What is Hyaluronic Acid

What is Hyaluronic Acid? Dr. Stanley Dysart: HA is Hyaluronate. It's a substance found in the joint, found in the cartilage, even found in the eye. It's a very viscous substance, and in the knee it has important effects. HA acts as a lubricant. It acts as a shock absorber per se. It also has important effects refining on the cartilage and on aligning of the knee. So it's a very important substance in the knee, but it's also found in many other areas in the body. Dr. Jeffrey Rosen: There has become increasing interest in the use of hyaluronate therapy or hyaluronic acid therapy for the treatment of arthritis and joints. Again, the interest arises out of the desire to have localized therapy as opposed to systemic therapies. Hyaluronate is a substance that adds moisture, lubrication and cushioning to the inside of a joint. Hyaluronate is found throughout all of our joints, inside the joints and through the lining of the joints, and helps to provide a number of different functions for the health of cartilage within that joint. Dr. Stanley Dysart: HA was approved by the FDA in 1997. Prior to that, it was used worldwide in other locations. HA is a very effective modality for treatment of osteoarthritis and its use is increasing. Dr. Jeffrey Rosen: Over the past ten years research has indicated that these therapies may do a lot more than originally thought. It's found that they have some degree of an anti-inflammatory effect. They have the ability to help with pain control inside of joint. They have been shown to help with stiffness, and alleviating stiffness within the surrounding tissues, tissues of an arthritic joint. It's hoped that they do a lot more for helping, slow down the process of cartilage degeneration within a joint that's arthritic. Dr. Stanley Dysart: There are five HA preparations in this country that are FDA-approved, four of them are Avian-Based products. What I mean by that is that they are produced by extracting the active compound, by extracting the HA from chicken or rooster combs. They take the rooster combs or the chicken combs. They extract the active ingredient and that's how they give the HA. Dr. Jeffrey Rosen: The latest product that's hit the United States market is a product that derives its hyaluronate molecules from a bacterial fermentation process. This is a process in which they take the coding of an organism that is a bacteria. It is a bacteria that is not dangerous in anyway. The bacteria naturally produces a coat of hyaluronate that is then extracted from the bacteria and filtered and purified to get what they claim as the most pure form of hyaluronate that exists. Dr. Stanley Dysart: Maybe they are injected once a week for three weeks in the instance of the bioengineered product, or once a week for five weeks in other products. Dr. Jeffrey Rosen: The use of hyaluronate therapy or injection therapy for osteoarthritis patients has a variable length of a time that it helps patients with pain relief and stiffness relief. There have been patients who have had relief for up to two years and there have been patients who have had relief only about last three to six months. Dr. Stanley Dysart: The FDA has said that you can repeat the series of injections in six months after the last injection, if it's clinically indicated or if the patient continues with discomfort, and is not ready for a surgical treatment of osteoarthritis. Dr. Jeffrey Rosen: We hope that patients get at least six months of relief from hyaluronate injection therapy to make it a worthwhile therapy for this condition. It's thought that if you're not getting relief for about last six months, that maybe it is time to look for other treatment options. Stanley Dysart: The candidate for treatment of an HA product are those with osteoarthritis, and they have failed other nonoperative approaches such as use of non-steroidals or use of Tylenol. The patients that are not a candidate are those patients that have an infection, those patients that have tolerance issues with the HA or those patients that have failed an HA series treatment. Dr. Jeffrey Rosen: Hopefully, a patient is not so far along in their osteoarthritis disease that they still have the potential to get some beneficial effect from hyaluronate injection therapy. It's thought that the worst the arthritis is, and the more that you have cartilage loss inside a joint, the less that any therapy is going to work and it maybe time to consider a knee replacement surgery. Dr. Stanley Dysart: It's difficult to find a product that works for everyone. For the majority of patients, HA injections have been found to be effective in the treatment of osteoarthritis.