Q: I am a 61-year-old woman that has had knee problems for the last 10 to 15 years. Sometimes the pain and swelling will last two days, sometimes it will last a week. This time it’s been two months. My doctor wants me to try a series of three shots of Synvisc. A few friends I’ve talked to told me to say no and then go on to tell me all kinds of horror stories. One friend had it done and it worked fine. I’m having a hard time deciding if I should get them. Is there anything you can tell me that may help me decide?
A: As I have indicated countless times in the past, medications and treatment patterns work differently on each of us. Some individuals will have very good results, others will tell horror stories – all about the same medication taken in the same way for the same purpose. I guess that’s what makes us so unique. So, to begin with, I suggest you educate yourself as much as possible regarding this method of treatment for your knees.
Knee pain and swelling can be caused by arthritis, osteoarthritis, bursitis, gout, and countless other possibilities. Other common reasons are torn ligaments, tendinitis, cartilage tears, and runner’s knee for those individuals who actively exercise. You could have a bone chip, causing it to freeze up, swell, and be painful. Your kneecap could be partially dislocated, causing it to slide out of position. If you had an injury many years ago without receiving proper treatment, it may act up periodically. Another remote consideration is that you could have pain elsewhere that manifests in your knee. For example, hip or foot pain will cause a person to modify the way he or she walks. The modification may feel better but the process can place additional stress on your knee. If you are carrying excess weight, you are putting more stress on your lower extremities than you did in the past. An overweight condition also will place you at higher risk for developing osteoarthritis by accelerating the breakdown of cartilage in your joints.
Because of the duration of your symptoms, my guess is you have utilized all of the well-known home tricks such as putting ice on your knee, wrapping it with an elastic bandage, resting it, and taking over-the-counter NSAIDs such as Aleve, Motrin, Advil and others. These drugs should not be taken long-term without your physician’s approval since they can carry side effects.
It would help to know what testing your primary care physician has ordered and whether you have been referred to an orthopedic specialist. In order to receive a proper diagnosis, you may require X-rays, a CT, ultrasound, MRI or special MR arthrogram in which dye is injected into the knee to better identify what is going on within the joint.
Synvisc acts as a shock absorber and lubricant for joints and is prescribed for knee pain that results from osteoarthritis. It is commonly recommended only after other arthritis medications have been tried unsuccessfully. Side effects may include hives, facial/tongue/throat swelling, headaches, dizziness, stiffness/pain/swelling around the injection site, nausea, calf cramping, ankle edema, phlebitis with varicosities, respiratory difficulties, and pseudosepsis that can occur up to 72 hours following the injection. The symptoms of pseudosepsis may not occur following the first injection but the probability will heighten following the second or third dose. There can be a drug interaction if the patient is on specific medications including Lipitor, Ambien, Celebrex, and others. Therefore, it is extremely important you provide your physician with a complete listing of all prescriptions, OTCs, and supplements you may be on.
One algorithm found Tylenol, followed by NSAIDs and then steroids might be used as first line therapy. If they have been tried unsuccessfully, there is a change hyaluronate injections might be a good choice before knee replacement would be recommended. Having said this, the entire country could be frightened with potential side effects from taking one common aspirin, so make sure your physician has answered all your questions and feels Synvisc is right for you. Ask for a second opinion if you will feel more comfortable about making such a serious decision. I don’t know how severe your symptoms are, nor do I know your complete medical history, but your doctor does. If you fully trust him and agree with the decision, then go for it. If not, consider more conservative approaches for reducing your symptoms. Good luck.
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