For the week of: 7/6/98

Question: "I understand the Food and Drug Administration has approved a new "lubricant", Hyaluronan, for direct injection into the knee joint for people with pain due to osteoarthritis. As someone who can not tolerate anti-inflammatory medications by mouth because of stomach problems I am interested in Hyaluronan. My personal doctor does not know much about it yet. Who should try this approach? Does it work? Is it costly? Do very many insurance's pay for it yet? How long do the effects seem to last? I'm interested in seeing any type of specialist who has been having good luck with this product."

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by Dr. James B. Dolan, M.D.

Answer: Hyaluronic acid (Synvisc or Hylagan) is a naturally occurring substance isolated from the comb of roosters. It has been used extensively in Europe and by vets for several years and became FDA approved in the last two years.

It is indicated for use in patients with osteoarthritis who have failed to respond to NSAIDs and for whom a joint replacement is not a viable option. Studies indicate about a 80% reduction in pain for most patients lasting for five months up to a year. It is given as a series of five injections into the joint each a week apart.

Experience in this area is that only about half the managed care insurers will pay for the treatments with the rest calling it "experimental" in spite of FDA approval. The cost for the series of injections is between $1500 and $2000 dollars.


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