Hyaluronic Acid

Osteoarthritis

The use of hyaluronic acid (HA) in osteoarthritis has been found to be effective in terms of relieving pain due to osteoarthritis (OA) of the knee and may potentially be a structure-modifying drug. Results of a study of 100 patients with OA of the knee who were treated with five weekly injections of intra-articular HA demonstrated significant improvement in terms of pain on walking at week five, which persisted for six months in two-thirds of patients. [Rheumatology 1999; 38: pp.602-607]

Knee Pain

Physicians have injected hyaluronic acid directly into the synovial fluid in the knee as a treatment for osteoarthritis for the last 20+ years. There are many peer-reviewed articles written on the use of hyaluronic acid for this purpose. Please see the link between knee pain and Glucosamine.

In a meta-analysis of eight hyaluronan trials involving 971 patients, outcomes in patients treated with hyaluronan were superior to outcomes in patients treated with placebo at the end of the treatment cycles and after six months. [Ann Rheum Dis 1998;57:pp. 637-40]

Treatment is expensive. For a package of three prefilled syringes of Synvisc, the average wholesale price is $620.00. Third-party reimbursement is variable, but Medicare and most insurance companies now cover viscosupplementation. A product called Synvisc-One is now available which achieves a similar result in just one injection.

A study of Synvisc-One (hylan G-F 20) was conducted in 253 patients in six countries outside the United States. Patients were at least 40 years old, had mild or moderate knee OA and were experiencing moderate to severe knee pain. Patients in the study were given either:

•A single injection of Synvisc-One

•An injection of salt water (called a “saline control”)

The goal was to determine how well Synvisc-One reduced knee pain during five common activities (walking, going up stairs, etc.). Doctors evaluated the patients at weeks 1, 4, 8, 12, 18 and 26.

Results: The study showed that patients who received Synvisc-One had significantly less pain over six months and felt significantly better than the saline control group. Specifically, 71% of patients reported pain relief with Synvisc-One. Most patients reported pain relief starting at week four.

Side effects were also tracked. The types and frequencies of side effects were similar between the two groups. The most common side effects were knee pain, stiffness, and swelling or fluid buildup in or around the knee. These were generally mild to moderate and did not last long. Other side effects, such as rash, may also occur. Side effects were generally mild to moderate and did not last long. No serious side effects were seen in the injected knee during the study that were related to the use of Synvisc-One.

Before trying Synvisc-One or SYNVISC, tell your doctor if you are allergic to products from birds—such as feathers, eggs or poultry—or if your leg is swollen or infected. Synvisc-One and SYNVISC are only for injection into the knee, performed by a doctor or other qualified health care professional. Synvisc-One and SYNVISC have not been tested to show pain relief in joints other than the knee.

Synvisc-One is the same formulation as SYNVISC. The only difference is that Synvisc-One is provided with one injection, compared to the three injections required for SYNVISC. Both treatments can provide up to six months of pain relief.

Here is the home page of this product. This one-time injection costs upwards of $400.00 wholesale, so prolotherapy should be considered for those who can not afford this.

An FDA review of this product, also called Genzyme, at that time, can be found here.

Concern Over Wrinkled Skin

Hyaluronic acid injections can improve the skin’s contour and reduce depressions in the skin due to acne, scars, injury or lines. This augmentation usually lasts between 6-9 months. This effect seems to last considerably longer than collagen implants.