Viscosupplement

Part 1.

It is remarkable that rooster combs have provided the source of a commonly used treatment for osteoarthritis (OA) knee. Through a combination of research and serendipity, viscosupplement-type lubrication treatment for osteoarthritis of the knee, originally derived from rooster combs, are widely used by rheumatologists and orthopedic surgeons. But are they really effective? This article discusses both part of the evidence in the medical literature.

Viscosupplement are compounds that have been created to simulate the effects of normal synovial fluid. Synovial fluid is the lubricating fluid in normal joints that allows sliding and also helps to dampen. The synovial fluid is produced by cells lining the joints and is essential for proper nourishment of the cartilage that caps the ends of long bones. At low levels of shear force (standing and walking for example), the main effect of synovial fluid is a lubricant. At high levels of shear force (running and jumping), synovial fluid has a higher damping function.

The major component of synovial fluid is a substance called hyaluronic acid. (HA). All synthetic HA viscosupplement also as a major component. In this article I will use the term viscosupplement and HA interchangeably.

The first question is do these compounds work for osteoarthritis (OA) of the knee? Like any treatment, there is the possibility of negative studies. Viscosupplementation is no exception. Lo concluded that HA products have a small effect compared to placebo (Lo GH, et al. JAMA. 2003; 290: in 3115-3121). Brandt said that HA and placebo produced similar results (Brandt KD, et al. Arthritis Rheum. 2000 43: 1192-1203). Karlsson and asked that neither of two HA products have more than placebo at 26 weeks (Karlsson J, et al. Rheumatol. 2002; 41:1240-1248).

However, the majority of studies have demonstrated a significant effect. But how well do they? The interpretation of the effectiveness of these preparations has been difficult due to a number of factors. These include:

Global consumption of these compounds with different measurement instruments and techniques in research studies;

aec unique compared to multi-center study
aec Changes in criteria for inclusion and exclusion
aec Various measures of statistical results
aec Other study design

And the comparisons have been made to other treatments than placebo. Two studies have focused on viscosupplement compared to non-steroidal anti-inflammatory drugs (NSAIDs). Altman RD (, et al. J Rheum. 1998; 25:2203-2212; Adams ME, et al. Osteoarthritis and Cart. 1995; 3: 213-216). They found that viscosupplement performed as well or better than NSAIDs. However, issues of study design makes interpretation somewhat difficult. It should be noted that adverse events were observed in both treatment groups. Not surprisingly, systemic therapies (NSAIDs) have more side effects and systemic therapies HA had more local adverse events.

A question that clinicians often ask about, "What about injections of steroids? How do they compare? These preparations are used to reduce pain and inflammation, especially in knee osteoarthritis and acute attacks are relatively fast acting

However, there are gaps. They include:

aec Duration of effectiveness may not last
aec frequent injections (more than 3 per year) can cause damage to the cartilage
aec The local adverse effects
aec rash post-injection pain
aec Skin atrophy
aec osteonecrosis (bone death)

Studies have evaluated the effects of glucocorticoids viscosupplement vs intra-articular. These include the following studies:

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