Submitted By Tom Klootwyk M.D.
07.08.2008

Injections offer relief for arthritis sufferers

As it appeared in the Indianapolis Star

By Shari Rudavsky

Dr. Tom Klootwyk is an orthopedist with Methodist Sports Medicine. He specializes in the treatment of knee disorders.

Question: What can you tell me about visco- supplementation as a treatment for arthritis?

Answer: It’s the generic term for the treatment of a joint with a number of different products that are available. The substance most often used is hyaluronic acid, which is glycoprotein, a naturally occurring substance in the synovial fluid of our joints.

The visco-supplementation replaces the glycoprotein that seems to be lacking or maybe not working as well as we’d like in a joint that has some arthritis in it. There are different drugs, but they all have the same basic principle. I use Synvisc.

Q: How does this work?

A: There’s no absolute clear-cut science on it. It does increase the lubrication of the joint. It does help a little bit with shock absorption. The main way that we think it works is that it stimulates the body to manufacture the natural glycoprotein.

So it’s almost as if, “Let’s put a little in there, give the system a boost and see if we can stimulate the system to make more of its own.” There are some people that will get months to a year or two of relief from the injections, although the medicine is only around for a few weeks.

Q: For whom do you recommend this treatment?

A: The person who’s the candidate for the injection is a mild to moderate arthritic patient, who has had symptoms for a while. It’s not the initial form of treatment. The initial treatment is rest, physical therapy, oral medications. We may even do an injection once of cortisone into the joint. If we’ve tried those and we’re still having issues with pain and not necessarily swelling, then it becomes time to consider the Synvisc injection.

If you are a severe arthritic patient, it’s not going to help you. If you’ve worn away all of the cartilage in your knee, you’re not going to get predictable relief with these injections.

Q: How many shots are needed?

A: It differs depending on the product. With Synvisc, it’s three injections over two weeks and goes right into the joint. You can use it in any joint, though clinical experience is going to be highest with knees, because they’re commonly affected with arthritis and easily accessible.

Q: Can you repeat injections?

A: You can, but you want to wait at least six weeks, and you’re really better waiting for up to a year. If someone has had good relief for nine months or so and they start to have some symptoms, it’s reasonable to try it again. The most I’ve injected somebody over a five-year time frame is about three different times, and the last time, we didn’t get anywhere with it. It is not curing the arthritis; it is allowing you to deal with the symptoms a little bit longer. If it is meant for you to have a knee replacement, whether you get Synvisc or not, it’s going to happen. It’s just that you may be able to be more comfortable and functional in the interim.

More