Viscosupplementation Treatment for Arthritis

The first line of treatment for osteoarthritis of the knee aims to relieve pain. Normally, pain
relievers such as ibuprofen or nonsteroidal anti-inflammatory drugs (NSAIs! are used, along
"ith physical therapy, applications of a topical analgesic and in#ections of a corticosteroid.
$o"ever, some people have a reaction to NSAIs and these agents usually bring only temporary
relief.
A relatively ne" procedure, called viscosupplementation, in#ects a preparation of hyaluronic acid
into the knee #oint. $yaluronic acid is a naturally occurring substance found in the synovial
(#oint! fluid. It acts as a lubricant to enable bones to move smoothly over each other and as a
shock absorber for #oint loads.
%eople "ith osteoarthritis (&"ear-and-tear& arthritis! have a lo"er-than-normal concentration of
hyaluronic acid in their #oints. 'iscosupplementation may be a therapeutic option for individuals
"ith osteoarthritis of the knee.
(ffects of 'iscosupplementation
'iscosupplementation has been sho"n to relieve pain in many patients "ho cannot get relief
from nonmedicinal measures or analgesic drugs. The techni)ue has been used in (urope and Asia
for several years, but the *.S. +ood and rug Administration did not approve it until ,--., and
then only for treating osteoarthritis of the knee. Several preparations of hyaluronic acid are no"
commercially available.
Immediate (ffects
$yaluronic acid does not have an immediate pain-relieving effect.
/ou may notice a local reaction, such as pain, "armth, and slight s"elling immediately
after the shot. These symptoms generally do not last long. /ou may "ant to apply an ice
pack to help ease them.
+or the first 01 hours after the shot, you should avoid e2cessive "eightbearing on the leg,
such as standing for long periods, #ogging or heavy lifting.
3onger Term (ffects
4ver the course of the in#ections, you may notice that you have less pain in your knee.
$yaluronic acid does seem to have anti-inflammatory and pain-relieving properties. The
in#ections may also stimulate the body to produce more of its o"n hyaluronic acid.
(ffects may last for several months.
Treatment
If there is any s"elling (effusion! in the knee, your physician "ill remove (aspirate! the e2cess
fluids before in#ecting the hyaluronic acid. *sually, this can be done at the same time, "ith only
one needle in#ected into the #oint, although some doctors may prefer to use t"o separate syringes.
epending on the product used, you "ill receive 5 to 6 shots over several "eeks.
4utcome
'iscosupplementation can be helpful for people "hose arthritis has not responded to basic
treatments. It is most effective if the arthritis is in its early stages (mild to moderate!. Some
patients may feel pain at the in#ection site, and occasionally the in#ections result in increased
s"elling.
The long-term efficacy of viscosupplementation is not yet kno"n and research continues in this
area.
If your arthritis is not responding "ell or if you are trying to delay surgery, you may "ish to
discuss this option "ith your orthopaedic surgeon.
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