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      El ozono intrarticular modula la inflamación, mejora el dolor, la rigidez, la función y tiene un efecto anabólico sobre la artrosis de rodilla: estudio cuasiexperimental prospectivo tipo antes-después, 115 pacientes Translated title: Intra-articular ozone modulates inflammation, ameliorates pain and rigidity, improves function and has anabolic effect on knee osteoarthritis: a prospective quasi-experimental before-and-after study, 115 patients

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          Abstract

          RESUMEN Objetivo: El objetivo del presente estudio es verificar por primera vez en la literatura el efecto sintomático y modificador de enfermedad del ozono (O2-O3) mediante la mejoría clínica (dolor, función y rigidez), bioquímica (proteína C-reactiva [PCR], velocidad de sedimentación globular [VSG], ácido úrico) y radiológica (mínimo espacio articular medial y lateral) en una serie de pacientes con artrosis de rodilla. Material y métodos: Se realizó un estudio cuasiexperimental prospectivo tipo antes y después a 115 pacientes con artrosis de rodilla con Kellgren-Lawrence grado 2 o más. El protocolo de ozono consistió en 4 sesiones (una sesión/semana) de una infiltración intrarticular de 20 ml de una mezcla médica de oxígeno-ozono (95-5 %) a una concentración de 20 µg/ml. Las variables de resultado incluyeron variables clínicas (dolor, rigidez y función), bioquímicas (PCR, VSG, ácido úrico) y radiológicas (mínimo espacio articular femorotibial). Resultados: La edad media de los pacientes fue de 64.81 ± 11.22 años. Los pacientes femeninos representaron el 75.6 % (n = 87), con una relación mujer/hombre de 3:1. Variables bioquímicas: la PCR disminuyó de 0.42 ± 0.54 mg/dl a 0.31 ± 0.33 mg/dl (p = 0.0142). La VSG disminuyó sus valores desde 14.52 ± 10.14 mm/h hasta 13.08 ± 8.78 mm/h (p = 0,0014). El ácido úrico en suero disminuyó su valor de 5.12 ± 1.22 mg/dl a 5.05 ± 1.24 (p = 0.1307). Variables clínicas: el ozono (O2-O3) mejoró significativamente las variables clínicas dolor, rigidez y función (p = 0.0000). El dolor medido por EVA fue de 7.11 ± 1.11 puntos y disminuyó significativamente a 3.56 ± 1.56 puntos (p = 0.0000). Antes de la intervención, la subescala WOMAC-dolor fue de 14.3 ± 2.29 puntos y disminuyó a 7.13 ± 3.13 puntos (p = 0.0000), la subescala WOMAC-rigidez fue de 2.73 ± 1.39 puntos y disminuyó a 1.16 ± 1.13 puntos (p = 0.0000), la subescala WOMAC-función fue de 41.66 ± 8.1 puntos y mejoró a 25.29 ± 9.72 puntos (p = 0.0000). Variables radiológicas: en 53 pacientes analizados radiológicamente (según protocolo estandarizado) al año de seguimiento después del tratamiento con ozono, el compartimento interno aumento significativamente de 4.12 ± 1.41 mm a 4.4 ± 1.35 mm (p = 0.0008) y el compartimento externo aumentó de 6 ± 1.37 a 6.16 ± 1.4 mm (p = 0.0753). Conclusiones: El ozono intrarticular ha demostrado efecto sintomático y modificador de la enfermedad en los pacientes con artrosis de rodilla, mejorando el dolor, la función y la rigidez; disminuyendo los marcadores de inflamación (PCR, VSG y ácido úrico), y aumentando el mínimo espacio articular del componente medial y lateral evidenciado radiológicamente. En este estudio se ha evidenciado que el ozono modula la inflamación, disminuye el dolor y la rigidez, mejora la función y tiene efecto anabólico en los pacientes con artrosis de rodilla. No se ha observado ningún efecto adverso tras las infiltraciones intrarticulares de ozono.

          Translated abstract

          ABSTRACT Purpose: The objective of the present study is to verify for the first time in the literature the symptomatic and modifying disease effect of ozone (O2-O3) through clinical (pain, function and stiffness), biochemical (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], uric acid) and radiological improvement (minimum medial and lateral joint space) in a series of patients with osteoarthritis of the knee. Methods: A prospective quasi-experimental before-and-after study was performed in 115 patients with knee osteoarthritis Kellgren-Lawrence grade 2 or more. The ozone protocol consisted of 4 sessions (one session / week) of an intra-articular injection of 20 ml of a medical mixture of Oxygen-Ozone (95-5ºC) at a concentration of 20 µg / ml. Outcome variables included clinical (pain, stiffness, and function), biochemical (CRP, ESR, uric acid), and radiological variables (minimal femorotibial joint space). Results: Mean age of the patients was 64.81 ± 11.22 years. Female patients accounted for 75.6 % (n = 87), with a female / male ratio of 3 : 1. Biochemical-variables: CRP decreased from 0.42 ± 0.54 mg/dL to 0.31 ± 0.33 mg/dL (p = 0.0142). ESR decreased from 14.52 ± 10.14 mm/h to 13.08 ± 8.78 mm/h (p= 0.0014). Serum uric acid decreased from 5.12 ± 1.22 mg/dL to 5.05 ± 1.24 (p = 0.1307). Clinical variables: Ozone (O2-O3) significantly improved pain, stiffness and function clinical variables (p = 0.0000). Pain measured by VAS was 7.11 ± 1.11 points and decreased significantly to 3.56 ± 1.56 points (p = 0.0000). Before the intervention, WOMAC-pain subscale was 14.3 ± 22.29 points and decreased to 7.13 ± 33.13 points (p = 0.0000), WOMAC-stiffness subscale was 2.73 ± 1.39 points and decreased to 1.16 ± 1.13 points (p = 0.0000), WOMAC-function subscale was 41.66 ± 8, 1 points and improved to 25.29 ± 9.72 points (p = 0.0000). Radiological variables: In 53 patients analyzed radiologically (according to standardized protocol) at one year of follow-up after ozone treatment, the internal compartment increased significantly from 4.12 ± 1.41 mm to 4.4 ± 1.35 mm (p = 0.0008) and the external compartment increased from 6 ± 1.37 to 6.16 ± 1.4 mm (p = 0.0753). Conclusions: Intra articular ozone has demonstrated a symptomatic and disease modifying effect in patients with osteoarthritis of the knee, improving pain, function and stiffness; decreasing markers of inflammation (CRP, ESR and uric acid), and increasing the minimal joint space of the medial and lateral component evidenced radiologically. In this study it has been shown that ozone modulates inflammation, decreases pain and stiffness, improves function and has an anabolic effect in patients with osteoarthritis of the knee. No adverse effect has been observed after intra articular infiltrations of ozone.

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          Most cited references31

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          Uric acid is a danger signal of increasing risk for osteoarthritis through inflammasome activation.

          Uric acid (UA) is known to activate the NLRP3 (Nacht, leucine-rich repeat and pyrin domain containing protein 3) inflammasome. When activated, the NLRP3 (also known as NALP3) inflammasome leads to the production of IL-18 and IL-1β. In this cohort of subjects with knee osteoarthritis (OA), synovial fluid uric acid was strongly correlated with synovial fluid IL-18 and IL-1β. Synovial fluid uric acid and IL-18 were strongly and positively associated with OA severity as measured by both radiograph and bone scintigraphy, and synovial fluid IL-1β was associated with OA severity but only by radiograph. Furthermore, synovial fluid IL-18 was associated with a 3-y change in OA severity, on the basis of the radiograph. We conclude that synovial fluid uric acid is a marker of knee OA severity. The correlation of synovial fluid uric acid with the two cytokines (IL-18 and IL-1β) known to be produced by uric acid-activated inflammasomes and the association of synovial fluid IL-18 with OA progression, lend strong support to the potential involvement of the innate immune system in OA pathology and OA progression.
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            Low-level increases in serum C-reactive protein are present in early osteoarthritis of the knee and predict progressive disease

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              Review of Hyperuricemia as New Marker for Metabolic Syndrome

              Hyperuricemia has long been established as the major etiologic factor in gout. In recent years, a large body of evidence has accumulated that suggests that hyperuricemia may play a role in the development and pathogenesis of a number of metabolic, hemodynamic, and systemic pathologic diseases, including metabolic syndrome, hypertension, stroke, and atherosclerosis. A number of epidemiologic studies have linked hyperuricemia with each of these disorders. In some studies, therapies that lower uric acid may prevent or improve certain components of the metabolic syndrome. There is an association between uric acid and the development of systemic lupus erythematosus; the connection between other rheumatic diseases such as rheumatoid arthritis and osteoarthritis is less clear. The mechanism for the role of uric acid in disorders other than gout is not well established but recent investigations point towards systemic inflammation induced by urate, as the major pathophysiological event common to systemic diseases, including atherosclerosis.
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                Author and article information

                Journal
                dolor
                Revista de la Sociedad Española del Dolor
                Rev. Soc. Esp. Dolor
                Inspira Network Group, S.L (Madrid, Madrid, Spain )
                1134-8046
                April 2020
                : 27
                : 2
                : 78-88
                Affiliations
                [1] Madrid orgnameHospital Universitario Santa Cristina orgdiv1Servicio de Rehabilitación y Medicina Física España
                Article
                S1134-80462020000200078 S1134-8046(20)02700200078
                10.20986/resed.2020.3775/2019
                6030463a-2e4e-4f0a-a3e7-400b85b8108f

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 16 February 2020
                : 28 October 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 40, Pages: 11
                Product

                SciELO Spain

                Categories
                Originales

                WOMAC,Ozono,biomarcadores,dolor,artrosis,rodilla,Ozone,biomarkers,pain,osteoarthritis,knee

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