Arthritic Conditions
HBOT for Arthritic Conditions
Introduction
Both preclinical and clinical evidence shows that hyperbaric oxygenation therapy or hyperbaric oxygen therapy (HBOT), has potential as an adjunctive treatment to manage inflammation and pain associated with arthritic conditions, particularly rheumatoid arthritis. Hyperbaric Oxygenation (HBO) is a form of therapy directed to significantly increase the partial pressure of oxygen in the blood and in the tissues of the patients to the levels significantly exceeding those achieved in normobaric conditions.
Mechanisms of Action of HBOT
Hyperbaric Oxygen Therapy (HBOT) consists of breathing oxygen at a pressure higher than local atmospheric pressure for the treatment or prevention of specific diseases. There is a general consensus that the term HBOT can only be applied when the partial pressure of oxygen in breathing mixture exceeds 1.5 absolute atmosphere (ATA) for a minimum period of 60 minutes (excluding compression and decompression) for multiple sessions. HBOT may benefit arthritis associated with inflammation through several mechanisms, primarily by enhancing oxygen delivery to tissues and relieving inflammation.
1. Enhanced Oxygen Delivery: Arthritic joints often suffer from hypoxia, which may worsen inflammation and impair tissue repair (Quiñonez-Flores et al., 2016a). HBOT increases the amount of oxygen dissolved in the blood, significantly improving oxygen delivery to tissues (Cannellotto et al., 2024).
2. Reduced Inflammation: Many arthritic conditions are associated with inflammation (Poudel et al., 2023). HBOT may decrease inflammation by inducing a reduction in the levels of pro-inflammatory cytokines and modulating the immune response (Cannellotto et al., 2024). In autoimmune and inflammatory arthritis models, HBOT promotes an anti-inflammatory immune phenotype, leading to a decrease in arthritic symptoms (Harnanik et al., 2019; Harnanik et al., 2020a). HBOT decreases inflammatory cytokines in the arthritic joint (Harnanik et al., 2020b) and modulates the activity of several other inflammatory pathways associated with arthritis and joint damage (Bosco et al., 2018; Lin et al., 2019).
3. Modulation of Oxidative Stress: Oxidative stress plays a significant role in the pathogenesis of both arthritis (Quiñonez-Flores et al., 2016b; Ansari et al., 2020). Reactive oxygen species (ROS) produced by activated immune cells cause tissue damage and perpetuate inflammation. HBOT may reduce excessive ROS production (Bosco et al., 2018; De Wolde et al., 2021) and hyperbaric oxygen has been shown to reduce the levels of reactive oxygen species in a rat model of auto-immune arthritis (Nagatomo et al., 2009).
4. Mitochondrial Function: Mitochondrial dysfunction is implicated in inflammatory arthritic conditions, such as rheumatoid arthritis (Ma et al., 2022). HBOT enhances mitochondrial function by improving oxygen availability, boosting ATP production, and reducing oxidative damage (Schottlender et al., 2021).
5. Cartilage Protection and Regeneration: Some preclinical studies suggest HBOT may promote cartilage repair following injury (Yuan et al., 2004; Ueng et al., 2013; Leite et al., 2023).
Benefits of HBOT for Patients with Arthritic Conditions
HBOT is generally well tolerated and serious side effects are rare (Camporesi, 2014; Zhang et al., 2023). There are several potential benefits of HBOT as an adjunctive therapy for patients with arthritic conditions, including:
1. Pain Relief: By reducing inflammation and oxidative stress and promoting tissue repair, HBOT may help alleviate the joint pain associated with inflammation (Sümen et al., 2001), including in rheumatoid arthritis patients (Sit et al., 2021). The anti-inflammatory effects of HBOT correlate with reductions in pain and stiffness in animal models and patients, providing patients with a non-pharmacological alternative for pain management (Slade et al., 2016; Hallak et al., 2024).
2. Improvement in Joint Function and Activity: The benefits of HBOT in alleviating inflammation and promoting healing may translate into improved joint function for patients with rheumatoid arthritis (Slade et al., 2016).
3. Reduced Dependency on Medication: Long-term use of anti-inflammatory and pain-relieving medications can lead to adverse effects, including gastrointestinal issues, cardiovascular risks, and immunosuppression (Ghlichloo & Gerriets, 2023; Yasir et al., 2023). HBOT may help patients reduce their reliance on these medications (Hallak et al., 2024), minimising the risk of side effects and improving overall health outcomes.
4. Enhanced Quality of Life: Enhanced quality of life: HBOT’s ability to alleviate pain, improve mobility, and reduce medication dependency can collectively enhance patients’ quality of life (Slade et al., 2016). Enhanced quality of life: HBOT’s ability to alleviate pain, improve mobility, and reduce medication dependency can collectively enhance patients’ quality of life (Slade et al., 2016).
Clinical Evidence Supporting HBOT of Arthritic Conditions
While more large-scale, randomised controlled trials are needed to definitively establish HBOT’s role in arthritis treatment, the available clinical and preclinical evidence suggests that HBOT can provide tangible benefits for patients with inflammatory forms of arthritis, such as rheumatoid arthritis.
1. Animal Studies: Animal studies: Numerous animal studies have shown the potential benefits of HBOT in treating arthritic conditions. In a rat model of rheumatoid arthritis, HBOT (100% O2, 2 ATM, 60 mins, 18 daily treatments) led to a decrease in arthritis scores, paw swelling and levels of TNF‐α and IL‐1β that were comparable to the effects of etanercept or leflunomide (Hallak et al., 2024). In a collagen-induced mouse model of arthritis, HBOT (100% O2, 2 ATM, 90 mins, daily treatments) decreased joint swelling and inflammatory tissue damage and increased anti-inflammatory regulatory T cells (Moon et al., 2017). Other studies in animals have shown that HBOT may be as effective as pharmacological interventions in reducing pain and inflammation. In a carrageenan-induced model of acute arthritis in rats, a single 90-minute HBOT session at 2.4 ATM was as effective as aspirin in decreasing mechanical paw withdrawal thresholds and joint inflammation (Wilson et al., 2007). Similar results have been reported comparing the effect of diclofenac and HBOT on paw oedema in the same model (Sümen et al., 2001).
2. Reviews: The literature review of Kinga et al. (2024) concluded that HBOT of rheumatoid arthritis reduces the severity of pain and swelling in the knee and hand joints and slows the process of joint destruction.
3. Clinical Studies: Preliminary studies indicate that HBOT may be beneficial in the treatment of patients with arthritic conditions (Kamada, 1985; Slade et al., 2016; Sit et al., 2021; Dulberger et al., 2023). In a pilot study in the USA, nine rheumatoid arthritis patients underwent HBOT (100% O2, 2 ATA, 90 minutes, 30 sessions over 6–10 weeks) and none of the patients demonstrated radiologic progression of erosions, synovitis or bone marrow oedema at 3- and 6-month scans (Dulberger et al., 2023). In the same study, there was a statistically significant effect of HBOT on disease activity scores and decreases in pain were observed (Sit et al., 2021). A case report described three patients who were treated with HBOT (100% O2, 2 ATA, 90 minutes, 7–55 sessions) for unrelated diagnoses who all reported significant improvements in rheumatoid arthritis-related pain, increased activity and improved sleeping patterns (Slade et al., 2016).
Conclusion
HBOT holds promise as an adjunctive treatment for various types of arthritis, offering potential benefits through its anti-inflammatory, antioxidant, and regenerative effects. Clinical evidence suggests that HBOT can reduce pain, improve joint function, and enhance quality of life for patients with rheumatoid arthritis. Although further research is needed to establish its efficacy, HBOT represents a valuable therapeutic option for inflammatory arthritis patients seeking non-pharmacological alternatives to manage their symptoms.
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