In the United States, knee osteoarthritis (OA) affects 40% of adults over the age of 45 and this number may grow with obesity rates on the rise. Sometimes called degenerative joint disease, OA is the most common chronic condition of the joints.
In normal joints, a firm, rubbery material called cartilage covers the end of each bone. Cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between the bones. In OA, the cartilage breaks down, causing pain, swelling, and problems moving the joint. As OA worsens over time, bones may break down and develop growths called spurs. Bits of bone or cartilage may chip off and float around in the joint worsening the condition. In the final stages of OA, the cartilage wears away and bone rubs against bone leading to joint damage and more pain. There are multiple options for the treatment of knee OA, and making a choice based on the efficacy, safety, and tolerability is often confusing.
In 2011, the US Agency for Healthcare Research and Quality released an exhaustive meta-analysis in the Annals of Internal Medicine, comparing 137 studies on the most common analgesics for knee OA. These included oral and topical nonsteroidal anti-inflammatory drugs (NSAID’s) such as diclofenac, ibuprofen, Aleve, and Celebrex; intra-articular (IA) injections of hyaluronic acid or corticosteroids; acetaminophen; and oral and injected placebo. The studies reviewed were published between 1980 and 2014, included 33,243 participants (median age of 62 years), and analyzed data on pain, function, or stiffness.
· Acetaminophen, the most widely used over-the-counter treatment, did not provide a
clinically significant reduction in pain.
· All active treatments were superior to placebo for pain.
· IA treatments were significantly superior to most oral therapy in reducing pain.
· All treatments except IA corticosteroids were superior to placebo in terms of
function. NSAIDs were superior to acetaminophen in this outcome.
· Nonselective NSAIDs were associated with more gastrointestinal events and study
withdrawals resulting from adverse events compared with acetaminophen and Celebrex.
· Topical NSAID’s were similarly effective as oral NSAIDs for localized OA, with fewer
gastrointestinal adverse events.
· IA treatments were generally well-tolerated and the rate of adverse events was similar in
comparing IA hyaluronic acid and IA corticosteroids.
· This meta-analysis suggests that IA hyaluronic acid shows the best treatment outcome for
knee OA, with the lowest side effects.
At SageMED, we offer several treatment options for osteoarthritis. In particular, we are excited to offer IA hyaluronic acid and Platelet Rich Plasma (PRP) injections for palliating pain and increasing joint function associated with knee OA. To learn more about PRP, click here. Hyaluronic acid is a natural substance found in the body that helps cushion, lubricate, and protect joints. In patients with OA of the knee, this substance is thinner and less able to provide these protective properties. When injected into the knee, it replenishes the hyaluronic acid, helping to provide long-lasting pain relief. When PRP and hyaluronic acid are combined, compared to either being used separately, patients experience 20 - 30% improvements in less pain, greater mobility and knee function.
Qualifying patients are covered under most insurance plans for a series of three injections over three weeks, providing pain relief for an average of 6 months. At that time, patients can be reauthorized for another series of 3 injections, providing patients with a year of pain relief and increased knee mobility. To qualify for the injections a patient has to have observable OA diagnosed from a X-Ray, and have failed treatment for three weeks or more with pain medications such as acetaminophen, ibuprofen, or naproxen, or from exercise and physical therapy. At SageMED we can examine your knee for signs of OA, refer you to an imaging center for X-Ray, and submit documentation to your insurance company to see if you qualify for the injections.
At SageMED we use a bioengineered form of hyaluronic acid called Orthovisc. This video demonstrates how hyaluronic acid facilitates pain relief of osteoarthritis.
This video demonstrates the simplicity of the hyaluronic acid and PRP injection.
To learn more about qualifying for these injections, make an appointment at SageMED and we will discuss the best course of action needed to get you pain free!