Osteoarthritis Management with Hyaluronic Acid and Ozone Therapy

Guideline Recommendations

• The American College of Rheumatology/Arthritis Foundation conditionally recommends against intra-articular hyaluronic acid injections for patients with knee and first carpometacarpal joint osteoarthritis, and strongly recommends against them for patients with hip osteoarthritis, based on meta-analyses showing limited effect size compared to saline injections 1, 2
• Clinicians may still consider hyaluronic acid injections for patients who have failed to achieve adequate symptom relief with other treatments, as acknowledged by guidelines from the American College of Rheumatology/Arthritis Foundation 2, 3

Treatment Selection and Efficacy

• The American College of Rheumatology recommends beginning with non-pharmacologic therapies, topical and oral NSAIDs, and intra-articular steroids as first-line treatments for osteoarthritis, with hyaluronic acid and ozone therapy considered for patients with inadequate response to first-line treatments 1, 2
• Neither ozone nor hyaluronic acid injections are strongly supported by current osteoarthritis treatment guidelines due to limited evidence of benefit, as stated by the American College of Rheumatology/Arthritis Foundation 1, 2, 4