This time last year, Pat Spillane was in constant pain, had difficulty walking and standing and was unable to sleep or to perform his job as a PE teacher.

One year on, he has gone from being “a virtual cripple” to being able to lead a normal life again. Although he accepts that he will never jog or run again and still cannot walk or stand for very long periods, he has a much better quality of life with limited pain and much greater mobility and he has returned to work.

Pat attributes the vast improvement in his condition to a new therapy called Synovial Fluid Replacement Therapy, which although growing in popularity worldwide, is still relatively unknown in Ireland.

The former Kerry footballer, who is regarded as one of the great players of his generation and a key member of the successful Kerry teams of the 1970s and 1980s, was left with a lasting legacy of his footballing days – a “fecked up” knee.

In fact, Pat Spillane’s knee was once the most famous knee in the country, even ending up on The Late Late Show. In 1981, Pat ruptured his anterior cruciate ligament, an injury which at that time invariably spelt the end of a footballer’s career.

However, after undergoing surgery on his knee in Cambridge, England in 1982, he became the first Irish sportsman to return to play at top level after sustaining such an injury. And what a successful comeback he made, going on to win three All-Ireland Senior Football Championships Medals in 1984, 85 and 86 to add to the five he already boasted.

The Kenmare native went on to play club football for another seven years after that and played and trained into his early 40s, “getting another 21 years out of the knee”.

However, his early injury came back to haunt him about six years ago and on top of that, he began to suffer from arthritis in his knee. He had a number of operations to scrape out cartilage in his knee, but by 2005, he was unable to walk properly or stand for any length of time, was being kept awake at night with the constant pain and had to take time off from work.

When he saw the new lease of life that his 80 years old mother got from a knee replacement, he went to see orthopaedic consultant, Mr Richard Creedon at the Bon Secours in Cork last year to discuss having a similar operation.

Pat explains: “I will have to have a knee replacement because my knee is such a mess but at 50, my consultant told me I was too young to get one. There is a danger if you get it done too young that you will be overly active and reduce the lifespan of the knee. You would need a second replacement then and there is quite a high risk that it would not be as successful as the first.”

It was at this point that his consultant offered Pat the option of Synovial Fluid Replacement, a therapy he had never heard of. The fluid was injected into the synovial cavity of his knee where it basically acted as an oil to lubricate the joint.

Three weeks on, after his third injection, Pat was back walking again and within six months of starting the therapy, he was leading a fairly active life again. As well as working full-time as a PE teacher, he presents The Sunday Game for RTE during the summer and writes a weekly GAA column for The Sunday World.

“This is something that actually works and the majority of GPs and many orthopaedic surgeons know nothing about it. There are people out there suffering, taking pain killers and anti-inflammatories which have side effects and can actually cause more damage who know nothing about this treatment which is not expensive,” he says.

Osteoarthritis in Ireland

Osteoarthritis is one of the most common chronic diseases and the most frequent cause of pain leading to long term disability in the older population in Ireland. Every year, around 400,000 people in this country consult their doctor with symptoms related to arthritis.

The incidence and prevalence is higher in women than in men, especially after the age of 50 and chronic cases lead to the need for joint replacement. The disease occurs most frequently in the knees, hands, thumb base, hips, back, neck.

Sports people who suffer cartilage injuries as well as wear and tear to the joints are more susceptible to developing arthritis in later years.

A sticky or squeaking hinge can be ‘cured’ with a drop of oil, so it makes sense that a hinge joint, like the knee, would also benefit from a little lubrication – at least, that’s the premise behind one new form of treatment for arthritis of the knee.

The procedure, called viscosupplementation or Synovial Fluid Replacement injects a preparation of Sodium Hyaluronan into the knee joint. Sodium Hyaluronan is a naturally occurring substance found in the synovial (joint) fluid. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads.

Derived from naturally occurring biological substances, Synovial Fluid Replacement Therapy is injected into the synovial cavity of a joint once a week for three weeks. For a patient with mild to moderate osteoarthritis, studies have found that three injections will provide pain relief for up to six months, while those with a more severe form of the disease will need more injections.

Synovial Fluid Replacement Therapy is available on the General Medical Scheme in Ireland since February 1, 2005.

Traditionally, weight loss, physiotherapy and exercise are recommended in the treatment of osteoporosis. If this is unsuccessful, analgesics as well as anti-inflammatory drugs and steroids may be used to relieve pain – but the effects, even of steroids, are short lived.

Consultant orthopaedic surgeon at Mayo General Hospital and the Galway Clinic, Mr Derek Bennett has been using Hyaluronan acid treatment in his patients for the past three years with good results.

“I think it’s a great tool that is part of the equipment we can use against osteoarthritis of varying stages. For a lot of people with moderate arthritis that is not bad enough to require knee replacement surgery, it’s a fantastic, simple, safe and effective method for them,” he says.

Mr Bennett advises his patients to return to him once their pain returns – some return a year after treatment while others get two years out of it.

However, he points out that the viscosupplementation procedure does not work for everybody and is totally ineffective in the treatment of rheumatoid or any kind of inflammatory arthritis.

“It’s not a magic cure. It won’t take away the need for a knee replacement but it could delay it for many years in people with mild to moderate osteoarthritis. The downside is that it doesn’t work for everybody, only those with osteoporosis and even then, it doesn’t work all the time,” Mr Bennett explains.

Having said that, he points out that people who are worried about having to go for major surgery are usually very happy to have the three injections instead and it is a very effective procedure in some patients.

For further information on arthritis or Synovial Fluid Replacement Therapy, go to http://myknee.ie

Glenn Taylor looks at a new arthritis website that aims to provide a better understanding
of common procedures such as diagnostic arthroscopy and articular cartilage problems

A new website has been launched in Ireland with the aim of providing information
on arthritis and various therapies to the public, as well as providing ‘how-to’
training and educational videos for doctors.

A special feature of the site — www.arthritiscare.ie — supported
by a medical supply company, is an on-line education section that has graphic
explanations of various othopaedic surgeries that will help doctors explain
and show their patients, through animated graphics, what some procedures would
entail.

The site mainly focuses on osteoarthritis and joint injuries. The graphical
representations of partial and total joint replacements in the knee, hip and
shoulder are featured, as well as information surrounding arthroscopy and sports
medicine.

The main backer of the site, Premier Medical, said that making such information
available would give patients a better understanding of common procedures like
diagnostic arthroscopy, articular cartilage problems, torn meniscus and torn
anterior cruciate ligaments.

“Patients who understand their surgery are more likely to be satisfied
with the quality of their care,” a spokesperson for the company said.
“Unfortunately, patient anxiety and the foreign terminology of surgery
can make patient education challenging.

“This website is a new resource for doctors who can direct their patients
to this website for more information and explanations.”

Of equal interest to doctors is the inclusion on the website of training video
downloads for intra-articular injections.

A leading Canadian rheumatologist demonstrates techniques on how to perform
intra-articular procedures, involving anatomical models as well as live patients.

“The videos give step-by-step instruction and practical tips on how to
gain access for a smooth injection technique,” the spokesperson explained.
“Demonstrations include how best to approach a patient, accessing the
joint space and the importance of positioning, also gaining access to a complex
joint such as the shoulder and identifying landmarks of the shoulder or technical
aspects of improving success in a small joint, like the first metacarpalpharangeal
joint.”

All doctors need to do is go to the website www.arthritis care.ie and then
on to the healthcare professionals’ section and register. You will receive
a password sent to your e-mail address that you can then use to gain access
to the training video downloads.

Article Source: Medicine Weekly

Fiachra Ó Cionnaith spoke with Dr Richard Steadman about how severe knee
injuries may no longer mean an end to an international sporting career

Performing surgery on a patient is stressful enough; to perform it on a professional
athlete with millions of euro depending on the operation’s success is even
more so. Yet some people seem to thrive in this pressure-cooker environment.

In the three decades that Dr Richard Steadman has been working in the orthopaedics
field, the renowned surgeon has worked ‘miracles’ for countless
athletes across the world, in a process pioneering how knee injuries are approached
and ultimately overcome.

Since the mid-1980s the Colorado-based surgeon has successfully operated on
Irish legend Roy Keane, the likes of Brazil and Real Madrid superstar Ronaldo,
German World Cup winning captain Lothar Matheus, tennis Grand Slam winners Monica
Seles and Martina Navratilova, and a host of hall-of-fame American football
players including Dan Marino and Joe Montana.

“If I were to get injured, although it could keep me from participating
in my favourite recreational activity, I could just shift to another —
a professional athlete simply does not have that flexibility,” Dr Steadman
told Medicine Weekly in a recent interview after the Winter Olympics.

“Everyone that has an injury has a projection for the level they need
to get back to, but it’s more focused with professional athletes because
they have to get back to the highest level of their specific sport. Because
of that the treatment, including surgery and rehabilitation, has to be tailored
so that they can get back to the highest level in their sport.”

A native of Texas, Dr Steadman’s path to treating the leading athletes
of our time began after he left his role as a US army surgeon to take up an
orthopaedics residency, specializing in knee disorders, in New Orleans. In 1976,
the US Ski Team appointed him their chief physician, and within four years Dr
Steadman had helped no less than 14 future World Championships and Winter Olympics
medallists to recover from a variety of serious — and in some cases career-threatening
— knee injuries.

Athletes in almost every sport were soon flocking to him to benefit not only
from his surgical skills but also his innovative rehabilitation techniques;
techniques which, while at the time were unique, have since been adopted worldwide
as the key protocols of orthopaedic medicine.

A key reason for this is the micro-fracture, a surgical technique he refined
in the early 1980s that allows for the use of bone marrow to make new cartilage.
This surgical technique has been behind many of the recoveries of Dr Steadman’s
most high-profile patients and, to date, no other knee surgery procedure has
proven to be more effective. Although other procedures are being developed,
such as stem cell treatment, the micro-fracture is still considered the benchmark
of knee surgery.

“What I tried to do with the micro-fracture was bring together a procedure
that had a good ability not only to make the new cartilage but to anchor it
to the bone and then come up with a rehabilitation programme that would enhance
the ability of it to become a long-standing and long-operating cartilage.

“I know of at least three studies being carried out at the moment that
compare the micro-fracture with other types of cartilage procedures. The first
one would say there’s no improvement were the patient’s own cells
are grown in the lab and put back in — in a randomized study the micro-fracture
came out equal with that, if not slightly better. As a result of that study
the benchmark now is micro-fracture.”

Post-injury techniques have also become increasingly important in recent decades.
“In the late 1970s and early 1980s I treated a lot of well-known athletes
and in those days the therapy was not what it should be. I recognized this and
so did the athletes, so I became physically involved in not only the surgery
but the therapy as well. That really gave me a better sense of what’s
required and what level an athlete can come back to after serious injury.

“In my view, if you are going to quantify the importance of different
steps after injury, the early post-injury period is the key because surgery
needs to be done in a way that allows for early rehabilitation and early mobilization.
The fixation has to be good, the understanding of the different ranges of motion,
and then as you go from that level you have to recognize the importance of mobility.

“My experience has shown me that mobility seems to be the key in getting
a joint to come back to its highest level and to maintain that level, with the
onset of arthritis as a result of early return.”

One of the downsides of his specialty, however, is that when an injury is too
severe to overcome he is often the one who has to first mention the dreaded
‘r’ word — retirement. After reaching the heights of being
voted World Footballer of the Year, Marco van Basten had to face such a reality,
but Dr Steadman was adamant that despite the pressure placed on the athlete
to continue, sometimes accepting defeat really is the best long-term choice.

“I’ve had to tell a number of very successful ones that if they
try to continue at their level they will suffer in the future. You can’t
try to make your knee fit your sport.”

For those that don’t heed this advice, the focus of Dr Steadman’s
latest work — the long-term injury concerns for retired sports stars —
should be of genuine interest. In the surgeon’s view, the improvements
being made in arthoscopic procedures, the use of hyaluronic acid in the prevention
of joint injuries while still competing and other medical developments can significantly
reduce the onset of arthritis and the need for knee replacements as time takes
its toll.

It’s research that is not only of benefit to the leading sports stars’
of the day, however. In Dr Steadman’s view, what can be learned from innovative
techniques to help improve the recovery of this select group of patients will
ultimately be of significant benefit to the rest of the population.

“Recreational athletes can learn a lot from the super athlete. The super
athlete is like a race car that technology goes into, but the technology spills
over into the general population.”

Article Source: Medicine Weekly

No Synovial Fluid Replacement Therapy is not painful. Naturally, as with all injections, there is mild and short-lasting discomfort during the actual procedure, but aside from this Synovial Fluid Replacement Therapy is virtually painless. Often your physician will use a topical anaesthetic to reduce the discomfort.

If there is considerable inflammation around the joint, the physician may remove some of the excess fluid (exudate) prior to an injection.

Synovial Fluid Replacement Therapy can be an effective alternative for all stages of Osteoarthritis.

Download leaflet on Synovial Fluid Replacement therapy

· lubricates the joint and restores the elastic properties of the fluid
· ability to act as a shock absorber.
· Movement of the joint becomes easier and more comfortable.
· decreases pain for up to six months and also improves function in patients with OA of the knee.
· patient’s reliance on other pain relieving medications is significantly reduced.
· available on Medical Card Scheme
· may delay necessity for knee replacement surgery
· effective in treating patients with early to middle stage arthritis who wish to improve their function and reduce pain.
· effective in patients with more advanced arthritis who may experience delays in receiving a total joint replacement.
· valuable tool for GPs whose patients find themselves on long waiting lists to see an orthopaedic surgeon.
· effective use in treatment of sports injuries particularly in the knee
· can prevent further loss of cartilage
· may stimulate the natural production of synovial fluid by the body a process know as visco-induction
· is a longer lasting alternative which is safe and could help to reduce dependence on anti-inflammatory medication

The treatment of osteoarthritis can result in serious side effects that have encouraged the development of a therapy that mimics the unique properties of the joint¹s own synovial fluid. Dr Robert Petrella, Medical Director of the Canadian Centre for Activity and Ageing gives some insights into viscosupplementation

Introduction

Osteoarthritis (OA) is the fourth most common debilitating condition among women and the eighth most common among men in Western countries. At least 50 per cent of the population over 65 has radiographic evidence of osteoarthritis and more than 10 per cent have major disabilities as a result. Approximately 5 per cent of this population will require total hip replacement surgery. Non-medical management of the condition involves weight loss, exercise and physiotherapy.

Use Of NSAIDS

Palliative medical interventions use paracetamol as a first choice analgesic. An NSAID should only be used if paracetamol is ineffective or is there is significant inflammation involved. When given regularly in full doses, NSAIDs have an analgesic and anti-inflammatory effect, but they are generally more useful in rheumatoid arthritis than OA, although they can benefit patients with severe OA.
Of course, there are significant risks associated with long-term use of NSAIDs, particularly in the elderly. GI bleeding is the most serious side effect, but NSAIDs may also worsen cardiac disease and renal impairment in the elderly. However, NSAID tolerance varies widely. Cox-2 inhibitors are licensed for pain relief in OA. Where cox-2 therapy is used, they may be combined with H2-receptor antagonists or proton pump inhibitors to reduce GI effects. Finally, in the treatment progression of OA, is joint replacement therapy, although most patients with OA typically do not need it.
Corticosteroids are sometimes used intra- and peri-articularly in patients with localised inflammation, but they have only short-term benefits (typically three to six weeks) and are recommended for use infrequently or as an adjunctive therapy.
Viscosupplementation or synovial fluid replacement therapy using hyaluronan became available on the GMS in February. It has been licensed for clinical use in OA treatment in much of Europe since 1995 and in the US since 1997.

Benefits Of Viscosupplementation

The Director of the Canadian Centre for Activity and Ageing, Dr Robert Petrella, was in Dublin recently to talk about the benefits of viscosupplementation.
“The OA disease process is initiated through an inflammatory process in which joint cartilage is involved. Within the joint there is a milieu of material, of synovial fluid, which has a composition which allows patients to perform normal movements like walking, that create impacts on joints. But as the disease process continues, we know that the synovial fluid changes in its characteristics,” Dr Petrella explained.
“If you were to sample that fluid in someone who has no arthritis and someone with a very early onset of an arthritic condition, the composition of the fluid is really quite markedly changed. There is a change in its viscous property; it’s less able to withstand the stressors of activity,” he said. “Initially, patients may feel pain during particular activity such as going up and down stairs, but the rest of their activity may still be pretty good. As the disease process develops further they get further degradation of synovial fluid, typically with pain during very simple activities, such as getting out of a chair. So we think that the changes in synovial fluid are probably a marker or precursor of the changes that occur in the arthritis process.”
Eventually, he said, the patient will develop cartilage and bone changes which are irreversible.
“The opportunity that you have when the synovial fluid is being changed by arthritis is a fairly short window, an ongoing moving target. As in all the way through the condition’s progress, the material continues to change.”
Viscosupplementation is a process which tries to reintroduce a normal milieu within the synovial fluid in the joint space, altering its properties such that it can withstand different kind of stress.

Dynamic Molecules

Synovial fluid is made up of various chains of hyaluronan. It is responsible for the viscous properties observed in the fluid. Hyaluranon is a dynamic molecule. It changes in its configuration and its physicochemical properties, depending on what types of stressors are being placed on the joint.
“If you were to sample a joint after a high level of bouncing activity, for example, in a basketball or volleyball player, you’ll see that there is a shift in the molecules’ composition to a more dynamic form, with a more viscous property, as opposed to what you would find in someone who has just been sitting around or gently walking,” Dr Petrella explained.
“There are a number of products that try to mimic what should be in the joint. They vary in their molecular weight and in their concentration. The idea behind all of them is that, if you can mimic what the joint needs, you would be able to forestall the progression of arthritis to the irreversible bone and cartilage changes, but also you could enable patients to function in a more normal way,” according to the doctor.
All of the products are introduced as a liquid gel, intra-articularly injected into the joint space, he commented, but stressed that there is a dosing aspect involved.
“In order to get the material up to a level that’s actually bio-useful in the joint requires a certain volume at a certain dosing frequency. For instance, in the knee at any one time you can introduce between 2-3.5ml of any fluid, including hyaluranon, before you would begin to cause pain due to stretching of the joint capsule. So you would introduce maybe 2ml of viscosupplementation to the joint, then allow it to equilibrate and dose again a week later. The typical treatment tends to be 2ml once a week for three weeks to reach a critical concentration/volume to allow the surrounding tissue to withstand physical force.”
“The material introduced to the joint is gradually cleared through the lymphatic system surrounding the joint, and probably has a half-life of four weeks or so. However, the relief from symptoms tend to last up to six months and even up to one year. Patients at my own practice who have had the series of three injections and have had good resolution of their symptoms, maybe not 100 per cent, but very close, have typically had this relief for eight to 12 months.”
“The beauty of this material is that because it is natural, it can be introduced at any time and has no accumulative effects. So patients come back in, have another series of three injections, and get a repeat of symptom relief for a similar period,” Dr Petrella said.
“I think that another advantage of the product being natural is that it has no interaction with other drugs. It’s not excreted through the liver or kidney, so there’s no problem with co-morbidity, so it really has no contra-indication for any patient with arthritis. The only thing of course, as with any injection, is that it must be introduced using sterile technique, to protect from infection. The incidence of adverse events is very very low; between 1-2 per cent per injection. And those side effects tend to be in the range of what the patients are already experiencing – pain within the joints, some swelling. These also tend to be very transient side effects.”

Active Investigation

“An area of very active investigation is the change in synovial fluid composition or its characteristics as the condition progresses. What we would like, but don’t have now, is a way or a marker to determine at what stage a patient may be in the disease progress” he commented.
“We do know from clinical history that certain occupations, activities or being overweight may predispose people to the development of OA, as does having arthritis in other joints. We just don’t have a good marker of the development of arthritis in a joint we are studying that would allow us to say that this is the point when we should start using viscosupplementation. Obviously that would be very useful, allowing us to predict the optimal time to start therapy.”
“More importantly right now, we know that this is a process that starts very early and continues to develop until the end of the joint’s life. We can introduce this product at any time in the disease process. Even patients who are waiting for a total knee joint replacement can still have about a 60 per cent improvement in their symptoms if they have viscosupplementation injections, even if they have very late stage arthritis. We really don’t have any other options in that case. Patients are typically waiting considerable periods before they will have the replacement surgery. I know in Ireland the wait can be two years or more but in the interim patients actually do very well with this therapy,” he said.
“It’s safe to use viscosupplementation if a patient has a co-morbidity such as cardiovascular problems or GI disease, or are taking NSAIDS for arthritis. The big issue about viscosupplementation is awareness,” according to Dr Petrella. “I think there is a lack of awareness of the therapy as an option, particularly in Ireland, where it has just been introduced.

Lifestyle Modification

Dr Petrella’s role as Director at the Canadian Centre for Activity and Ageing at the University of Western Ontario is to oversee its activities as a clearing house for community-based programmes and laboratory-based research into activity-related disease.
³Specifically, the work that I’m doing is related to musculoskeletal changes with ageing. We’re also very much into lifestyle modification, so we investigate exercise and dietary changes within the older population to enhance activity and to lower cardiovascular risks.”

Dr.Robert Petrella was in Ireland to address a meeting to discuss the treatment of OA, chaired by Dr. Doug Veale, consultant rheumatologist,St Vincent’s University Hospital.

Irish Medicine Weekly

A New Joint Injection therapy can treat pain and improve function in osteoarthritis and sports injuries for up to six months, it has been claimed.

Synovial fluid replacement therapy, a recent meeting of GPs and specialists in Dublin was told, can be used in patients in all type of osteoarthritis and can offer a new option in sports medicine.

The therapy involves a series of injections into the knee and can, it is claimed, relieve pain for up to six months. It is now available on the medical card scheme…

New Joint Injection Therapy Article and Discussion continued here…

Ageing population: A leading arthritis specialist has warned that a major crisis is looming because of our ageing population and the lack of services for people with arthritis.

Dr Douglas Veale, consultant rheumatologist at St Vincent’s Hospital, said there were already waiting lists of four years or more to see a rheumatologist in some areas.

With the number of over 65-year-olds expected to increase by up to 25 per cent in the next 20 years, the demand on arthritis services would spiral, he said.

This would be compounded by the increase in the number of sports people getting osteoarthritis.

GAA and rugby players were training harder and resting less between games so damaged joints were not getting time to heal, he said.

“There is already a crisis,” he said. “Very few GPs have experience of musculoskeletal health and we have the lowest number of rheumatologists in Europe. We have 25 rheumatologists for a population of four million. That’s worse than Croatia.”

His comments were backed by Arthritis Ireland, a support group for arthritis sufferers. John Church, Arthritis Ireland chief executive, said the problem was even worse than might be envisaged as all consultant rheumatologists had to spend about 50 per cent of their time on Accident & Emergency calls “thus diluting the resources even more”.

He said half of all patients who developed rheumatoid arthritis would develop work disability within 10 years of diagnosis if they did not receive proper patient care.

“They may end up losing their job thus drawing further on the State resources. The irony is that by continuing to ignore the under-resourcing of rheumatology services in Ireland, the country is facing an even bigger bill in the long term.”

Mr Church said the increasing incidence of obesity was another risk factor as more weight put more pressure on damaged joints.

Arthritis Ireland has called for the establishment of a full-time professor of rheumatology with research staff.

“Otherwise, we are just sticking our finger in the dyke. Without research, we are attacking the symptoms but not the cause.”

Mr Church said arthritis rarely made the headlines as people did not see it as being life-threatening in the way that cancer or heart disease was.

“But the long-term consequences extend beyond just joints and disability. It impacts on patients’ lives, family income and has huge socio-economic implications for the country. It’s a time bomb just waiting to go off,” he said.

According to Dr Veale, one in four people with osteoarthritis has never seen a doctor as they feel it is part of the ageing process. “It’s a big hidden problem.”

He was speaking at the launch of a new therapy to treat osteoarthritis and sports injuries. Synovial fluid replacement therapy involves a series of injections into the knee joint, giving pain relief for up to six months. One such product, Suplasyn, has now become available for medical card holders.

It is being promoted as an alternative to anti-inflammatory drugs and a way of reducing reliance on pain-relieving medication.

Dr Veale said the new treatment seemed to work most effectively for people with early stage arthritis, rather than those with long-term damage.

Irish Times

A meeting took place in Dublin recently to discuss the treatment of osteoarthritis (OA), a condition that up to 400,000 people in Ireland suffer from annually.

The meeting, which was hosted by Premier Medical and chaired by Dr Douglas Veale, consultant rheumatologist, St Vincent’s Hospital, Dublin, heard about recent changes in the treatment of OA and sport injuries of the knee.

Guest speaker, Dr Robert J Petrella, medical director at the Canadian Centre for Activity and Aging, gave insights into the use of synovial fluid replacement therapy using hyaluronan, and also showed the results of research on the treatment and its different applications and benefits.

The therapy involves a series of injections into the knee joint, resulting in pain relief which can last up to six months. It also prevents further loss of cartilage in some cases. The patient’s reliance on pain-relieving medications may also be reduced. It also improves function in patients with OA of the knee, thus increasing their mobility and allowing them to exercise. The therapy, known also as viscosupplementation using hyaluronan, came into clinical use in Japan and Italy in 1987, in Canada in 1992 and in Europe in 1995. It has been approved in the US since 1997.

An interview with Dr Petrella will appear in next month’s issue of Irish Pharmacist.

A meeting took place in Dublin recently to discuss the treatment of osteoarthritis, a condition that up to 400,000 people in Ireland suffer from each year.

This meeting, which was hosted by Premier Medical and chaired by Dr Douglas Veale, consultant rheumatologist, St Vincent’s Hospital, Dublin, was an informative symposium on recent changes in the treatment of osteoarthritis and sport injuries of the knee. Synovial fluid replacement therapy was also introduced at the meeting.

Guest speaker Dr Robert J Petrella, Medical Director at the Canadian Centre for Activity and Aging, gave insights into the use of synovial fluid replacement therapy using hyaluronan, and also showed the results of research on the treatment and its different applications and benefits.

This information was welcomed by the Irish doctors as being a positive addition to current practises, especially in light of recent limitations regarding the prescription of anti-inflammatory drugs, according to Premier Medical.

This therapy, involving a series of injections into the knee joint, results in pain relief which can last up to six months. It also prevents further loss of cartilage in some cases. The patient’s reliance on other pain relieving medications is also significantly reduced, claim the manufacturers Premier Medical. It is valuable for patients who find themselves on long waiting lists to see an orthopaedic surgeon as it can delay the necessity for knee replacement surgery in suitable cases. It also improves function in patients with OA of the knee, thus increasing their mobility and allowing them to exercise, says the company. This therapy is available on the GMS.

It can also be effectively used in the treatment of sport injuries to the knee, providing athletes with pain relief, reducing the need for anti-inflammatory drugs.

The therapy, known also as viscosupplementation using hyaluronan, came into clinical use in Japan and Italy in 1987, in Canada in 1992, and in Europe in 1995. It has been approved in the US since 1997.

The product Suplasyn, a prescription-only product, is now available on the GMS in Ireland since February.

The length of waiting lists for orthopaedic and rheumatology services can cause further difficulty for patients in extreme pain. Currently, the standard treatment for these patients is weight loss and physiotherapy. If this approach is not successful, analgesics, as well as anti-inflammatory drugs, may be used, as well as steroid injections. However, the effects of these may only last up to six weeks.

Another recent development is the use of Hyaluronan in the area of sport-medicine. Many patients have been treated successfully to date and this therapy and its applications to sport medicine are currently attracting a lot of interest from specialists world-wide. However, hyaluronan injections can prevent further loss of cartilage, states Premier Medical.

This is good news for team doctors, sportspersons, GPs and physiotherapists where early symptoms of wear and tear osteoarthritis are apparent.

This becomes more apparent when considering the results of a survey of over 260 top GAA players, which was conducted by Dr Veale, with the help of team doctors. Conducted during last year’s championship season, the results of the survey showed that 65 per cent of players were suffering pain and stiffness compared to rates of around 10 per cent in the general population.

Irish Medical News