Viscosupplements: Synvisc vs Cortisone

Synvisc and cortisone: What are they?

Synvisc and cortisone are fundamentally different in many aspects. Cortisone is often used as blanket term to refer to corticosteroid, which has a long history of use in the treatment for knee pain. Medically, corticosteroid injections are used to alleviate pain associated with different forms of arthritis. They are also effective in treating injury- or surgery-related pain. In general, cortisone is used as part of a larger treatment plan. Being a potent anti-inflammatory steroid, cortisone tends to be most useful for conditions in which there is substantial inflammation (e.g. rheumatoid arthritis and gout). There is usually little inflammation in osteoarthritis, therefore cortisone may be of little help. While cortisone injections can sometimes produce good response, the benefits are usually short-lived, with symptoms such as knee stiffness and pain returning in 1 or 2 weeks. However, in some patients, the improvement seems to be long lasting. In general, it is not advisable to inject more than 3–4 cortisone injections in a year.

On the other hand, Synvisc is a type of viscosupplementation. Supplied in the form of injectable gel, Synvisc helps to cushion the knee joint, thereby allowing smoother movements between the bones. Through its shock-absorbing actions, Synvisc significantly improves patient mobility and knee pain. The injectable gel is usually administered into the joint space with a needle. Before injection, it is important to remove any excess fluid from the knee joint. The injection process is usually completed within several minutes. Patients should refrain from any physical activities several days after injection. Synvisc should be injected in a clinic by a board-certified doctor. Apart from Synvisc, there are many other brands of viscosupplementation, including Hyalgan, Orthovisc, and Supartz.

Currently, there are very few clinical trials that compare corticosteroids to Synvisc, making it difficult to draw a comparison. In one of the studies that involved over a hundred patients, researchers compared betamethasone (a corticosteroid) to Synvisc for osteoarthritis knee pain. The findings have indicated no significant difference in terms of clinical efficacy between the two drugs. Similarly, in a study published in the American Academy of Orthopedic Surgeons, Synvisc injections are shown to be equally effective as cortisone in pain control in a damaged knee cartilage. That being said, the effects of Synvisc typically lasts for up to 6 months.

Synvisc and cortisone: Are they really effective?

Viscosupplements remain controversial due to the conflicting evidence regarding its efficacy. Some clinical trials have suggested limited clinical benefits and increased risks of complications from viscosupplementation injections. In contrast, findings from other clinical trials have indicated long lasting symptomatic improvement (for around one year) after injections.

A recent conducted by researchers at Tufts Medical Center has found hyaluronic acid-based injections and corticosteroid the most effective solutions for osteoarthritis knee pain.

Despite mixed reviews, Synvisc is often used as an effective second-line treatment for osteoarthritis.

What is osteoarthritis: causes, symptoms and treatments

Osteoarthritis is a degenerative, progressive condition that mainly affects the knee joint. It is estimated that osteoarthritis affects more than 27 million adults in the United States alone. Patients in their mid to late 40s are usually more susceptible to developing osteoarthrosis.  Osteoarthritis is one of the leading causes of disability and pain. In fact, it has been ranked as the 11th highest contributor to disability. Due to its multifactorial, complex nature, the mechanisms underlying the progression and incidence of osteoarthritis are not fully understood. It is believed that wear and tear, repetitive movements and stress on the joint are the main causes of osteoarthritis. There are a number of known risk factors which are preventable and modifiable. This includes joint injury and obesity. Apart from that, genetic factors also seem to play a role in the development of osteoarthritis. Some of the main symptoms of osteoarthritis include stiffness, pain, tenderness, a grating sensation, loss of flexibility, and bone spurs. These symptoms tend to worsen over time. In severe cases, patients may experience difficulty climbing stairs, walking or even standing. Currently, the mainstays of treatment for osteoarthritis knee pain are pain medications and physical therapy. Lifestyle modifications such as weight reduction may be implemented if the patient is obese. Additionally, viscosupplements such as Synvisc are used as a second line treatment for osteoarthritis-related knee pain. Commonly prescribed for gout and rheumatoid arthritis, cortisones or corticosteroid injections can also be used for managing osteoarthritis.

Conclusion

Osteoarthritis is a progressive, generative condition characterized by severe knee pain. If poorly managed, osteoarthritis may impact the ability to walk (or even stand), disrupting the daily activities of patients. First-line treatments such as pharmacotherapies, exercise, and lifestyle modification can help to alleviate knee pain and restore patient mobility. However, they may not work for all patients. Viscosupplements such as Synvisc are frequently prescribed as symptomatic treatment of osteoarthritis. While more commonly used in inflammatory diseases such as rheumatoid arthritis, cortisone injections can also be used to manage osteoarthritis knee pain. That being said, most patients opt for Synvisc due to its long-lasting benefits.