRI in patients with knee osteoarthritis. Ann Rheum Dis. 2010;69(12):2095-101. doi: 10.1136/ard.2009.122002. [PubMed: 20570834].
  • 22. Schell J, Scofield RH, Barrett JR, Kurien BT, Betts N, Lyons TJ, et al. Strawberries Improve Pain and Inflammation in Obese Adults with Radiographic Evidence of Knee Osteoarthritis. Nutrients. 2017;9(9). doi: 10.3390/nu9090949. [PubMed: 28846633]. [PubMed Central: PMC5622709].
  • 23. Fernández-Cuadros ME, Pérez-Moro OS, Mirón-Canelo JA. Could ozone be used as a feasible future treatment in osteoarthritis of the knee? Diversity and Equality in Health and Care. 2016;13(3).
  • 24. Fernández Cuadros ME, Pérez Moro OS, Albaladejo Florin MJ, Mirón Canelo JA. Ozone improves pain, function and quality of life in patients with knee osteoarthritis: A prospective quasi-experimental before-after study. Middle East J Rehabil Health. 2016;4(1). doi: 10.17795/mejrh-41821.
  • 25. Fernandez-Cuadros ME, Susana Perez-Moro O, Jesus Albaladejo-Florin M. Knee osteoarthritis: Condroprotector action and symptomatic effect of ozone on pain, function, quality of life, minimal joint space and knee arthroplasty delay. Middle East J Rehabil Health. 2006;4(1). doi: 10.17795/mejrh-43200.
  • 26. Fernández-Cuadros ME, Pérez-Moro OS, Albaladejo-Florín MJ. Ozone decreases biomarkers of inflammation (C-reactive protein and erythrocyte sedimentation rate) and improves pain, function and quality of life in knee osteoarthritis patients. A before-and-after study. Middle East J Rehabil Health. 2018.
  • 27. Peat G, Thomas E, Duncan R, Wood L, Hay E, Croft P. Clinical classification criteria for knee osteoarthritis: performance in the general population and primary care. Ann Rheum Dis. 2006;65(10):1363-7. doi: 10.1136/ard.2006.051482. [PubMed: 16627539]. [PubMed Central: PMC1798313].
  • 28. Burckhardt CS, Jones KD. Adult measures of pain: the McGill pain questionnaire (MPQ), rheumatoid arthritis pain scale (RAPS), Short‐Form McGill pain questionnaire (SF‐MPQ), verbal descriptive scale (VDS), visual analog scale (VAS), and West Haven‐Yale multidisciplinary pain inventory (WHYMPI). Arthritis Care Res. 2003;49(S5). doi: 10.1002/art.11440.
  • 29. Woolacott NF, Corbett MS, Rice SJ. The use and reporting of WOMAC in the assessment of the benefit of physical therapies for the pain of osteoarthritis of the knee: findings from a systematic review of clinical trials. Rheumatology (Oxford). 2012;51(8):1440-6. doi: 10.1093/rheumatology/kes043. [PubMed: 22467082].
  • 30. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494-502. doi: 10.1136/ard.16.4.485. [PubMed: 13498604]. [PubMed Central: PMC1006995].
  • 31. Tholen DW, Kallner A, Kennedy JW, Krouwer JS, Meier K. Evaluation of precision performance of quantitative measurement methods; approved guideline-second edition. 2004.
  • 32. Billiet L, Doaty S, Katz JD, Velasquez MT. Review of hyperuricemia as new marker for metabolic syndrome. ISRN Rheumatol. 2014;2014:852954. doi: 10.1155/2014/852954. [PubMed: 24693449]. [PubMed Central: PMC3945178].
  • 33. Sautin YY, Nakagawa T, Zharikov S, Johnson RJ. Adverse effects of the classic antioxidant uric acid in adipocytes: NADPH oxidase-mediated oxidative/nitrosative stress. Am J Physiol Cell Physiol. 2007;293(2):C584-96. doi: 10.1152/ajpcell.00600.2006. [PubMed: 17428837].
  • 34. So A, Thorens B. Uric acid transport and disease. J Clin Invest. 2010;120(6):1791-9. doi: 10.1172/JCI42344. [PubMed: 20516647]. [PubMed Central: PMC2877959].
  • 35. Bagnati M, Perugini C, Cau C, Bordone R, Albano E, Bellomo G. When and why a water-soluble antioxidant becomes pro-oxidant during copper-induced low-density lipoprotein oxidation: a study using uric acid. Biochem J. 1999;340 ( Pt 1):143-52. doi: 10.1042/bj3400143. [PubMed: 10229669]. [PubMed Central: PMC1220232].
  • 36. Khosla UM, Zharikov S, Finch JL, Nakagawa T, Roncal C, Mu W, et al. Hyperuricemia induces endothelial dysfunction. Kidney Int. 2005;67(5):1739-42. doi: 10.1111/j.1523-1755.2005.00273.x. [PubMed: 15840020].
  • 37. Bonora E, Targher G, Zenere MB, Saggiani F, Cacciatori V, Tosi F, et al. Relationship of uric acid concentration to cardiovascular risk factors in young men. Role of obesity and central fat distribution. The Verona Young Men Atherosclerosis Risk Factors Study. Int J Obes Relat Metab Disord. 1996;20(11):975-80. [PubMed: 8923153].
  • 38. Lyngdoh T, Marques-Vidal P, Paccaud F, Preisig M, Waeber G, Bochud M, et al. Elevated serum uric acid is associated with high circulating inflammatory cytokines in the population-based Colaus study. PLoS One. 2011;6(5). e19901. doi: 10.1371/journal.pone.0019901. [PubMed: 21625475]. [PubMed Central: PMC3098830].
  • 39. Wangkaew S, Kasitanon N, Hongsongkiat S, Tanasombat C, Sukittawut W, Louthrenoo W. A comparative study of serum and synovial fluid levels of uric acid between patients with gout and other arthritides. J Med Assoc Thai. 2014;97(7):679-85. [PubMed: 25265764].
  • 40. Krasnokutsky S, Oshinsky C, Attur M, Ma S, Zhou H, Zheng F, et al. Serum Urate Levels Predict Joint Space Narrowing in Non-Gout Patients With Medial Knee Osteoarthritis. Arthritis Rheumatol. 2017;69(6):1213-20. doi: 10.1002/art.40069. [PubMed: 28217895]. [PubMed Central: PMC5449226].
  • 41. Srivastava RN, Sanghi D, Mishra A, Sharma A, Raj S, Natu S. Serum uric acid as a predisposing factor of clinico- radiological severity of osteoarthritis knee. Osteoarthr Cartil. 2013;21. S251. doi: 10.1016/j.joca.2013.02.517.
  • 42. Panina SB, Krolevets IV, Milyutina NP, Sagakyants AB, Kornienko IV, Ananyan AA, et al. Circulating levels of proinflammatory mediators as potential biomarkers of post-traumatic knee osteoarthritis development. J Orthop Traumatol. 2017;18(4):349-57. doi: 10.1007/s10195-017-0473-8. [PubMed: 29058227]. [PubMed Central: PMC5685991].
  • 43. Ding X, Zeng C, Wei J, Li H, Yang T, Zhang Y, et al. The associations of serum uric acid level and hyperuricemia with knee osteoarthritis. Rheumatol Int. 2016;36(4):567-73. doi: 10.1007/s00296-015-3418-7. [PubMed: 26743214].

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