Episode 33: The Role of Hylauronic Acid and Arthrosamid Injections in the Management of Osteoarthritis

Hello, this is Dr. Karmic for Chronic Pain Chronicles, and today I wanted to discuss a specific type of injection, which generally is referred to as viscous supplementation.

It's quite a mouthful, but essentially it is an injection of hyaluronic acid.

And hyaluronic acid is a substance which naturally occurs in our body and among other functions.

it is there to lubricate joints.

So the hope is that if you inject somehow uronic acid into an arthritic joint, it will help to lubricate it and perhaps provide additional cushioning.

It was developed a long time ago as an alternative to cortisone injections.

There was always concern about cortisone injections causing cartilage and bone damage.

Although these complications are very rare with cortisone, when they do occur, they can be quite disabling.

So how does it compare to cortisone? First of all, it does not work very well for inflamed joints.

If anything, it can sometimes make inflammation worse.

So if somebody has a red, swollen joint that they can barely put weight on, injection of hyaluronic acid is not likely to help.

Second of all, at least in my clinical experience, it is less effective than cortisone in terms of percent of patients responding.

With cortisone, 70% of patients will respond for three months or longer, while with hyaluronic acid, in my experience, about one in three patients responds.

When they do

respond, the response takes anywhere from one to four weeks to see the benefit.

And on average, the response can last for about six months.

Of course, that some people might get three months and some people might get a year.

but an average about six months.

When compared to regenerative medicine treatments, such as platelet-rich plasma injections or enstride injections, my impression is that hyaluronic acid is less effective and the duration of effect seems to be shorter.

Also how uronic acid does not stimulate regeneration of cartilage.

On the plus side, compared to regenerative medicine approaches, there's definitely a financial advantage.

First of all, it's covered under most private drug plans.

So for patients who have a private drug plan, the injection can be free of charge.

And even if the patients do have to pay for the injection out of pocket, which costs around $550 in Ontario, it is still, generally speaking, cheaper than regenerative medicine alternatives.