Hyaluronic Acid Joint Injections

[Eve]

Hi, my knees are knackered but not knackered enough for surgery yet and consultant said surgery might make things worse so these have been suggested.

Just wondering if anyone else has had any of these and how they found them.

[Sqad]

Sorry Eve....my knowledge on this subject is limited....very limited.

The technique is straight forward, the side effects are minimal....almost zero, but how it works, nobody is quite sure.

Long term results seem to be variable.

[Eve]

No worries Sqad, whatever you know if definitely more than I do :)

Had never heard of them before today though I'm more used to rheumatology speak than orthopaedic speak. That said, they said rheumatology would need to do the injections.

I'm liking minimal side effects!

[tonyav]

Eve, just how knackered do your knees have to be before the consultant will consider surgery.

[slaney]

I could find a Canadian paper which looked at a series of 13 randomised controlled trials which concluded...
"Viscosupplementation with HA is a reasonable treatment for patients with mild-to-moderate OA of the knee who have ongoing pain or are unable to tolerate conservative treatment or joint replacement. The effect lasts longer with high-molecular-weight preparations, and patients can experience improvement in clinical outcomes for up to 1 year. Intra-articular HA appears to have a slower onset of action than intra-articular steroids but the effects seem to last longer. Patients should be warned of cost and of potential side effects, including local swelling."
So might be worth considering Eve.

[Eve]

From what I could understand, much more damage showing on an x-ray/scan. They didn't scan them today though, last done ages ago, maybe a year ago.

I think the look on my face when he said it had to be much worse said it all! They are causing big problems and a lot of pain and giving way so I'm not sure I want to find out how much worse :(

I really hope that if they go ahead with them that these injections make a difference.

[tonyav]

Eve, could you not ask him to do another scan.

[Eve]

Thanks Slaney, definitely worth a try! He did mention steroids too but said these would be better, mentioned about it lubricating them more.

One thing I didn't think to ask until I'd left and doing a brief google was whether they are now saying I have osteoarthritis in my knees as well as the RA generally.

I remember it being said there was some damage (chondromalacia I think it said) from my MRI result.

He mentioned various factors like the RA, the shape of the leg, use etc...

[slaney]

I think injection with HA is only approved for use in patients with osteoarthritis, so it might be worth while clarifying that with your consultant.

[Eve]

I don't go back to orthopaedics until it gets a lot worse Tony :( I'm not sure I could dare ask them to do scans, am really not very assertive and I always assume they will do them if they think I need one, guess it depends how long they think more damage would take. Will see what my rheumatology consultant says.

I'm really struggling being in a house, especially with the stairs, I need to move to somewhere all on one level and get some help with cleaning and such. Not just due to my knees though.

[Eve]

Thanks Slaney, that was what made me think, seeing something like that on a page I googled. Will see if I can get someone to find out next week as got my infusion and pre-bloods (hoping my ALT has calmed down!).

Actually, while you and Sqad are about, is it normal for your white cell count (neutrophils I think) and platelets to start dropping while on tocilizumab? Am guessing it is maybe the nature of the drug and not worried as they haven't reached the bottom of the normal range yet though did wonder as they have dropped further each time I get my bloods book back.

[tonyav]

Eve, I think that sometimes it's a case of if you don't ask then you don't get.

[slaney]

There is a tendency for the WBC and platelets to fall initially Eve , but this usually stabilises.
How many doses have you had, and more importantly is there any improvement yet?

[Eve]

True Tony :) Thanks Slaney.

Next week will be my fifth, was taken off methotrexate (again) and off the trial but cleared to still have the drug. I only had a half dose last time though due to ALT results and it's been a tougher month.

There has been improvement, more of a slower burn but, my ESR is down to 2 which is pretty incredible and my joint count is way down as it was really bad before I started! Fluid has been complicating things though as it's going crazy in the heat and my feet and ankles and fingers have been getting badly swollen. My shoulders and hips have improved too so it seems to be tackling the bursitis too :) I do have to remember though that I have other conditions which are still there though, fibro and such which also contribute to pain, fatigue etc...

I am starting to feel a bit more myself more often though which is good! My ALT may put a spanner in the works though which is crap.

Had an abdominal and "lady" scan recently due to some symptoms which were thought could be something like an ovarian cyst or other things (pain, bad bloating, awful indigestion etc...) and they found some fatty liver. I rarely drink so not alcohol related.

[slaney]

Good about the ESR and feeling somewhat better - I presume the fatty liver (many many causes including Methotrexate) and abnormal ALT are going to be looked into to try and find the cause. Depends how bad it is I suppose.

[Eve]

GP said the fatty liver wasn't anything to worry about (they ordered the scan) and mentioned it to rhumo. Will see what they come back with this coming week, they went over 100 then back down (hoped that taking away the methotrexate had cracked it) then back up over 100 again, 106 I think last time. So not massively high but was told that if it stays up they will rethink and put me on something else. Hopefully the half dose will have brought it down again, fingers crossed!

[tonyav]

Hope you don't have to wait to long for the scan, Eve.

[Eve]

Thanks Tony x

[tonyav]

With a bit of luck you'll get your knees sorted.

[Eve]

Thanks to everyone for answering, not good news I'm afraid, my rheumatologist said they don't do the injections as they can cause more harm than good so it's all a bit of a no go.

So back to the drawing board!

[tonyav]

Sorry to hear that, Eve. The rheumatologist didn't suggest an alternative then.