Since the 1970s, some doctors have treated arthritic knees by injecting them with hyaluronic acid, a substance originally derived from cockscomb. Specialists have promoted this therapy zealously, costing patients a few hundred dollars a pop and repeated so widely that Medicare alone pays $300 million a year for it. Doctors claim that it reduces pain and increases joint mobility.
It barely lives up to that billinghowever, offering patients little more relief than a placebo (saline or salt water), the researchers found after reviewing half a century of data from 169 clinical trials involving more than 20,000 patients.
The wildly popular viscosupplementation procedure, as reported by Stat, a medical and scientific news site, showed an average effect “about 2 points beyond the placebo effect on a pain scale ranging from 1 to 100”. Researchers from Canada, Great Britain and China concluded this from their study, as published in BMJ, a respected medical journal of the British Medical Association:
“Strong conclusive evidence indicates that, in patients with knee osteoarthritis, viscosupplementation is associated with a clinically irrelevant reduction in pain intensity and an increased risk of serious adverse events compared to placebo. Our results do not support the widespread use of viscosupplementation for the treatment of knee osteoarthritis.
Stat reported that researchers said physicians should not ignore the risks posed by this therapy (as noted above):
“Some studies [they examined] reported gastrointestinal inflammation and infections, cardiovascular problems, blurred vision, and dizziness, among other problems, in patients receiving hyaluronic acid, although the authors dismissed these as unrelated to the injections. In 2018, more than a quarter of Medicare spending on viscosupplementation was incurred for the treatment of subsequent joint infections, the paper says. Since people who take part in trials tend to be healthier than the general population, these risks could be even more pronounced in real-world settings.
Certainly, as the Stat article reports, patients seek relief from pain and discomfort when considering injections, which they hope are preferable to surgery:
“Osteoarthritis is a chronic, incurable disease that occurs when cartilage breaks down in the knees, hips, hands or other joints, leading to pain, limited range of motion and swelling. More than 32 million people adults in the United States suffer from osteoarthritis, according to estimates from the Centers for Disease Control and Prevention.Since there is no cure, people with osteoarthritis often manage their condition with exercise, physiotherapy, medications and injection therapies…Chronic illness can be a journey of despair…Faced with progressively worsening osteoarthritis, patients and doctors often seek out tools that could help avoid surgery. along the way, many encounter through word of mouth, seemingly legit health websites, or heavy marketing, a slew of supplements and therapies backed by little or no scientific evidence. impartial.
The researchers, whose experiences with patients who had undergone this therapy had made them skeptical, raised questions about doctors’ willingness to inject patients with a substance with so little evidence of its benefits for so long. Indeed, they noted that soon after doctors began injecting patients, researchers launched a slew of clinical trials – so numerous that their results “far exceeded the ability of the field to find, evaluate and distill the evidence”.
The companies that supplied the injections, in the next phase, conducted their own trials. The researchers said these trials appeared to have been launched with sufficient rigor – except that their results, as too often happens, were not “fully published”, although they “reported similar treatment effects or worse”. [from injections] on osteoarthritis pain [the] placebo.”
Further trials were then assured, still at robust levels, and the researchers expressed objections to this, writing:
“[B]Between 2009 and 2021 alone, more than 12,000 patients received intra-articular injections in viscosupplementation trials, raising ethical concerns. Based on our trial sequential analysis, a sufficient number of patients have been recruited to confidently conclude that viscosupplementation is not only ineffective compared to placebo, but may also be seriously harmful and should therefore be used with caution in any ongoing trial.
In my practice, I not only see harms experienced by patients when seeking medical services, but also their difficulties in accessing and paying for safe, effective and excellent medical care. This has become an ordeal due to the skyrocketing cost, complexity and uncertainty of treatments and prescription drugs, too many of them turn out to be dangerous drugs.
Before undergoing increasingly expensive, complex and risky procedures for knee and joint problems, patients should discuss with their doctor the benefits of rest, exercise, physical therapy and medication. All medical procedures carry risk, and that includes injections, and it’s worth noting, as Stat reported, that the American Academy of Orthopedic Surgeons released clinical guidelines in 2013. and doubled in 2016advising against the use of hyaluronic acid injections for patients with knee osteoarthritis.
As for the “next step”, more invasive surgeries – even operations like knee, shoulder and hip replacements that doctors and hospitals insist on have become almost routine – should never be undertaken without careful discussion, preparation, investigation and care.
Too many patients have found that knee surgeries, for example, have their ‘risks and limitations’, and ‘doctors are increasingly concerned that the procedure is being overused and its benefits have been oversold’, the independent said. . The Kaiser Health News (KHN) service reported not so long ago.
Patients rightly view personal mobility as fundamental to the quality of their life, and this ability – along with freedom from discomfort and pain – may argue for the increased activity of bone procedures. and joints. But we have a lot of work to do to ensure that rigorous evidence exists for treatments before they become widespread, expensive and of little or no benefit to patients.