RESUMO
Rheumatoid arthritis (RA) and osteoarthritis (OA) are the most common arthritic diseases. Medical ozone has demonstrated its effectiveness in combination therapy with methotrexate or non-steroidal anti-inflammatory drugs for RA and OA, respectively. Although RA and OA have been compared from different points of view, few studies have considered their redox status in spite of the oxidative processes that are involved in both diseases. The aim of this study was to compare RA with OA, evaluating their redox status and the effects of ozone on their clinical response to combined therapy with ozone. The redox status of 80 patients was determined: antioxidant defenses, injury markers, two subjective variables (pain and disability), and levels of antibodies against cyclic citrullinated peptides were evaluated. Oxidative stress and clinical response to combined therapy with ozone was higher than in the case of RA. After medical ozone treatment, there was an increase in antioxidant defense and a decrease in injury markers as well as pain, disability, and autoantibody concentrations. Redox biomarkers were able to differentiate between both arthritic diseases and combined therapy with ozone (methotrexate + ozone), showing a therapeutic selectivity for RA in comparison with OA.
RESUMO
Medical ozone reestablishes cellular redox balance so that it may be a valid therapeutic approach in the prevention and management of age-related diseases with oxidative etiology in older people. The aim of this study is to evaluate oxidative stress and some vasoactive substances in elderly (60-70 years) rheumatoid arthritis patients with diabetes and hypertension, as well as another group with bronchial asthma patients in order to demonstrate the beneficial effects of medical ozone in the prevention and therapy of age-related diseases in these age groups. A randomized clinical study with 45 older patients (60-70 years) was performed. Group I (n = 15) with rheumatoid arthritis + diabetes and hypertension received no ozone treatment, and group II (n = 30) was treated with medical ozone. This group was divided into two subgroups (n = 15 each), group IIa: the same as group I + medical ozone and group IIb: bronchial asthma patients. Indicators of RA in I and IIa groups were evaluated. Redox balance was assessed through defense and injury biomarkers. Thromboxane A2 (TXA2) and prostacyclin levels were assessed in group IIb patients. Medical ozone arrested oxidative injury progression in the Ia group and decreased thromboxane levels and the TXA2/6-keto PGF1α ratio in the IIb group. Medical ozone arrested the progression of oxidative damage and modulated those endogenous mechanisms that promote a suitable redox status and TXA2/PGI2 balance. These results suggest that medical ozone may become a standard approach in the prevention and management of age-related oxidative diseases in elderly people.
RESUMO
Introducción: El ozono médico tiene eficacia clínica e incrementa la relación beneficio/riesgo en pacientes con artritis reumatoide tratados con la terapia combinada metotrexate + ozono. Hoy, la gamma glutamil transferasa se considera como un marcador de riesgo de enfermedades de una alta morbilidad y mortalidad, y tiene particular valor en la artritis reumatoide por desempeñar un papel patológico asociado al estrés oxidativo y a la remodelación ósea, lo que causa daño al cartílago y al hueso. Objetivo: Evaluar los efectos del ozono médico sobre los niveles de gamma glutamil transferasa. Métodos: Se estudiaron pacientes portadores de dos enfermedades artríticas: artritis reumatoide (n = 100; grupo tratado con metotrexate [n = 50] y grupo con metotrexate + ozono [n = 50]) y osteoartritis de rodilla (n = 40; grupo precondicionado con ozono antes de la artroscopía [n = 20] y grupo sin pretratamiento con ozono antes de la artroscopía [n = 20]). Los pacientes con artritis reumatoide fueron valorados con indicadores clínicos específicos, incluidos los niveles de anticuerpos contra péptidos cíclicos citrulinados, así como las concentraciones de glutatión reducido, importante antioxidante endógeno. Resultados: El ozono médico reguló la actividad sérica de gamma glutamil transferasa. Correlacionó de forma inversamente proporcional con los niveles de glutatión reducido que, a su vez, fue el único marcador redox que para los pacientes tratados con la terapia combinada metotrexate + ozono fue directamente proporcional con todas las variables clínicas evaluadas. Conclusión: Se debe considerar a la gamma glutamil transferasa un indicador de la eficacia clínica del ozono médico en las enfermedades estudiadas, por su doble función: biomarcador de estrés oxidativo e indicador de la remodelación patológica del hueso(AU)
Introduction: Medical ozone has demonstrated its clinical efficacy as well as the increase of beneficial/risk relationship in rheumatoid arthritis patients treated with metotrexate+ozone combined therapy. At present, gamma-glutamyl transpeptidase is considered as risk indicator of high morbimortality diseases. It has a special value in arthritis diseases due to its pathologic role associated to oxidative stress and in the abnormal bone remodeling processes. Objective: Assess the ozone medical effects on gamma-glutamyl transpeptidase levels. Method: Patients who suffered of two arthritic diseases: rheumatoid arthritis (n=100; Group treated with Metotrexate (n=50) and metotrexate+ozone (n=50) and knee osteoarthritis (n=40); Group preconditioned with ozone before arthroscopy (n=20) and Group without previous treatment with ozone before arthroscopy (n=20). Rheumatoid arthritis patients were assessed through specific clinic indicators which included antibodies against cyclic citrullinate peptides as well as reduced gluthatione concentrations which are an important endogenous antioxidant. Results: Medical ozone regulated serum gamma-glutamyl transpeptidase activity which correlated in inverse proportion to reduced glutathione levels which was the only one redox marker that correlated with all clinical variables (p < 0.05) when patients were treated with metotrexate+ozone. Conclusion: Gamma-glutamyl transpeptidase should be considered as biomarker of medical ozone clinical efficacy in rheumatoid arthritis and knee osteoarthritis due to GGT´s both pathologic functions: indicator of oxidative stress and abnormal bone remodeling processes(AU)
Assuntos
Humanos , Masculino , Feminino , Ozônio/uso terapêutico , Artrite Reumatoide/terapia , Osteoartrite do Joelho , gama-Glutamiltransferase/análise , Resultado do Tratamento , Terapia CombinadaRESUMO
Realizamos un estudio prospectivo descriptivo y analítico acerca de 130 pacientes con el diagnóstico de Artritis Reumatoide de cuerdo con los criterios del Colegio Americano de Reumatología.(ACR), en los cuales se evaluaron una serie de variables muchas de las cuales resultan inusualmente estudiadas aunque entrañan un incalculable valor. Se analizaron variables como el comportamiento clínico de la enfermedad, frecuencia y severidad de las crisis, discapacidad mediada por HAQ, en su versión cubana recientemente validada, frecuencia de manifestacione extraarticulares , tratamiento utilizado así como el nivel de respuesta y causas determinantes de la suspensión del tratamiento . Se evaluó finalmente el nivel de aceptación en el orden psicológico de laenfermedad. Los resultados fueron volcados en tablas de salida y se destacan conclusiones de interés científico acerca de la serie de pacientes cubanos estudiada(AU)