Are Injections for Osteoarthritis Right for You?
I have a confession to make. I don’t like needles.
Whether it was the measles, mumps, and rubella vaccine or the needle for the IV fluids before one of my surgeries, each time I was poked with a needle, I shut my eyes and thought of my happy place.
Now dealing with the later stages of early-onset osteoarthritis in my ankle, at 39, I’m again faced with more needles as my pool of treatments shrink. NSAIDs and other oral medications have worked well, but they have begun to lose their effect. For my next treatment, I'll choose one of two injections to help with the pain and inflammation brought on by my arthritis. The two types of injections most often used for osteoarthritis sufferers are cortisone and hyaluronic acid.
Cortisone Injections: An Overview
The first type of injection is a corticosteroid injection, also known as a cortisone injection.
The purpose of a cortisone injection is to reduce inflammation in an arthritic joint. The injection, which is given directly into the joint, can decrease pain and improve mobility. Cortisone works by limiting the dilation of small blood vessels surrounding the joint, helping to reduce blood flow and decrease the build-up of cells associated with inflammation and joint damage.
Cortisone injections can take effect quickly, usually between 24 and 48 hours, and can last anywhere from 6 to 12 weeks. Their duration depends on several factors and can vary from person to person. Regardless of how long a cortisone injection lasts, a joint should not receive more than four shots over 12 months. The reason being is that cortisone can damage the existing cartilage in and around the joint, contributing to the deterioration of the joint’s health.
Potential Side Effects
While there are some side effects, such as a small chance of infection or temporary flare-up of arthritis in the infection joint, cortisone injections are considered safe for healthy individuals who are looking for relief from arthritis when NSAIDs or other medications have stopped working.
A Personal Story
I’ve had a few cortisone injections in my right ankle, the most recent was before a hiking trip I took in September of 2016. After telling the doctor about my hiking plans, a 75-mile, 8-day hike across the Sierra Mountains, we opted for the strongest dosage. Because I'm not a big fan of needles, I was convinced the injections were going to hurt…a lot.
To my delight, I hardly felt the needle!
Receiving the cortisone injection a few weeks before I left gave the medicine enough time to do its job and help with the inflammation. Without receiving the injection, completing the hike would have been impossible. While I was in good shape and had my Arizona brace to provide extra stability and take much of the strain off my ankle, the cortisone injection played a key role in helping me complete the hike.
Hyaluronic Acid: An Overview
Hyaluronic acid (HA) is another popular injection to help treat arthritis. It’s also known as hyaluronan or viscosupplementation.
Hyaluronic acid is a substance naturally produced by the body in the synovial fluid within a joint. HA gives the synovial fluid a viscous quality that helps a joint lubricate and absorb shock. When a joint has been damaged by osteoarthritis, often times there is less HA in the joint fluid. By injecting HA into the affected joint, an individual can experience pain relief and less inflammation.
While cortisone injections are done in a single doctor visit, hyaluronic acid injections are usually given over a period of a few weeks. Depending on the brand of HA that’s used, injections are given weekly over the course of 3 to 5 weeks. For example, Euflexxa is given once a week for three weeks while Hyalgan and Supartz are given over a five week period. Synvisc-One is only needed once. Regardless of the brand of HA, the injections should only be received once every six months.
My Experiences with Hyaluronic Acid
Even before receiving a cortisone shot in my ankle, I went through a round of Euflexxa injections about five years ago. Because my ankle had so little cartilage left, the doctor wanted to see how I responded to the hyaluronic acid before trying cortisone. In my experience, my ankle did feel better after the HA injections. I had less inflammation, pain, and my ankle joint did feel like it had a smoother motion to it than before the injections.
Currently, hyaluronic acid is only approved for the knee by the FDA, but physicians have been known to use it on other joints with mixed degrees of success. Even though HA is naturally produced, swelling and some irritation can occur, so it’s best to avoid strenuous activity for a few days after receiving an injection.
New Advances in Medicine
While cortisone and hyaluronic acid injections are the most common, new injections such as plasm rich protein (PRP) and stem cell injections have started to come into the market. These newer classes of injections have yet to be approved by the FDA, but some studies have shown that there is a lot of potential in helping to reduce the pain and inflammation cause by osteoarthritis and possibly even reversing osteoarthritis. Even though more testing is needed, just the slightest bit of hope that there could be better treatments on the horizon is every arthritis sufferers dream, even if it means a few more needles!