Medical ozone increases methotrexate clinical response and improves cellular redox balance in patients with rheumatoid arthritis

Eur J Pharmacol. 2016 Oct 15:789:313-318. doi: 10.1016/j.ejphar.2016.07.031. Epub 2016 Jul 20.


Medical ozone reduced inflammation, IL-1β, TNF-α mRNA levels and oxidative stress in PG/PS-induced arthritis in rats. The aim of this study was to investigate the medical ozone effects in patients with rheumatoid arthritis treated with methotrexate and methotrexate+ozone, and to compare between them. A randomized clinical study with 60 patients was performed, who were divided into two groups: one (n=30) treated with methotrexate (MTX), folic acid and Ibuprophen (MTX group) and the second group (n=30) received the same as the MTX group+medical ozone by rectal insufflation of the gas (MTX+ozone group). The clinical response of the patients was evaluated by comparing Disease Activity Score 28 (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), Anti-Cyclic Citrullinated (Anti-CCP) levels, reactants of acute phase and biochemical markers of oxidative stress before and after 20 days of treatment. MTX+ozone reduced the activity of the disease while MTX merely showed a tendency to decrease the variables. Reactants of acute phase displayed a similar picture. MTX+ozone reduced Anti-CCP levels as well as increased antioxidant system, and decreased oxidative damage whereas MTX did not change. Glutathione correlated with all clinical variables just after MTX+ozone. MTX+ozone increased the MTX clinical response in patients with rheumatoid arthritis. No side effects were observed. These results suggest that ozone can increase the efficacy of MTX probably because both share common therapeutic targets. Medical ozone treatment is capable of being a complementary therapy in the treatment of rheumatoid arthritis.

Keywords: Medical ozone; Methotrexate; Rheumatoid arthritis.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Antirheumatic Agents / pharmacology
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / metabolism*
  • Biomarkers / metabolism
  • Drug Synergism
  • Female
  • Humans
  • Male
  • Methotrexate / pharmacology
  • Methotrexate / therapeutic use*
  • Middle Aged
  • Oxidation-Reduction / drug effects
  • Ozone / pharmacology*
  • Treatment Outcome


  • Antirheumatic Agents
  • Biomarkers
  • Ozone
  • Methotrexate