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Viscosupplementation May Relieve Pain in Knee Arthritis

NEW YORK (May 1, 2013)

As we age, the wear and tear on joints can result in osteoarthritis, particularly in weight-bearing joints such as the knees. It's a problem that affects up to 27 million Americans, "and the incidence is growing," according to Jeffrey A. Geller, M.D., an orthopedic surgeon at NewYork-Presbyterian.

In osteoarthritis, the cartilage that acts to cushion around bones in a joint wears away and the bones rub together, causing inflammation and pain. In addition, the usually viscous synovial fluid that helps lubricate joints decreases and becomes more watery.

Managing Symptoms

Jeffrey A. Geller, M.D.
Jeffrey A. Geller, M.D.

"We can't stop osteoarthritis so the goals of treatment are to manage symptoms," said Gregory S. DiFelice, M.D., also an orthopedic surgeon at NewYork-Presbyterian. For knee osteoarthritis, weight loss and low-impact exercise are the cornerstones of treatment followed by use of pain relievers (NSAIDs) and cortisone injections. However, for some patients a technique known as viscosupplementation may provide symptom relief.

With viscosupplementation, doctors inject hyaluronic acid into the joint. The acid, which already occurs naturally in synovial fluid, returns the fluid's viscosity closer to its original form. "Hyaluronic acid essentially acts as a lubricant for the remaining cartilage," said Dr. Geller. The main benefit of this treatment is pain relief and improvement in function as a by-product."

Gregory S. DiFelice, M.D.
Gregory S. DiFelice, M.D.

The exact mechanism of action of viscosupplementation is not entirely clear, Dr. DiFelice explained. Clinical studies show conflicting data, with some showing no improvement over cortisone injection or placebo and some showing better efficacy. "However, what we do know is that a good number of people do feel better from these injections," he said. Pain relief can last six months or more in some patients and the treatment can be repeated.

Injections Work Best in Mild to Moderate Disease

The injections tend to work better in patients with mild to moderate osteoarthritis who are symptomatic. "Patients who present with advanced arthritis have a low chance of success with these types of injections," said Dr. Geller. "I prefer to give patients with advanced disease a cortisone injection, which has been proven to be more effective with better pain relief and improvement in swelling."

Viscosupplementation has a low risk of side effects, with pain, swelling, or bruising at the injection site being the most common. Patients with an egg or bird allergy should mention this to their doctor as the hyaluronic acid used in the injections is derived from chicken combs.

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