About 27 million Americans suffer from osteoarthritis -- a condition that causes joint fluid to thin out, resulting in bone-on-bone pain. Surgery is invasive and requires a long recovery. Now, a simple injection may help patients, and it comes from an unlikely source.
Ion Hartunian used to train for triathlons. Today, he's just happy to go for a leisurely ride.
"That bike was collecting dust in my closet for two years. I could not ride it at all," Hartunian said.
Hartunian has osteoarthritis in both hips. Even simple activities like working at his computer were out of the question.
"I couldn't sit at the computer for longer than 20 or 30 minutes without getting on the floor and having to stretch," Hartunian said.
The pain was so bad doctors scheduled Hartunian for surgery. But he canceled the procedure after trying an injection -- called Synvisc.
It's made from the comb of a rooster.
"The proteins that are made out of that are similar to the proteins made in joint fluid." Joseph Robinson, M.D., Musculoskeletal Radiologist at Cedars-Sinai Medical Center in Los Angeles said.
In a 15-minute procedure, doctors take x-rays of the patient -- infusing a dye to show them that the needle is in the arthritic joint. Then, they inject the gel directly in that spot. It cushions and lubricates the area -- just like real cartilage.
"You can think of it kind of like motor oil for your joints." Dr. Robinson said.
It’s typically injected every six months. It's currently being used for knees and hips but can potentially be placed in any joint. A recent study showed 75 percent of patients were able to delay knee replacement surgery after having the treatment. Doctors say that's a big benefit for younger patients.
"Just like a car will wear out after a certain number of years, implants have a lifespan," Dr. Robinson explained.
At 50 years old, the injection was a welcome option for Hartunian.
"It just got me back to a normal lifestyle," Hartunian said.
Now, he can sit and work for hours at a time or ride around town.
"Quitting is not an option for me. I want to be as active as possible and keep doing everything that I want to do," Hartunian said.
And he can -- without pain slowing him down.
Synvisc is covered by most insurance companies as a six-month treatment for knee osteoarthritis. There is a small risk of injecting it in the wrong spot, which can cause pain and inflammation, but Dr. Robinson says that is extremely rare.
Motor oil for your Joints -- In-Depth doctor's interview
Joseph Robinson, M.D., a musculoskeletal radiologist at Cedars-Sinai Medical Center in Los Angeles, talks about ways to relieve arthritis.
How long have you been doing this?
Dr. Joseph Robinson: About a year and a half, in terms of the specialty, before other radiology training.
You’ve seen a lot of people who are in a lot of pain.
Dr. Joseph Robinson: Yeah, all the time. A lot of people come with all kinds of joint pain.
Does it surprise you how young they’re getting?
Dr. Joseph Robinson: Yeah, it does. That’s one of the interesting things about the field. We do tend to see younger and younger patients as time goes on and understand what causes joint pain in younger patients. They’re more active and in a way it’s more devastating because they’re used to being super active and then they get this pain that is stopping them.
Up until now we have done a lot of these stories and everything is pretty invasive. We have hip replacement, implants, resurfacing; it’s all big surgery.
Dr. Joseph Robinson: Yeah, it’s something that you don’t want to think about especially if you’re a young patient, 30's, 40's, 50's. Having 20 or 30 years of your life with an artificial joint, going through the surgery, the potential complications after the surgery, the prosthesis can break down, it can fracture around the prosthesis, you have to go for other surgeries and need to be revised, so joint replacement is definitely something that there are definitely good reasons to try and put off at least until people are at a later age.
And like that guy we talked to, Mr. Hartunian. Basically, if he were to get implants it’s more than likely he would eventually need a new one because it’s going to wear out?
Dr. Joseph Robinson: Yes, it’s a mechanical thing. Just like a car will wear out within a given number of years, implants have a life span and if you put them in someone who is really young, chances are it’s going to wear out eventually, and it’s going to need to be replaced. A good option for these people is this new injectable substance.
And what’s it called?
Dr. Joseph Robinson: The generic name for what we do is visco-supplementation and there are various brand names of companies that make viscous supplements. The popular one that we use is Synvisc.
What is it?
Dr. Joseph Robinson: Well, you can think of it as motor oil for your joints. So, motor oil is supposed to reduce friction within a car engine and it’s a pretty viscous substance and, just like motor oil, breaks down as it gets used: it gets thinner, and it doesn’t work as well. The same thing happens to your joint fluid when you get arthritis. It’s suppose to be pretty dense and pretty viscous, but as it breaks down with arthritis it gets pretty thin and doesn’t do its job of lubricating and cushioning your joints. So, Synvisc is basically an artificial liquid that’s gelatinous and viscous and it helps it restore the viscosity to your joint fluids so they can cushion your joints better.
What’s it made of?
Dr. Joseph Robinson: It’s actually made of chicken combs. So when you see a picture of a chicken or rooster you see the chicken or rooster comb. The proteins that are contained within that are similar to the proteins contained in normal joint fluid.
So how does it work? Can you tell me how the procedure goes?
Dr. Joseph Robinson: Basically, since we are radiologists we have the advantage of having all kinds of imaging equipment to be able to guide a needle placement into a joint, so we know we are in the correct location to inject the medication. It really does no good if you’re only close to the location; you have to be right there inside the joint. So, we bring the patient into what’s called the fluoroscopy suite where we have an X-ray machine that takes both still X-rays and moving X-rays. That’s called fluoroscopy. So, we position the joint that we want to inject. We locate the area where we need to inject and then we use the X-ray machine to see our needle goes to where the joint is. We inject a little bit of dye or contrast agent that shows us that we are in the joint. When we inject the dye, it will give us a typical appearance if we are actually in the joint. Then we know for sure that we are in the joint and we attach the medication to the needle and inject it and that’s it. We pull out the needle, give them a band-aid and they go home.
So is it about a 15-minute procedure?
Dr. Joseph Robinson: There is a little bit of preparation time, so when the patients arrive we talk to them. We go over the procedure and what we are going to do. We also use sterile techniques, so we do prepping of the skin, and shaving, similar techniques prepping somebody for surgery to reduce any chance of infection occurring. There is a little bit of prep time for that.
Is there any joint you can’t do?
Dr. Joseph Robinson: Well, the most common joints are the knees. It’s been FDA approved for the knee and also reimbursed by insurance companies for injection into the knee. And that’s because we have the most experimental data that shows its efficacy in the knee. But it’s also being used in the hip. It won’t be reimbursed by most insurance companies for use in the hip to this point, but it’s also shown very promising experimental data and good effects with the patients who have had it injected in the hip as well. Other joints, like the shoulder, could also be potentially done. We are just scratching the surface of where we can go with it and so basically the potential (because joints are basically similar) is there that it could be applied in other joints as well.
It’s like a lifelong commitment. You have to come in every six months or so?
Dr. Joseph Robinson: Insurance companies, at this point, will pay for it every six months. The efficacy has been shown to be anywhere from twelve weeks to one year. Generally, on average, the effects do last right around six months. So, having every six-month injection is where we are at right now.
Is there any risk to it?
Dr. Joseph Robinson: The risk is small. If it were to be injected into some of the soft tissues close to the joint, but not within the joint, it can actually, cause an inflammatory reaction within the soft tissues, giving pain and swelling and redness.
Have you had that happen?
Dr. Joseph Robinson: No, we haven’t had that happen because, again, we have the advantage of being able to use the X-ray guidance and we know that we are in the joint before we inject.
Did I miss anything? How about Ion? How have you seen him change?
Dr. Joseph Robinson: Well, I remember talking with him. I believe he is a photographer, if I remember correctly, and he was talking to me about how he used to get a lot of pain when he was sitting for long periods of time, when he was at work and on his feet for a long period of time and he would have to quit whatever he was doing and lie on the floor and stretch it out or try to find something that would alleviate his pain. He seemed very satisfied, in terms of being able to overcome that and be able to work many hours and not have to stop what he is doing. In sum, continuing with his occupation and other things he like to do on a daily basis.
Is that what most people say? Basically, they were going to have to live with this pain forever.
Dr. Joseph Robinson: The experience that I’ve had is that they feel like this is something that really does improve their function. It may not completely eliminate the pain, but it does substantially reduce it to the point that they can continue on better with their daily activities.