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Dr.Tim Rindlisbacher. National Post - Jan 2008
29 Jan 2008
These articles are independently commissioned and the author may express opinions which are not necessarily those of Smith & Nephew limited.
Nobody likes injections. Pointy things hurt. Plus, we all wince when remembering how scary it was to get vaccinated as a child. But, while I've seen burly, 250-pound athletes pass out during a blood draw, there is one class of patient that welcomes the needle: people suffering from painful osteoarthritis. Cortisone has been the injection of choice for arthritic joints since the 1950s. This steroid is rapidly falling out of favour as studies show that repeated injections can degenerate the very joints they're meant to relieve. In its place, there's a new treatment that many people believe offers a substantial reduction of osteoarthritis pain.
They call it viscosupplementation. It's not a drug. Health Canada categorizes it as a device. Actually, the procedure involves the injection of a thick, jelly-like fluid (hyanluronate) into the afflicted joint, typically the knee. Hyanluronate mimics synovial fluid, the substance that oils our joints naturally but also degrades along with bone-cushioning cartilage as osteoarthritis progresses.
Your doctor gets viscosupplement prepackaged in small syringes. The standard treatment is three once-weekly injections, but a newly released variation only calls for a single shot. My patients seem to report the greatest pain relief eight to 12 weeks after receiving treatment, and they commonly feel some benefit for six months to a year.
Viscosupplementation is especially appropriate if you don't get relief from other treatments, such as physical therapy, weight loss, heat treatments or anti-inflammatories such as aspirin and ibuprofen. It appears to do the most good in early osteoarthritis, but can be used at any stage of the disease. Usually, viscosupplementation injections are reserved until everything else -- short of surgery --has been tried.
With our health system, many of us know or have heard about people who've spent months on lists waiting for joint replacement surgery. Anyone in this situation might want to consider viscosupplementation. It won't preclude surgery, but for temporary pain relief, it could be well worth the poke.
- Tim Rindlisbacher, BSc (PT), MD, diploma in sport medicine, is director of sports health at the Cleveland Clinic in Toronto.
