Viscosupplementation offers OA pain relief


1st on the web (January 17, 2008)
January 2008

LAHAINA, Hawaii - Using hyaluronic acid supplementation can offer pain relief for patients with osteoarthritis, according to an orthopedic investigator.

Hyaluronic acid (HA) suppresses cartilage degeneration, reduces the release of proteoglycans from the extracellular matrix of cartilage tissue, suppresses PGE2 production, and influences viscoelasticity and/or lubrication of the stroma.

"There is no question that as we get older we loose sodium hyaluronate," Robert D. D'Ambrosia, MD, said at Orthopedics Today Hawaii 2008, held here. "The concentration and molecular weight of these molecules in the synovial fluid are substantially decreased as we get older."

As these properties are decreased, the synovial fluid loses the ability to lubricate and protect joint cells, and the tissue is compromised, he said.

"The most distinctive property these products have, viscoelasticity, depends on the amount of shear force to which they are exposed," D'Ambrosia said. "If you have low shear force, you are going to have high viscosity and low elasticity, and if you have a high shear force, you will have reduced viscosity and increased elasticity."

D'Ambrosia, who uses HA viscosupplementation on his own knee, said the injections of HA provide relief for 1 to 6 months.

"I have a degenerative meniscus and I have been using it for about 8 years, and I haven't had my total knee replacement yet," D'Ambrosia said.

Although the actual biologic reasons are not clear as to why it works, D'Ambrosia said it could be an anti-inflammatory or direct analgesic effect.

Randomized clinical trial data across many studies indicate a 50% to 80% success rate, he said.

"I am using this as a conservative method, after weight loss and exercise, before I do a total knee replacement," he said.

Adverse events have been reported at less than 2% and include injection site pain, local skin reactions, pseudosepsis or severe acute inflammatory reaction, or acute pseudogout.

For more information:

D'Ambrosia RD. Local treatment for local disease. Presented at Orthopedics Today Hawaii 2008. Jan. 13-16, 2008. Lahaina, Maui, Hawaii.


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