- Euflexxa Launched, New Treatment for Osteoarthritis Knee Pain
- Do Hyaluronic Acid Injections Work for Knee Osteoarthritis?
- Research Regarding Hyaluronic Acid Injections for Knee Osteoarthritis
- Knee injections or knee replacement: What are my options?
- Corticosteroid injections
- Other injections
- Delaying your surgery
- Knee replacement risks
- Drugs & Medications
- hyaluronate/hyaluronan (Hyalgan, Supartz, Euflexxa, Orthovisc) Osteoarthritis Drug Side Effects
- What are the uses for hyaluronate injection?
- What is the dosage for hyaluronate injection?
- Which drugs or supplements interact with hyaluronate injection?
- Is hyaluronate injection safe to take if I'm pregnant or breastfeeding?
- What preparations of hyaluronate-injection are available?
- How should I keep hyaluronate-injection stored?
- What You Should Know About Euflexxa If You Have Knee Arthritis
- Hyaluronic Acid Injections: How Do They Treat Arthritis?
- What Is Hyaluronic Acid, and What Does It Do?
- Why Would an Arthritis Patient Get Hyaluronic Acid Injections vs. Other Treatments?
- Is It Worth Getting Hyaluronic Acid Shots to Delay a Knee Replacement? Should You Just Get the Surgery?
- Where Are Hyaluronic Acid Shots Given? Do They Hurt?
- How Long Does Relief Last?
- What Are the Side Effects of Hyaluronic Acid Shots?
- Why Don’t Some Medical Groups Recommend Hyaluronic Acid Shots?
- Keep Reading
Euflexxa Launched, New Treatment for Osteoarthritis Knee Pain
SUFFERN, N.Y., Nov. 14 /PRNewswire/ — Ferring Pharmaceuticals Inc. announced today the launch of EUFLEXXA(TM) (highly purified hyaluronan) for the treatment of pain caused by knee osteoarthritis (OA).
It is the first and only non-avian* derived hyaluronic acid (HA) indicated for a three-injection treatment regimen for patients who have failed to respond adequately to conservative non-pharmacologic therapy and simple analgesics. At the end of a 12-week study, significantly more patients treated with EUFLEXXA(TM) were symptom-free (p=0.
038) than those treated with Synvisc**, the leading HA product in its class.(1)
“EUFLEXXA(TM) is a new treatment option that can help millions of people who live with painful knees,” said Wayne C. Anderson, president, Ferring Pharmaceuticals. “It is proven to offer better drug-free symptom relief over a 12-week period than the current leading HA therapy.
Additionally, it offers proven safety and efficacy with significantly fewer joint effusions and less use of simple analgesics than Synvisc. Not surprisingly, patients reported higher satisfaction with EUFLEXXA(TM).”
In a prospective, multicenter, randomized, double-blind controlled trial, 321 patients with confirmed knee osteoarthritis were randomized to treatment with either EUFLEXXA(TM) (n=160) or Synvisc (n=161). The Western Ontario McMaster Universities Osteoarthritis (WOMAC) Index pain subscale was the primary efficacy measure.
Both products were administered as a course of three weekly injections, with follow-up evaluations at weeks 3, 6 and 12. Both treatment groups experienced statistically significant improvements from baseline (p=0.0001). EUFLEXXA(TM) (WOMAC pain score = 29.8 mm (-61.6%)) was shown to be comparable in efficacy to Synvisc (WOMAC pain score = 28.8 mm (-54.9%)).
(1) At the study endpoint, 63% of patients treated with EUFLEXXA(TM) were symptom-free compared with 52% of those treated with Synvisc (p=0.038), as determined by a VAS (100-mm visual analog scale) score of EUFLEXXA(TM) also showed a significant advantage over Synvisc in the number of patients requiring supplemental simple analgesics (p=0.013), joint effusion (p=0.
0015) and patient satisfaction (p=0.03). For patient satisfaction, 50% of EUFLEXXA(TM) patients were 'very satisfied' with treatment results compared to 37% for the Synvisc group.
A subanalysis performed on patients with unilateral OA found that only 49% of patients treated with EUFLEXXA(TM) used supplemental simple analgesics compared to 82% of those treated with Synvisc (p=0.001).(1)
EUFLEXXA(TM) is the first and only non-avian derived hyaluronic acid approved in the U.S. for the treatment of pain caused by knee osteoarthritis.
Since it is not derived from an avian source (chicken or rooster combs), the risk of related reactions is eliminated.(2,3) In addition, the process used to manufacture EUFLEXXA(TM) results in ultra-high-purity HA with properties similar to the HA in human synovial fluid.
EUFLEXXA(TM) is also free of chemical cross-linking which minimizes the risk of related reactions.(2-7)
EUFLEXXA(TM) received approval from the U.S. Food and Drug Administration (FDA) on December 3, 2004, and is also approved in Israel and the European Union. Ferring acquired the product in July 2005 as part of its acquisition of the global biologics manufacturing business of Savient Pharmaceuticals, Inc.
About Hyaluronic Acid
HA is a viscous, elastic liquid that is naturally found in many tissues of the body and in high concentrations in joint cartilage and synovial fluid. Within a joint, HA is essential to water balance, viscosity, lubrication and the structure of cartilage.
(8) In cartilage, HA binds to other molecules, helping it withstand weight-bearing force and movement of the joint. Inside the knee joint, HA provides a cushion to protect the joint from mechanical damage and acts as both a shock-absorbing fluid and regulator of water and metabolites.
Osteoarthritis and the General Population
The Arthritis Foundation estimates that 66 million Americans are affected by arthritis, half of whom are unaware of available treatments, and that the disease costs the U.S. economy more than $86.2 billion annually. The Foundation also estimates that 21 million American adults suffer from osteoarthritis.
(9) Osteoarthritis, a form of arthritis, affects certain parts of the body, most commonly the knee. Over time, articular cartilage in the knee loses elasticity and becomes worn. As a result, the bony surfaces of the joint can grind together and eventually wear the cartilage away entirely. This leads to symptoms of pain, stiffness and impaired joint movement.
There are a wide range of treatment options for knee OA, including behavior modification, drug therapy, injections within the joint and knee replacement surgery.
Non-steroidal anti-inflammatory drugs (NSAIDs) are common first-line pharmacologic treatments for knee pain relief. Serious side effects and risks (i.e. potentially life-threatening stomach bleeding and kidney disease) have been associated with such treatments.
The effectiveness of different treatments varies from person-to-person and with the severity of the condition. Treatment options are generally a shared decision between the patient and his/her physician with total knee replacement surgery usually sought as the last option.
* Derived through bacterial fermentation
**Synvisc is a registered trademark of Genzyme Corporation.
(1) Data on file, Ferring Pharmaceuticals. (2) Schiavinato A, Finesso M, Cortivo R, & Abatangelo G (2002). Comparison of the effects of intra-articular injections of Hyaluronan and its chemically cross-linked derivative (Hylan G-F20) in normal rabbit knee joints. Clin Exp Rheumatol 20, 445-454. (3) Goomer RS, Leslie K, Maris T, & Amiel D (2005).
Native hyaluronan produces less hypersensitivity than cross-linked hyaluronan. Clin Orthop Relat Res 239-245. (4) Leopold SS, Warme WJ, Pettis PD, & Shott S (2002). Increased frequency of acute local reaction to intra-articular hylan GF-20 (synvisc) in patients receiving more than one course of treatment. J Bone Joint Surg Am 84-A, 1619-1623.
(5) Puttick MP, Wade JP, Chalmers A, Connell DG, & Rangno KK (1995). Acute local reactions after intraarticular hylan for osteoarthritis of the knee. J Rheumatol 22, 1311-1314. (6) Pullman-Mooar S, Mooar P, Sieck M, Clayburne G, & Schumacher HR (2002).
Are there distinctive inflammatory flares after hylan g-f 20 intraarticular injections? J Rheumatol 29, 2611-2614. (7) Chen AL, Desai P, Adler EM, & Di Cesare PE (2002). Granulomatous inflammation after Hylan G-F 20 viscosupplementation of the knee : a report of six cases. J Bone Joint Surg Am 84-A, 1142-1147. (8) Abatangelo, G., O'Regan.
Hyaluronan: Biological Role and Function in Articular Joints. European Journal of Rheumatology and Inflammation; Vol15(1) 1995.
(9) Arthritis Rheum 1999; 41(5):778-799
Source: Ferring Pharmaceuticals
Do Hyaluronic Acid Injections Work for Knee Osteoarthritis?
The results of hyaluronic acid injections for knee osteoarthritis vary with each patient. Some people experience complete relief from knee osteoarthritis symptoms, while others receive partial relief or no relief.1,2
See Knee Osteoarthritis Symptoms
Research Regarding Hyaluronic Acid Injections for Knee Osteoarthritis
Several clinical studies have investigated the effectiveness of hyaluronic acid injections in treating knee osteoarthritis.
Injections for Knee Osteoarthritis Video
A few findings from these studies include:
- Pain relief is not immediate, and usually begins around the fourth week after the initial injection.3-5
- Duration of relief periods may vary from 2 months up to 6 months.1,3-6 The most effective period is usually between weeks 5 and 13.1,7
- Multiple injections regimes may be more effective than a single injection in some people.8,9
- Additional injections may provide longer relief up to 3 years in some patients who show initial improvement with this treatment. This long period of pain relief may help postpone total knee replacement surgery in some cases.1
See Scheduling vs. Postponing Knee Replacement Surgery
Not all studies conducted to test the effectiveness of hyaluronic acid injections in treating knee osteoarthritis have reported positive results. For this reason, some doctors may not recommend this treatment.2 Research also shows that these injections may not work in overweight people due to the narrowing of joint space in the knee.10
See How Effective is Weight Loss for Treating Knee Arthritis Pain?
Research suggests that hyaluronic acid injections may work in several ways to reduce knee osteoarthritis symptoms.1,3 For example, hyaluronic acid injections may reduce inflammation and friction; and the slow the degeneration of cartilage and bone.
Effects on knee pain and inflammation
Hyaluronic acid injections may reduce knee osteoarthritic symptoms by one or more of its following properties:
- Lubrication. In some people, the viscosity of hyaluronic acid may provide better lubrication and shock absorption in the knee joint. These effects may reduce friction within the joint, thereby reducing pain and stiffness, and preventing the loss of cartilage and bone.1,3
- Anti-inflammatory effects. Research shows hyaluronic acid injections may provide anti-inflammatory effects such as reduced pain, inflammation, and/or swelling in the knee.1,3
- Pain-relieving effects. In some people, hyaluronic acid molecules form a boundary around nerve endings, preventing pain signals from being sent to the brain. These molecules also bind to other cells in the knee that signal pain. Through these mechanisms, knee pain may be decreased.1,3
The viscosity of hyaluronic acid may also have positive effects on the cartilage, bone, and other surrounding tissues in the knee.
See Knee Anatomy
Effects on knee cartilage and bone
In general, hyaluronic acid that is injected in the knee stays in the joint for only a few days. However, the results may last for months. Proponents believe this extended pain relief suggests hyaluronic acid injections may actually modify the osteoarthritic disease process—and not just suppress the symptoms.1,3
Hyaluronic acid injections may stimulate an increase in the growth of cartilage producing cells or chondrocytes. These injections also protect existing chondrocytes, thereby increasing the overall cartilage formation.
Specifically, in some people, hyaluronic acid knee injections may act by:
- Aiding the growth and protection of cartilage by stimulating an increase in the growth of cartilage-producing cells, called chondrocytes. These injections also protect existing chondrocytes, thereby increasing the overall cartilage formation.1,3
- Strengthening existing cartilage by producing important proteins (proteoglycans) and carbohydrates (glycosaminoglycans).3
- Strengthening existing bone by altering the density and thickness of the knee’s subchondral bone (bone that lies immediately below the cartilage). The changes in bone structure may help reduce stresses on the cartilage when the knee bears weight.3
- Stimulating the body to produce its own hyaluronic acid, in turn restoring the quantity of hyaluronic acid in the knee and providing long-term effects.1,3
These effects may help prevent the progression of osteoarthritis.
The US Food and Drug Administration (FDA) has approved the use of hyaluronic acid injections for knee osteoarthritis.
The FDA also states that this injection must be used after other treatments such as physical therapy and the use of pain-relieving medications have been tried and failed.
7 Off-label use of hyaluronic acid injections may be considered by some doctors in treating osteoarthritis of the ankle, shoulder, and thumb joints.
Watch Physical Therapy for Knee Osteoarthritis Video
See Pain Medications for Arthritis Pain Relief
Depending on the pharmaceutical brand, there can be one (Synvisc One), three (Euflexxa, Synvisc), four (Orthovisc), or five (Hyalgan) injections of hyaluronic acid for knee osteoarthritis. For brands using more than one injection, each shot is given once a week (for 3 to 5 weeks).7 Generic formulations are also available.
Knee injections or knee replacement: What are my options?
Osteoarthritis is a degenerative joint disease that can cause problems with the knees. Treatments for this include injections into the knee and replacing tissue in the knee. Which is best for treating osteoarthritis?
The condition often affects people aged 50 years and older, although it can also occur in younger people. According to the Arthritis Foundation, over 50 million people in the United States have arthritis.
Osteoarthritis (OA) is a chronic condition that causes the breakdown of cartilage between the joints. Cartilage serves as a cushion for joints and protects the surface of the bones. Without this cushion, bones can rub or grind together, causing pain, stiffness, and swelling.
If a patient continues to experience discomfort, swelling, or extensive joint damage, their doctor may suggest knee replacement or a knee injection.
Doctors will typically recommend knee injection therapy before recommending surgery. For some people, injections help to alleviate knee pain.
Corticosteroid injections are among the most common knee injections. Doctors inject corticosteroids directly into the knee joint to help relieve knee pain and inflammation quickly.
They are a class of medications related to the steroid cortisone. They are routinely used to reduce inflammation. Corticosteroids mimic the effects of a substance called cortisol that is naturally produced by the adrenal glands.
In high doses, corticosteroids can reduce inflammation. They also effect the immune system. This can be helpful for controlling conditions in which the immune system mistakenly attacks its own tissues, such as rheumatoid arthritis.
The corticosteroid is absorbed into the bloodstream quickly and travels to the inflammation site. Injection therapy provides rapid relief to the inflamed area and is more powerful than traditional oral anti-inflammatory medications.
In addition to providing quick relief, the injection does not cause many of the side effects that oral corticosteroid medications do.
Doctors can administer the injection in their office. They may numb the knee area before injecting the corticosteroid drug directly into the joint. Some people feel almost immediate relief, while others feel the effects several days later.
Depending on the condition of the knee, the benefits can last from a few days to more than 6 months. Factors that play a role in how long the effects of the steroid injection will last such as the extent of inflammation and overall health. It is important to note that the effects of the shot are temporary.
Additional cortisone injections may be necessary.
Many people have no adverse effects after a steroid injection besides a little pain or tingling where the injection was made. However, corticosteroids can cause dangerous side effects for some people, especially when taken too often.
Side effects include:
- the death of nearby bone, known as osteonecrosis
- joint infection
- nerve damage
- thinning of the skin and soft tissue around the injection site
- a temporary flare of pain and inflammation in the joint
- the thinning of nearby bone, known as osteoporosis
- whitening or lightening of the skin around the injection site
- diabetic patients can experience elevated blood sugar
- allergic reaction
Exposure to high levels of cortisol over a prolonged period of time increases the risk of developing hypercortisolism or Cushing’s syndrome.
These effects include:
- upper body obesity
- a round-shaped face
- increased bruising
- trouble healing
- weak bones
- excessive hair growth
- irregular menstrual periods in women
- fertility problems in men
This side effect is treated by gradually reducing the amount of cortisone used or adjusting dosage.
Some people have tried platelet-rich plasma or stem cell injections, but both the American College of Rheumatology and the Arthritis Foundation advise against using these treatments.
There is no standard procedure for either approach, and a person will not know exactly what is in their injection. Also, there is not enough evidence to show that these options are safe or effective.
Though corticosteroid control pain and inflammation efficiently, it only provides temporary relief. As OA progresses, mobility and quality of life may get worse, leaving a knee replacement as the only option.
A doctor will ly recommend knee replacement surgery once all other treatment options such as physical therapy and injections have been tried.
A knee replacement is also referred to as knee arthroplasty or knee resurfacing, because only the surface of the bones is replaced. The surgeon will cut away damaged bone and cartilage from the shinbone and kneecap, and then replace it with an artificial joint.
During a total knee replacement, the damaged knee joint is removed and replaced with a prosthesis made metal, ceramic, or high-grade plastic, as well as polymer components.
There are four basic steps:
- Preparing the bone: The cartilage surfaces that are found at the end of the femur and tibia are removed along with a small amount of underlying bone.
- Positioning the metal implants: The removed cartilage and bone are then replaced with metal components to recreate the surface of the joint. The metal parts are either cemented or “fit” into the bone.
- Resurfacing the patella: The undersurface of the patella, or kneecap, may be cut and resurfaced with a plastic button.
- Inserting a spacer: The surgeon inserts a medical-grade plastic between the metal components to create a smooth gliding surface, making walking easier and smoother.
Before the procedure, patients will work alongside doctors to design their artificial knee. A range of factors is taken into account, such as age, weight, activity levels, and overall health.
Delaying your surgery
There are risks associated with delaying knee replacement surgery. The main risks are further deterioration of the joint, increased pain, and reduced mobility.
Other risk factors include:
- a risk of deformities developing inside and outside the joint
- a risk of muscles, ligaments, and other structures becoming weak and losing function
- increased pain or an inability to manage pain
- increased disability or lack of mobility
- difficulty with normal daily activities
The doctor will thoroughly explain the procedure and allow the patient to ask questions as needed. They will record a medical history, including any medications or supplements currently being taken, also taking allergies and previous health problems into account.
The doctor will give the individual general anesthesia before the surgery, making them completely unconscious. Patients often begin physical therapy to get the new joint moving during a short hospital stay. Rehabilitation continues after leaving the hospital. This can help regain strength and range of motion.
Knee replacement risks
Though knee replacement surgery often goes smoothly, any surgery comes with risks.
- blood clots in the leg vein or lungs
- heart attack
- nerve damage
If surgery is postponed for too long, other risks may arise. Deformities may develop that complicate the knee replacement procedure. Surgery may take longer, and knee replacement options may be limited.
Learn more about the causes of severe knee pain here.
Drugs & Medications
Drugs & Medications
- Side Effects
- Side Effects
This medication is used to treat knee pain in patients with joint inflammation (osteoarthritis).
It is usually used in patients who have not responded to other treatments such as acetaminophen, exercise, or physical therapy. Hyaluronate (also known as hyaluronan) is similar to a substance that occurs naturally in the joints. It may work by acting as a lubricant and shock absorber in the joint, helping the knee to move smoothly, thereby lessening pain.
Read the Patient Information Leaflet provided by your health care professional before you start using hyaluronate and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Your doctor will give this medication by injection into the affected joint, usually once a week. Skin disinfectants that contain ammonium salts (such as benzalkonium chloride) should not be used to prepare the injection site. Your doctor may need to remove extra fluid from the joint before injecting the medicine. Dosage is your medical condition and response to treatment.
Hyaluronate should not be injected into a vein or artery because increased side effects may occur.
After receiving an injection of hyaluronate, you should avoid any activities that put stress on your knee (such as jogging, tennis, heavy lifting, standing on your feet for more than an hour) for 48 hours.
Also, after the injection, you may experience increased pain and swelling in the knee at first. If the pain or swelling continues or worsens, talk to your doctor promptly.
It is important to have this medication injected on schedule. It may take up to 3 injections before the full benefits of this medication occur.
Tell your doctor if your condition persists or worsens.
See also How to Use section.
Pain, swelling, redness/warmth/bruising at the injection site, or headache may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including: back pain, severe headache, fast/pounding heartbeat, fever, tingling skin.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US –
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
hyaluronate/hyaluronan (Hyalgan, Supartz, Euflexxa, Orthovisc) Osteoarthritis Drug Side Effects
Hyaluronic acid is a natural chemical that is found in almost all species of animal and in various parts of the human body. It works as a biological lubricant, reducing friction between adjacent tissues. It is present in high amounts in joints and synovial fluid (the fluid that fills the knee joint).
Sodium hyaluronate is used for the treatment of pain due to osteoarthritis of the knee in patients who do not get adequate relief from simple pain medicines or from exercise and physical therapy. It is administered by injection directly into the knee joint (intra-articular injection).
The exact mechanism by which sodium hyaluronate products work is not known. The synovial fluid in the knees helps lubricate and cushion our joints during movement. Sodium hyaluronate is the major component in the synovial fluid.
People with osteoarthritis do not have enough hyaluronic acid in their synovial fluid.
It is thought that sodium hyaluronate injection helps restore synovial fluid, thereby reducing some of the pain and discomfort associated with osteoarthritis.
The first sodium hyaluronate injection was approved in the US in 1997.
What are the uses for hyaluronate injection?
Sodium hyaluronate (hyaluronan) intra-articular injection is used to treat knee pain from osteoarthritis in patients who do not receive pain relief from simple pain medications acetaminophen (Tylenol and others).
What joints are most often affected by osteoarthritis? See Answer
What is the dosage for hyaluronate injection?
Sodium hyaluronate is administered into the knee joint (intra-articular injection) once a week for a total of 3-5 injections. 20 mg (Euflexxa, Hyalgan) or 25 mg (Supartz) should be injected into the affected knee once weekly.
Which drugs or supplements interact with hyaluronate injection?
No clinically significant drug-drug interactions between sodium hyaluronate injection and other medications have been reported.
Is hyaluronate injection safe to take if I'm pregnant or breastfeeding?
It is not known whether sodium hyaluronate is safe to use during pregnancy because it has not been evaluated in pregnant women.
NURSING MOTHERS: It is not known if sodium hyaluronate can enter human milk. The safety and effectiveness of sodium hyaluronate has not been established in nursing mothers.
What preparations of hyaluronate-injection are available?
Solution for injection into the knee joint (intra-articular injection): 10 mg/ml or 15 mg/ml
How should I keep hyaluronate-injection stored?
Sodium hyaluronate should be stored in the original packaging below 25 C (77 F). It should be protected from light.
Medications FDA Drug Labels on RxList.com Exercises for Knee Osteoarthritis and Joint Pain See Slideshow
Medically Reviewed on 9/4/2019
FDA Prescribing Information
What You Should Know About Euflexxa If You Have Knee Arthritis
Andy Crawford/Dorling Kindersley/Getty Images
Euflexxa is an injectable medication used to treat knee pain in people with osteoarthritis (“wear-and-tear arthritis”). Euflexxa contains a synthetic version of hyaluronan, the key ingredient of synovial fluid found naturally in the joint space.
This fluid thins and become less able to lubricate and protect the knee joint as the inflammatory stress of osteoarthritis takes its toll.
By injecting Euflexxa into the area, the viscosity and shock-absorbing properties of the synovial fluid can be restored, reducing joint pain and stiffness.
The synthetic hyaluronan also appears to interfere with inflammatory substances (such as cytokines and prostaglandins) that cause swelling and pain. There is even evidence that it may increase the body's natural production of hyaluronan (also known as hyaluronic acid or sodium hyaluronate), thereby preserving the remaining joint cartilage.
Euflexxa is commonly prescribed for people who have not found relief with more conservatives forms of treatment, including exercise, physical therapy, or over-the-counter analgesics Advil (ibuprofen) or Tylenol (acetaminophen). It is the first form of hyaluronan not derived from avian (bird) protein and is instead extracted from biologically modified bacteria.
Euflexxa is administered in a series of three weekly intra-articular injections. Each dose is supplied in a pre-filled glass syringe. Prior to the injection, your doctor may need to drain excess fluid from around the knee.
This not only helps reduce the localized swelling, but it also prevents the dilution of hyaluronan when injected. The two-step process of drainage and joint lubrication is known as arthrocentesis plus viscosupplementation.
After drainage, the Euflexxa injection is delivered into the joint space in the mid-kneecap region. While the initial needle prick may cause discomfort, most people will tell you that the injection itself doesn't cause any stinging or burning. It is only afterward that the body may react to the hyaluronan, triggering short-term inflammation and pain.
Your doctor will ly advise you to avoid sports, strenuous exercise, running, or heavy lifting for the first 48 hours following the injection. Even standing for a long period of time should be avoided.
Following the completion of the three-shot series, it generally takes around five weeks to feel the full benefits of the treatment. Benefits typically last for at least three months.
Despite the potential benefits of treatment, viscosupplementation success rates can vary dramatically.
According to a report from the Arthritis Foundation, around 30 percent of users may experience complete pain relief for up to two years, while 20 percent will experience no relief at all. To date, scientists have been unable to explain this disparity.
What most doctors will agree to is that viscosupplementation is not a quick fix. It is really only considered when conservative options have failed or as a means to delay more invasive procedures, such as knee surgery or knee replacement.
It is also often used in place of traditional corticosteroid knee injections. While corticosteroids can provide fast pain relief, usually within a few days, the benefits tend to last for only a month or so. Furthermore, repeated corticosteroid shots can actually accelerate cartilage damage.
Given the high variability of hyaluronan success rates, some doctors will give their patients two shots—one with hyaluronan and the other with a corticosteroid—to provide fasting-acting, long-lasting relief.
The most common side effect of Euflexxa use is musculoskeletal pain. The symptoms tend to mild and short-lasting and rarely result in treatment termination. According to the pre-market clinical research, the following side effects were experienced in more than 1 percent of users:
- Joint pain, swelling, and/or stiffness
- Back pain
- Increased blood pressure
- Runny or stuffy nose
- Tendon inflammation
- Leg pain
- Injection site infection
The risk of allergy is considered low to negligible.
If you experience persistent or worsening pain, fever, swelling, redness, and body aches, call your doctor immediately. These are signs of an infection that may require treatment.
You need to avoid Euflexxa if you have a known hypersensitivity to hyaluronan, sodium hyaluronate, or hyaluronic acid. The shot should also be delayed if you have a knee infection or a skin infection in or around the injection site.
Un avian-derived hyaluronan, which can cause reactions in people with an egg or poultry allergy, Euflexxa is purified from specially bioengineered from bacteria and is not believed to be as immunogenic. (By contrast, avian-derived formulations such as Hyalgan, Orthovisc, Supartz, and Synvisc are made from chicken or rooster combs and should not be used if you have an egg or poultry allergy.)
While Euflexxa is not contraindicated in pregnancy, there is limited research into the effect of the drug on a developing fetus. It is also not known if Euflexxa is excreted in breast milk. Speak to your doctor if you are pregnant or trying to get pregnant so that you can make an informed choice as to whether Euflexxa is right for you.
While Euflexxa is may be less costly than other brands of viscosupplementation, it is still expensive, retailing at around $5,000 for the three-shot series. Therefore, it may be reach for even insured individuals who have a high copay or coinsurance costs.
Euflexxa is included in many drug formularies and will generally be approved if your doctor can demonstrate that all other forms of conservative treatment have failed you.
There are no copay or patient assistance programs offered by the drug manufacturer.
It is important to remember that Euflexxa is not a cure-all. While effective, it only provides short-term relief of knee stiffness and pain. It does not regrow lost cartilage or reverse the symptoms of osteoarthritis. While it has been suggested that Euflexxa may significantly slow the course of the disease if started early, there is yet no evidence to support these claims.
If you are unable to access Euflexxa, speak with your doctor about alternative treatments such as intra-articular cortisone injections if your symptoms are especially severe.
If you are overweight, make an effort to lose weight with an appropriate diet and exercise plan whatever the stage of disease or treatment. Doing so may reduce the weight-bearing stress on your knee and help you better control your symptoms without the need for intra-articular medications.
Hyaluronic Acid Injections: How Do They Treat Arthritis?
You’ve tried all the conservative therapies for your knee osteoarthritis, and nothing is working. You really, really don’t want to go down the knee replacement surgery road yet.
What’s left to try? You might want to consider hyaluronic acid injections for your knee osteoarthritis (OA).
Be warned, though: Their effectiveness is up for debate, with medical research not quite backing up how well they work.
Yet, individual patients have reported relief from their arthritis pain with the shots — but not everyone. Even a CreakyJoints post soliciting feedback on patients’ experiences received responses ranging from “they worked a dream” and “amazing” to “they did nothing to relieve my OA knee pain” and even “they made my knee worse.”
Read on to find out more and decide if hyaluronic acid injections are worth a “shot” (sorry, bad pun intended) for you.
What Is Hyaluronic Acid, and What Does It Do?
Hyaluronic acid, also known as hyaluronan, is a gel- substance naturally present in the synovial fluid that lubricates your joints. Because arthritis patients lose hyaluronic acid as their joint wears away, the theory goes that replacing it with a process called viscosupplementation would make using the joint less painful. The injections are FDA-approved for knee osteoarthritis.
“Its mechanism of action [how a hyaluronic acid injection works] is not fully known, but is thought to at least temporarily increase the viscosity, or thickness, of the fluid that surrounds the joint it is injected into,” says Donald Miller, PharmD, a professor at the School of Pharmacy at North Dakota State University. “This may reduce pain and make joint movement easier.”
You can think of it WD-40 for your joints.
Why Would an Arthritis Patient Get Hyaluronic Acid Injections vs. Other Treatments?
Typically, you would try other conservative treatments first, weight loss, exercise, NSAID medications, and steroid injections. If those don’t help, hyaluronic injections may be an option.
Some patients might have other conditions for which for first-line treatments would be contraindicated. Some doctors might use hyaluronic acid injections along with steroid injections as well. “I had the injection every week for three weeks along with cortisone injections,” Sharon Ruoto told us on . “I did this every six months for years.”
Although hyaluronic acid is also available as a pill, the shots are usually preferred. “Advantages [to shots] are targeted relief to the joint with no systemic side effects from pills, and the convenience of not taking pills by mouth,” Dr. Miller says. Brand names of the hyaluronic acid shot include Euflexxa, Supartz, and Synvisc-One.
Is It Worth Getting Hyaluronic Acid Shots to Delay a Knee Replacement? Should You Just Get the Surgery?
Hyaluronic acid injections are often a last-ditch effort before knee replacement surgery. “It bought me a year before replacements,” Cathy Anderson Eberhardt told us on .
But because the shots don’t actually appear to affect the disease progression, some medical professionals think they just put off the inevitable, and only serve to tack on additional health care costs.
“For some people it can delay surgery or can avoid it altogether, but hyaluronans will generally not avoid eventual surgery in badly affected knees,” Dr. Miller says. But, they “will be helpful in patients not quite mentally ready for surgery.”
Where Are Hyaluronic Acid Shots Given? Do They Hurt?
If you are going to get hyaluronic acid injections, the actual process is fairly simple.
“They are directly injected into the affected knee joint, specifically within the synovial fluid that bathes the joint,” Dr. Miller says.
“ any injection, it may seem more painful to some people than others, but there should not be a lot of pain since a sharp needle is used and the joint may be numbed first with a local anesthetic.”
How Long Does Relief Last?
“It is quite variable but many patients report six months of relief, and the injections may be repeated every six months or physician judgement,” Dr. Miller says.
Our community confirms this, with most patients telling us relief lasted from four to six months; they got the shots (or series of shots) every six months. But, as Sarah Quina shared, “they don’t work repeatedly forever.
” Also, the shots may take several weeks to go into effect, un steroid injections, which work much faster.
What Are the Side Effects of Hyaluronic Acid Shots?
The shots are usually low risk, but some side effects may occur. “Typical side effects include pain, swelling, heat, redness, and/or fluid build-up around the knee,” Dr. Miller says. “Rest and ice afterward can help prevent the typical side effects.”
More rarely, infections of the joint are possible, as is damage to other parts of the knee, he says. “However, properly trained physicians will deliver an injection with very little risk of complications,” Dr. Miller says.
Why Don’t Some Medical Groups Recommend Hyaluronic Acid Shots?
Even though some patients have gotten relief from these shots, some professional organizations, such as the American Academy of Orthopaedic Surgeons, don’t recommend them due to the lack of robust scientific evidence of their effectiveness. “Some studies have found these injections are not more effective than placebo injections,” Dr. Miller says.
“However patients get a lot of relief from placebo effects of any injection, so this makes it difficult to show the independent effect of the hyaluronan.” In addition, given the expense of hyaluronan injections, he says, many insurance companies are reluctant to pay for something only a little better than placebo.
“I pay for them from Canada because my insurance won’t cover,” Quina told us on .
If you’re interested in hyaluronic acid injections for your OA, talk to your doctor and check with your insurance company to see if they may be an option for you.