Ozone Therapy for Rheumatic Diseases and Fibromyalgia

Stiff joints can make getting dressed in the morning difficult. Pain may cut a walk short, while a full night's sleep can still leave you feeling tired. These everyday difficulties matter when planning care for rheumatic diseases or fibromyalgia.

Ozone therapy is being studied as an addition to existing treatments. Researchers are looking at its possible effects on the immune response and the ways cells protect themselves, as well as symptoms such as pain, poor sleep and fatigue.

How does ozone relate to the immune response?

Immune cells communicate through chemical signals. In autoimmune conditions such as rheumatoid arthritis, the immune response can turn against the body's own tissues and keep joints inflamed. Treatment aims to regulate the response driving the disease.

Changing or regulating an immune response is called immunomodulation. Ozone is being studied because it can affect how cells respond to oxidative stimuli and influence some signals involved in inflammation. These effects help explain the interest in ozone as a complementary approach. Clinical studies are needed to understand what benefit a patient might experience. 1, 2

How cells protect themselves

Cells have their own antioxidant defences against oxidative stress. A protein called Nrf2 helps control the genes involved in these defences. A preliminary study in healthy volunteers found a temporary increase in Nrf2 activation and greater activity of certain antioxidant enzymes after ozone treatment. 1

Studies in animal models of arthritis have also reported changes involving TNF-alpha and IL-1 beta, signalling molecules that take part in inflammation. These findings help researchers understand the relationship between antioxidant defences and inflammation. Studies in patients assess how far such cellular changes translate into differences in symptoms. 2

What have studies in rheumatoid arthritis found?

One randomised study examined ozone as an addition to medication in 60 people with rheumatoid arthritis. Patients who received rectal ozone alongside a methotrexate-based treatment had more favourable changes in disease activity, daily function and certain oxidative stress markers after 20 days of treatment. 2

The study was small and brief, which matters when deciding how widely its findings apply. It also used rectal ozone, so the same results cannot be assumed for every rheumatic disease or other ways of administering ozone. Any additional treatment is assessed individually, with rheumatology follow-up and the medication used to control the underlying disease continuing as part of care.

Pain, sleep and fatigue in fibromyalgia

Fibromyalgia can cause widespread pain, fatigue, unrefreshing sleep and difficulty concentrating. It is not a classical inflammatory joint or autoimmune disease. How the nervous system processes pain is an important part of the condition. Research into ozone in fibromyalgia therefore needs to consider pain processing as well as immune responses. 3

A double-blind, placebo-controlled study involving 54 people with fibromyalgia found improvements in certain measures of sleep quality, fatigue and feeling well with ozone as an additional treatment. There was no statistically significant difference between the groups in the overall Fibromyalgia Impact Questionnaire score, which measures the condition's impact on daily life. The findings differed depending on the symptom or outcome measured. 4

Another study, published in 2025, reviewed the records of 25 patients and reported improvements in pain, sleep, fatigue and daily function. It had no control group, so the researchers could not establish how much of the change was due to ozone itself. These findings offer a starting point for larger studies. 5

What would make a difference in your daily life?

Your priority might be waking up feeling more rested. For someone else, it may be finishing a walk comfortably or finding everyday tasks less tiring. Discussing these goals helps connect treatment decisions with the difficulties you want to address.

Suitable exercise, sleep management and medication when needed remain central to fibromyalgia care. Considering ozone as an additional option involves reviewing your current treatments, overall health and personal priorities together. 3

Before your appointment, you can note which activities pain makes difficult, how tired you feel during the day and whether sleep leaves you refreshed. You can also describe how long you can walk comfortably. These details help you and your doctor discuss suitable options and track changes against clear goals. Whether ozone therapy has a place in your care can be considered during that conversation.

Sources

1. Re et al., 2014: A preliminary study of Nrf2 activation and antioxidant enzyme responses in healthy volunteers.
2. León Fernández et al., 2016: A randomised study of 60 patients assessing rectal ozone alongside methotrexate-based treatment for rheumatoid arthritis.
3. American College of Rheumatology: Patient information on fibromyalgia symptoms, pain processing and treatment.
4. Sucuoğlu and Soydaş, 2023: A double-blind, placebo-controlled study of additional ozone treatment in 54 people with fibromyalgia.
5. Üşen et al., 2025: A retrospective review of 25 fibromyalgia patients, without a control group.