• What is osteoarthritis?
Osteoarthritis, known as degenerative joint disease, is the most common form of arthritis, affecting millions of people worldwide, particularly people 50 years and older. It is a long-term, chronic disease characterized by the deterioration of cartilage in joints, which causes bones to rub together and creates stiffness, pain, and impaired movement. Although osteoarthritis most commonly affects the joints in the knees and hips, the disease is relatively common in the shoulders, hands, feet, and spine.
While osteoarthritis is related to aging, it is associated with a variety of both modifiable and non-modifiable risk factors, including obesity, lack of exercise, genetic predisposition, bone density, occupational injury, and trauma. Osteoarthritis also affects women more commonly than men.
• What is hyaluronic acid and how does it help osteoarthritis?
Sodium hyaluronate is a high molecular-weight, ubiquitous molecule that occurs naturally within the cartilage and all synovial joints. In particular, weight-bearing joints, such as ankles, knees, and hips, contain viscoelastic sodium hyaluronate. This substance has lubrication and shock-absorbing properties, allowing these joints to move normally and painlessly.
In patients with osteoarthritis, the viscoelasticity of the fluid within the synovial joint is significantly impaired, causing mechanical stress on the joint, breakdown of the articular cartilage, and, subsequently, limited and painful joint movement.
Adding hyaluronic acid to the existing joint fluid of an osteoarthritic knee helps to facilitate better knee movement, reduces pain, and many more benefits.
• Why is hyaluronic acid important in the treatment of osteoarthritis?
Hyaluronic-acid (HA) injections offer several advantages over other treatment options. These intra-articular injections, with their exceptional viscoelastic properties of highly purified sodium hyaluronate, help to improve the quality of a joint’s lubrication. This increased lubrication aids in shock absorption, reducing pain and improving joint mobility.
These beneficial effects may last for several months, following the recommended treatment cycle of intra-articular injections. Additionally, hyaluronic-acid products minimize the risk of systemic side effects and may even delay the need for total knee replacement.
• What are the indications for Reviscon treatment?
Reviscon 1.0% / Reviscon Plus 1.6% / Reviscon Mono 2.0% is indicated for the treatment of pain and loss of flexibility as a result of osteoarthritis in joints. Reviscon is recommended for patients who have not responded adequately to conservative, non-pharmacological therapy and simple analgesics (e.g., acetaminophen also known as paracetamol).
• In which osteoarthritis grades are HA injections recommended?
Hyaluronic-acid injections are recommended in the 2nd and 3rd Kellgren-Lawrence grading of osteoarthritis, when patients fail to respond to conservative, non-pharmacological therapy and simple analgesics.
• How does Reviscon work?
Reviscon acts as a lubricant and a shock absorber in the joints which enables the joints to work effectively. In addition, Reviscon treatment helps to stimulate new hyaluronic-acid synthesis. By working as a filter, it allows for the passage of cells needed by cartilage, synovium, and synovial fluid, and prevents the infiltration of inflammatory cells.
With its shock-absorbing effect, Reviscon smooths the force of sudden movement, preserves the joint, and aids in the protection and construction of joint cartilage and synovial membrane. Additionally, there are several clinically proven effects of intra-articular hyaluronic acid injections.
• How soon after a Reviscon treatment will a patient experience pain relief?
A patient will experience pain relief within few days after treatment. The patient should not strain their knee joint for two days after receiving Reviscon and should avoid activities such as jogging, soccer, tennis, heavy lifting, or standing for long periods of time. Temporary pain or swelling of the knee joint may occur after receiving a hyaluronic-acid injection.
• How long will pain relief last after a Reviscon treatment?
A patient can expect to experience pain relief from a Reviscon treatment for 6 – 9 months. This effect may last for several additional months following a recommended treatment cycle of intra-articular injections.
• How is a Reviscon treatment administered and can a treatment be repeated?
Reviscon 1% is five injections in a one-week interval; Reviscon Plus 1.6% is three injections in a one-week interval; and Reviscon Mono 2% is a one-shot injection. Depending on the patient’s condition and the doctor’s suggestion, these treatments may be repeated.
• How often can a patient receive Reviscon injections?
Reviscon’s effectiveness in reducing pain lasts from 6 – 9 months. As recommended, after 6 months, a patient should have the injections again.
• Can a patient receive Reviscon injections in more than one joint at the same time?
Several joints may be treated simultaneously; however, to avoid intra-articular infection, it is essential to apply strict aseptic-injection technique. Do not reuse a syringe. Any repeat usage of a syringe carries a risk of contamination and infection of the patient.
• What are contraindications for HA injections?
HA injections should not be administered to patients with known hypersensitivity to sodium-hyaluronate preparations. Additionally, intra-articular injections are contraindicated in cases where infections or skin diseases are present in the area of the injection site to reduce the potential for developing septic arthritis.
• What are the side effects of HA injections?
Following the use of Reviscon 1.0% / Reviscon Plus 1.6% / Reviscon Mono 2.0%, patients may experience localized symptoms in the joint being treated, such as pain, sensation of heat, reddening, and swelling. These side effects are self-limited and typically last no more than a few days. The patient can mitigate these side effects by applying an ice pack to the injection site and remaining upright. The following adverse effects have been reported for products similar to Reviscon: mild or moderate joint pain, aseptic joint effusions, itching, muscular cramps, and, in rare cases, skin rash.
• What other treatments are available for osteoarthritis?
Treatment is chosen according to the grade of osteoarthritis. Drugs, such as glucocorticoids and NSAIDs, have been widely used for the treatment of osteoarthritis; however, none of these agents provides a complete treatment and they have all been associated with adverse effects.
Recently, new treatment strategies are being proposed, including anti-cytokine therapy, gene therapy, delivery of growth factors, stem-cell therapy, neurotransmitter antagonists, bisphosphonates, and lubricant agents, such as lubricin.
• What is the origin of Reviscon?
Reviscon is bio-fermented sodium hyaluronate. It is manufactured by bacterial fermentation and rigorously purified. Reviscon 1.0% / Reviscon Plus 1.6% / Reviscon Mono 2.0% is a sterile, non-pyrogenic, clear, non-inflammatory, highly purified sodium hyaluronate of high molecular weight, dissolved in a buffered physiological saline solution.
• What is the molecular weight of Reviscon?
The molecular weight of Reviscon is 3MDa, which is one of the highest non-animal-sourced molecular weights on the market.
• How are the concentrations of Reviscon used?
Reviscon 1.0% / Reviscon Plus 1.6% / Reviscon Mono 2.0% is a product for the relief of pain and stiffness in patients with degenerative and traumatic changes to the knee joint and other synovial joints. A doctor can choose the right concentration of Reviscon for a patient’s specific condition.
• Is local anesthesia commonly used prior to HA injections?
Local anesthesia is not commonly used prior to HA injections; however, a doctor may administer a local anesthetic, such as lidocaine or numbing spray, prior to injection.
• Can ultrasound-guided injections improve clinical outcomes?
According to researches, only 40% of intra-articular injections are administered accurately. Overall, ultrasound-guided injections are more accurate than landmark-guided injections. While current studies indicate that ultrasound guidance improves efficacy and cost-effectiveness of many injections, these studies are limited and more research is needed.
• Is Reviscon considered a medical device or a drug?
Reviscon is considered as a medical device in most of the countries. However in some countries Reviscon may be categorized as a drug. Please check regulatory requirements of specific countries.
• What does linear chain mean?
The simplest polymer is a linear polymer. A linear polymer is simply a chain in which all of the carbon-carbon bonds exist in a single straight line.
References:
1. Reviscon IFU.approved @15.04.2020
2. Haq I, Murphy E, Dacre J. Osteoarthritis. Postgrad Med J. 2003;79:377-383. www.who.int/medicines/areas/priority_medicines/Ch6_12Osteo.pdf.
3. Neustadt DH. Intra-articular injections for osteoarthritis of the knee. Cleveland Clinic Journal of Medicine. 2006;73(10):897-911. www.rheumatology.org/Portals/0/Files/Viscosupplementation.pdf.
4. Migliore A, Bella A, Bisignani M, Calderaro M, De Amicis D, Logroscino G, et al. Total hip replacement rate in a cohort of patients affected by symptomatic hip osteoarthritis following intra-articular sodium hyaluronate (MW 1,500-2,000 kDa) ORTOBRIX study. Clin Rheumatol. 2012 Aug;31(8):1187-96.
5. Iannitti et al. Intra-articular injections for the treatment of osteoarthritis. Drugs R D. 2011 Mar;11(1): 13-27.