Joints need lubrication. In a normal, healthy joint, a thick substance called synovial fluid provides lubrication, allowing bones to glide against one another and acts as a shock absorber too. In people with osteoarthritis, a critical substance in synovial fluid known as hyaluronic acid breaks down and contributes to joint pain and stiffness.
When it comes to preventing Osteoarthritis, there are very few therapeutic options to slow or prevent cartilage damage. However, lubricating the joint by replacing hyaluronic acid has been found to relieve osteoarthritis symptoms.
Hyaluronic acid injections (also known as viscosupplements) are approved by the U.S. Food and Drug Administration (FDA) for treating osteoarthritis of the knee, though some doctors have used the therapy on other joints, such as the hip and ankle. Lab and clinical research hints that hyaluronic acid may do much more than simply re-grease a creaky joint.
History of lubricating joints
The idea of using hyaluronic acid to treat osteoarthritis was originally proposed 70 years ago by Hungarian scientist Endre A. Balasz. By 1987, hyaluronic acid treatments were being used overseas, though the first viscosupplement available in the United States, Hyalgan, wasn’t approved by the FDA until 10 years later. There are now five hyaluronic acid treatments for knee osteoarthritis in use.
In 2006, a team led by Nicholas Bellamy, MD, of the University of Queensland in Brisbane, Australia, reviewed 76 studies examining the use of hyaluronic acid for treating knee osteoarthritis. The review, the largest and most comprehensive of its kind, found that pain levels in the average patient who receives these injections are reduced by 28 to 54 percent. Meanwhile, hyaluronic acid improved the ability to move about and perform daily activities by 9 to 32 percent.
But hyaluronic acid is no quick fix, as it takes about five weeks, on average, before a patient experiences the full benefits of hyaluronic acid. By contrast, corticosteroid injections provide significant relief within a few days. However, pain relief from corticosteroids diminishes markedly within a month or so. What’s more, overuse of corticosteroids can have a catabolic effect – that is, it could cause cartilage to break down and deteriorate further, explains Case Western Reserve University rheumatologist Roland W. Moskowitz, MD. Meanwhile, the Cochrane review found that pain-relieving benefits of hyaluronic acid persist at peak levels for about three months, on average. Dr. Moskowitz sometimes gives patients a double shot in the knee – one injection each of hyaluronic acid and corticosteroids – for quick-acting, long-lasting relief.
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