Treating Osteoarthritis with Hyaluronic Injections

What is osteoarthritis?

Osteoarthritis is a painful joint problem. It is also called degenerative arthritis or wear-and-tear arthritis. Arthritis is what happens when the tissue that protects the bones wears away. This tissue is called cartilage (say: car-till-edge).

What causes osteoarthritis?

Doctors don't know what causes joint cartilage to wear away. But they do know that osteoarthritis is more common as you get older or if you are very overweight. Sometimes a serious knee, hip, shoulder or other joint injury can bring on arthritis after a few years.

How can my doctor tell if I have osteoarthritis?

The presence of osteoarthritis can be determined by case history questions, physical examination and x-ray. These x-rays can determine how serious the problem is.

How does hyaluronic injections treat my osteoarthritis?

Conservative non-invasive treatments are attempted first. If you still have knee pain, you may wish to consider joint injection therapy.

In the past few years, a medicine called hyaluronic acid has been used for joint injections. Some hyaluronic acid is already in the fluid in your joints. In people with osteoarthritis, the hyaluronic acid gets thinner. When this happens, there isn't enough hyaluronic acid to protect the joint like it used to. Injections can put more hyaluronic acid into your joints to help protect it.

Hyaluronic acid injections can help you in several ways. They may give you more pain relief than medications. They should improve your level of function and degree of pain and discomfort. If you have been told that you might need surgery on your joint, hyaluronic acid injections can make the pain go away long enough that you might not have to have surgery, or you might be able to delay having surgery. These injections can help the pain stay away for six months to a year, and sometimes longer. At IHA, we combine hyaluronic acid treatments with prolotherapy, trigger point therapy, acupuncture and other treatment to get the optimal benefit for your condition. Although most people benefit from these procedures, These injections don't help everyone. Usually a therapeutic trial of about 3-4 treatments is initiated to determine if they will be of benefit.

Hyaluronic acid injections are usually expensive, many physicians charge $300 to $600. At Integrative Healing Arts, the cost of Hyaluronic Acid Injections are included in the cost of prolotherapy joint injection therapies at a fraction of the medical cost.


Intra-articular Hyaluronic Acid Injections for Knee Osteoarthritis

DENNIS Y. WEN, M.D. University of Missouri­Columbia Medical School, Columbia, Missouri

Knee osteoarthritis is a common but often difficult problem to manage in primary care. Traditional nonsurgical management, consisting of lifestyle modification, physical therapy and pharmacologic therapy (e.g., analgesics, anti-inflammatory medications), is often ineffective or leaves residual symptoms. Viscosupplementation is a newly available option for patients with symptomatic knee osteoarthritis that involves a series of intra-articular injections of hyaluronic acid. The exact mechanism of action is unclear, although increasing the viscoelasticity of the synovial fluid appears to play a role. Clinical experience and studies of the two hyaluronic acid products available, hyaluronan and hylan G-F 20, are inconclusive but seem to indicate beneficial effects with minimal adverse reactions in a significant number of patients. The exact indications for viscosupplementation are still evolving, but it currently can be considered for use in patients who have significant residual symptoms despite traditional nonpharmacologic and pharmacologic treatments. In addition, patients who are intolerant of traditional treatments (e.g., gastrointestinal problems related to anti-inflammatory medications) can be considered for these injections. Family physicians with the ability to perform intra-articular knee injections should consider them an option in patients with symptomatic knee osteoarthritis. (Am Fam Physician 2000;62:565-70,572.)