The efficacy of intraarticular PRP, ozone and PRP + ozone injections in patients with osteoarthritis [abstract]
Authors: Ellialtioglu Aysegül , Yeprem Lale 
Published: February 2020

BACKGROUND: Osteoarthritis (OA) is the most common form of arthritis and some joints are predisposed more than others. The prevalence of OA increases with age and it represents the major problem for functional impairment in older patients.

PURPOSE: This study was performed to determine efficiency of ozone + PRP (platelet rich plasma) injections on pain in patients with knee osteoarthritis.

MATERIAL and METHODS: 102 patients with the diagnosis of OA according to the criteria of the American College of Rheumatology were enrolled in this study. Patients were randomized into three equal groups (34 patients each group).
Patients in the first group were treated with intra-articular injections of ozone 2 times/week, with 10 ?g/ml ozone, 5ml in volume for a total of 12 times .
Patients in the second group were treated with intra-articular injections of PRP + ozone (10 ?g/ml ozone, 5 ml volume) once a week for a total of 3 times.
Patients in the third group were treated only with PRP injections once a week for a total of 3 times.
The pain levels of patients were measured with visual analog scale (VAS).We chose the patients with VAS score 5 and above.
The improvement strength has been evaluated according to Clinical Global image scale.

RESULTS: In a retrospective study, Evaluation of the Clinical Global impression scale in the intra-articular injection of all patients (102 patients in total); 36 males and 66 females of 102 patients were found to have an average age of 56.11.
The stress subscale of the 34 patients who had only ozone injections decreased from 5.17 to the healing scale of 2.91
In the 34 patients who received Ozone + PRP combination, the stress subscale decreased from 5,.14 to the healing scale 1.52.
In the 34 patients who had only PRP, the subscale of stress subscale decreased from 4.9 to the healing scale 1.85.
When the mean recovery scores were evaluated, it was 2.26 in the ozone alone group, 3.62 in the ozone + PRP combination and 3.06 in the PRP patients only.
The recovery scores of the patients who received the ozone + PRP combination were significantly better than ozone or PRP injections alone.
No side effects were observed during and after the treatments.

DISCUSSION: OA is a degenerative joint disease that increases with age and causes pain and disability to significantly impair an individual's quality of life.
It is considered to be an organ disease that affects cartilage destruction and changes in the subchondral bone, and all the joints and tissues around the joint. Pathologically, destruction and loss of articular cartilage, subchondral sclerosis and osteophyte formation are often accompanied by synovial inflammation and destruction of other structures that support joint. The loss of pain and functioning impairs the patient to a wide variety of treatment seeking, but unfortunately there are no medical or physical methods that have proven scientifically and proven to be effective in humans to prevent joint cartilage degradation and therefore all treatment approaches are aimed at relieving symptomatic pain and minimizing functional deficits . The goal of treatment in knee OA should be to control pain, to preserve and correct joint functions, to provide functional independence and to improve quality of life. In order to achieve these goals, knee OA therapy should include non pharmacologic, pharmacologic and if necessary, surgical methods. Treatment should be tailored to each patient. Non-steroidal anti-inflammatory (NSAID) drugs are thought to be the standard treatment for OA in many cases but many patients are not able to tolerate these drugs or are exposed to side effects, while only analgesics are adequate in some patients.
As we have seen in the study above; ozone or PRP injections alone can be used for the patients with knee OA but the results of Ozone + PRP injections in knee OA reduced the pain more than the ozone and PRP injections alone.
This might be because of the anti inflammatory effect of ozone has been supported by the release of the growth factors from the platelets in PRP.
Therefore we can add ozone + PRP injections to patients who has OA without hesitation in additional to the classical treatment .
For further studies we can use Major Autohemotherapy for regeneration in addition to the injections of ozone, PRP, Ozone + PRP.

CONCLUSION: The combination of ozone + PRP offers the best results compared with PRP or ozone alone.
We could not get any biopsy from the cartilage so we could not show the healing or changes of the cartilage according to the decrease of pain and the increase of quality of life.
For further studies we could include biopsy and the measurement of inflammatory and anti inflammatory markers from the cartilage tissue before and after treatment.