Arthritis knee pain and osteoarthritis are both common causes of joint pain and stiffness, and the severity of this condition depends on each patient and their own risk factors. They are degenerative diseases progressively affecting the structure of the articulations, and patients should follow medical instructions and various recommendations to prevent complications.
In some cases, joint pain is very severe and self-limiting, and not every therapeutic approach appears to be sufficient to improve these symptoms.
Intra-articular injections usually provide relief to various types of joint pain, primarily when it is performed with corticosteroids. But we can use many other agents, including botulinum neurotoxin, platelet-rich plasma, and hyaluronic acid. But, is it useful to relieve joint pain?
What is hyaluronic acid?
Hyaluronic acid or hyaluronan, is a gel-like substance that is produced in the skin, the eye, the synovial fluid, and the connective tissue. It has the impressive ability to bind with water and retain liquids within its chemical structure to keep tissues lubricated.
In the synovial fluid, hyaluronic acid contributes to providing elasticity to the articulation. Since 1993, hyaluronic acid injections were proposed as an option to relieve joint pain in patients with osteoarthritis. By doing so, it would restore the viscoelastic property of the synovial fluid and increase the synthesis of endogenous hyaluronic acid as well.
Hyaluronic acid injections work with rheumatoid arthritis as well, and it has been found to improve the inflammatory condition in these patients. Even though it is not clear the exact reason why hyaluronic acid reduces the activity of pro-inflammatory substances released in the articulation, it is thought to change the activity of the nerve terminals in the articulation, modulating the nerve impulse and reducing hypersensitivity in patients with knee pain.
Am I a candidate for hyaluronic acid knee injections?
Hyaluronic acid knee injections are a very interesting approach for osteoarthritis and other forms of knee pain, but it is not for everyone, and you should ask your doctor if you’re a fitting candidate for this procedure. For example, the use of hyaluronic acid is approved for osteoarthritis, but that doesn’t mean that patients with rheumatoid arthritis and other types of knee pain won’t benefit from this treatment.
There are many options to relieve joint pain, and we don’t usually start by performing an intra-articular injection. Instead, it is considered one of the last choices when patients do not respond to any other form of treatment. It is also considered as an option when patients still have one or two painful articulations after non-invasive treatment, and if they have any type of contraindication.
Knee pain treatment usually starts with physical therapy and various exercise programs created to improve strength and flexibility. This provides extra support to the articulation, and in many cases, it is enough to alleviate symptoms in mild cases. Pharmacologic treatment is the next step, and it usually starts with acetaminophen and similar drugs. We can work our way up in the anti-inflammatory drug scale and reach opiates in cases of severe pain.
However, certain pain medications can be especially troublesome for older patients, and that’s why doctors consider the option of knee injections with corticosteroids or hyaluronic acid. It is also another way to improve pain in patients with severe symptoms for a longer time and without using opiates.
What to expect from this procedure?
According to studies, hyaluronic acid injections improve knee pain symptoms in patients with osteoarthritis for 5 and even 6 months. It is a useful approach to lubricate the joints and help them work smoothly. Another alternative for those less squeamish and is comparable to Knee Arthroscopy recovery times.
The procedure is very straightforward. It is a direct injection into your knee joint. Your doctor might need to see radiography images to assess your knee anatomy before starting this procedure. After he selects the right area, he would inject your knee while you’re at a sitting position with your knee flexed 90 degrees.
Patients usually need to repeat the same procedure once a week for better results, and that would mean 3 or 4 additional shots.
After hyaluronic acid knee injection, patients are usually recommended not to bear excessive weight for at least two days. If you find some redness or inflammation in the area, it is often enough to use anti-inflammatories and ice to improve these symptoms, and it is essential to rest your articulation while you’re at it.
Watch as Dr.Marcus is performs an injection into the knee of a patient at this clinic.
Is there any other option apart from the injection to relieve joint pain ?
Yes! Hyaluronic acid stands as a fascinating approach to relieve joint pain. It does not only increase the elasticity and viscosity of the synovial fluid but modulates the inflammatory function inside the articulation and may even reduce sensibility to pain in the knee.
Recent studies have evaluated the use of oral supplementation with hyaluronic acid as an alternative to those patients who do not want to undergo intra-articular injections. According to the data gathered by a review of the scientific literature, there is a significant improvement in knee pain and function in patients who took supplements with hyaluronic acid compared to placebo.
Moreover, hyaluronic acid as an oral supplement has been found to be safe with no toxicity reported so far. Thus, either if you want to use hyaluronic acid as an oral supplement or in intra-articular injections, you are still going to experience an improvement in your knee pain. This type of supplement can be used alongside medical therapy without any inconvenience, and it is still another way to prevent complications and treat pain in patients with osteoarthritis.
Migliore, A., & Granata, M. (2008). Intra-articular use of hyaluronic acid in the treatment of osteoarthritis. Clinical interventions in aging, 3(2), 365.
Guo, Y., Yang, P., & Liu, L. (2018). Origin and Efficacy of Hyaluronan Injections in Knee Osteoarthritis: Randomized, Double-Blind Trial. Medical science monitor: international medical journal of experimental and clinical research, 24, 4728.
Chou, C. L., Lee, S. H., Lu, S. Y., Tsai, K. L., Ho, C. Y., & Lai, H. C. (2010). Therapeutic effects of intra-articular botulinum neurotoxin in advanced knee osteoarthritis. Journal of the Chinese Medical Association, 73(11), 573-580.
Briem, K., Axe, M. J., & Snyder-Mackler, L. (2009). Functional and perceived response to intra-articular hyaluronan injection in patients with knee osteoarthritis: persistence of treatment effects over 5 months. Knee Surgery, Sports Traumatology, Arthroscopy, 17(7), 763-769.
Lo, G. H., LaValley, M., McAlindon, T., & Felson, D. T. (2003). Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. Jama, 290(23), 3115-3121.
Oe, M., Tashiro, T., Yoshida, H., Nishiyama, H., Masuda, Y., Maruyama, K., … & Fukui, N. (2015). Oral hyaluronan relieves knee pain: a review. Nutrition journal, 15(1), 11.