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Hyluronic Acid Injection for Osteoarthritis
Osteoarthritis is the most common form of arthritis in the world, affecting huge numbers of people and is a major cause of disability. As industrialized populations become older and live longer, the effects of osteoarthritis (OA) will become more marked. New treatments are continually being developed as the understanding of OA moves forward rapidly.
The synovial fluid is the fluid secreted by the lining of the knee, hip or ankle joint and other synovial joints. This fluid provides a useful function in the life of our knees. One of the main constituents of synovial fluid, hyaluronic acid, gives viscosity and elasticity to the fluid, allowing it to improve the way joints functions. In OA this viscosity and elasticity is reduced, and this may contribute to the abnormal functioning of the joint.
Viscosupplementation has been developed to replenish the hyaluronic acid part of the synovial fluid. This has shown some promise in improving the pain and abnormal function of osteoarthritic knees. Experiments have shown that adding hyaluronic acid to the cells in human synovial membrane stimulates them to produce hyaluronic acid themselves. Hyaluronic acid as a lubricant and shock absorber in the synovial fluid. It is not toxic when injected, has few side effects and has a rapid onset of action.
The concentration and molecular weight of hyaluronic acid in osteoarthritic joint fluid is reduced. Normal viscosity of the synovial fluid is vital to joint lubrication and is thought to have protective effects on the joint cartilage.
The technique involves the injection of 2ml of high concentration hyluronic acid into the joint. This is usually repeated at weekly intervals for three weeks. Alternately there is a single shot preparation. This increases the concentration and molecular weight of the hyaluronic acid inside the joint. It also has an analgesic effect on the pain mediators in the synovium. The increased viscosity of the synovial fluid also has the effect of increasing joint lubrication, improve the nutrition of the chondrocyte cells in the articular cartilage, and control swelling of the joint.
Injection of hyaluran preparations has shown significantly greater pain relief than injection of a placebo; the effect is as good as taking anti-inflammatory medications. There is better pain relief than injection of steroids, and although the effect takes longer to develop it also lasts much longer than a steroid injection. The average time of pain relief is seven months. However 10% of people did not get any real pain relief. There are few complications to its use and these are usually mild and temporary.
OA costs enormous amounts of money and if this treatment reduces or puts off the need for arthroscopic surgery or joint replacement, there could be a considerable cost saving. This treatment seems to be developing into an important treatment for OA joints.
Arthritis Care www.arthritiscare.org.uk
Complementary Medicine Association www.the-cma.org.uk
National Ankylosing Spondylitis Society www.nass.co.uk
Ankylosing Spondylitis is one of the commonest arthritic diseases, especially amongst young men. Although not usually severely disabling, it can have a big effect on a person’s life.
National Osteoporosis Society www.nos.org.uk
Arthritis Research Campaign www.arc.org.uk
The ARC is the fourth largest medical charity in the UK and had an annual income of £26m in 2001-2. It funds research into all the different kinds of arthritis and provides information for professionals and the public.
Arthritis Researchalot.com. Resource site for everything to do with arthritis. Full of newsletters, articles, links and other resources – ALL FREE – in one easy to navigate site to save time and money.
Arthritis Resources. Comprehensive information. A comprehensive site devoted to arthritis and degenerative joint disease. www.arthritisedu.com
Author: DAVID P JOHNSON MB ChB FRCS FRCS. MD
Consultant Orthopaedic Surgeon
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