Physician’s Corner ––

 Oil Those Joints!

By: Ronald A. Ripps, MD

Arthritis sufferers may have been overlooking a fairly new pharmaceutical remedy that is much safer and more effective than anything else in our armamentarium. Hyaluranon is a large molecule made by our cells that plays a major role in the development and function of cartilage and joint fluid. It has had clinical application since the late 1970s, and there are now three brands available –– Hylagan, Synvisc, and Supartz –– which differ slightly by molecular size.

At this time the FDA has only approved use in the knee, but favorable outcomes have already been reported for many other joints to include the hip, shoulder, jaw, basilar joint of the thumb, and even the sacroiliac joints. The drug is delivered directly into the joint by a series three to five injections spaced five to 12 days apart. Patients can have a second series at six months or when symptoms reappear. It may be used in conjunction with one’s usual arthritic medication or in place of it and has been shown to provide 40–80 percent pain improvement for months after treatment.

Curiously, the actual residence time that the hyaluronan stays in the joint is only one to three days, yet the clinical effect can last a year. Originally thought to be only a viscoeleastic joint lubricant, we now know that hyaluronan does much, much more. It not only stimulates our own cells to make more hyaluronic acid, it increases cartilage production, decreases arthritic degradation, and acts as a joint surface analgesic as well.

Although a few recipients of Synvisc have developed transient joint inflammation, the incidence of adverse reactions is very low, comparable to the placebo control group in most studies.

The consensus is that hyaluronan is best suited for individuals who have mild to moderate arthritis. It is especially useful for people who cannot take anti-inflammatory medications: people on blood thinners, people who have kidney or liver disease, or people who have ulcers or bowel disease. It is also indicated for anyone for whom surgery is just not an option (risk of heart disease, for example). Hyaluronan treatment may delay the necessity of total knee replacement is as many as 80 percent of cases. Some of the best results are in people who have patellofemoral arthritis (of the kneecap), which has always been a difficult management problem in the past. There have been some exciting studies that show that hyaluronan promotes scarless wound healing and may help surgeons by preventing adhesions in tendon surgery, abdominal surgery, and heart surgery.

Dr Ripps, a specialist in hip and knee replacement surgery and hand surgery, is the founder of Connecticut Family Orthopedics in Danbury and Ridgefield.