Alternative Medicine Cabinet—The Barnyard Cure for Pain
By Lorie Parch
Of all the signs of advancing age, two of the least pleasant are more wrinkles and less supple joints. But bad knees and aging skin share something else as well: They both seem to respond to a most unlikely-sounding remedy, a substance found in rooster combs (and in some vegetables and in the human body) called hyaluronic acid (HA). “This substance is a lot like egg white, only not quite as thick,” says Jason Theodosakis, physician and coauthor of The Arthritis Cure. “In joints, it works to ease movement and absorb impact.” In faces, it gives skin volume and shape.
But not all varieties work equally well, and some of the claims made for HA are more credible than others. Hyaluronic acid comes in supplement, cream, and injectable form. Some people say that in addition to cushioning joints and filling in wrinkles, the pill form, in particular, can also help you live longer.
Alas, the evidence for this appealing idea is rather sketchy. In fact, according to Theodosakis, the idea burst onto the scene when a village in Japan was discovered where people lived to an unusually old age, and some speculated it might be due to the HA-rich vegetables they ate. But the theory was just that, and has never been proven.
Even where HA does hold solid promise—for knees and wrinkles—experts agree that you’ll get more bang for your buck with the injectable varieties than with creams. Those inclined toward less invasive approaches may be disappointed by that caveat, but there’s good reason to believe the shots may have some distinct advantages for arthritis and aging skin. Here’s what they are.
Hyaluronic acid became big news several years ago when the FDA approved it for treating arthritis of the knee. Its claim to fame is that it seems to do something conventional arthritis treatments do not: It bolsters the joint’s natural cushioning. Most other treatments—medicinal ones, at least—target the inflammation that occurs (and causes pain) when the bones of the joint rub against each other. Even cortisone shots work the same way.
“With osteoarthritis, the fluid in the knee that normally provides cushion and support thins out,” says Dennis Wen, a physician and associate professor of family and community medicine at University of Missouri Columbia Medical School. “HA appears to add thickness to that fluid and therefore helps the knee move with less friction and pain.”
Still, that doesn’t mean all knee pain sufferers should get HA shots. Theodosakis says that people who do well with the arthritis supplements glucosamine and chondroitin don’t seem to derive any further benefit from HA. So the best candidates are people who have pretty much exhausted traditional arthritis remedies, don’t respond to supplements, and want to avoid surgery (though even some potential HA users may first need to have surgery to clean out any loose bits of cartilage or bone chips that may be causing trouble).
One missing piece of the puzzle is why the pain relief seems to last much longer than the HA actually stays in your knee. (The HA disappears within days, or even hours, but the pain stays away for six to 12 months, says Theodosakis.) But overall, about half of sufferers respond well to the treatment.
And the good news is that unlike with many other types of arthritis therapy, you’ll find out quickly whether this one works for you. “If it’s going to help, you should start to feel better within a couple of weeks,” says Theodosakis.
Who it’s good for: Those with osteoarthritis of the knee who aren’t getting relief from other methods. How to use it: Patients are typically given three or five weekly injections of one of three formulas: Synvisc (the synthetic version of HA), Hyalgan (the natural variety, though some experts say it’s not any better than the synthetic), and the most recently approved Orthovisc (also natural). The series will cost about $1,000 to $1,500, which is covered by Medicare and most insurance companies.
If you have arthritis in a joint other than the knee, your orthopedist may still do the injections—“a joint is a joint,” says orthopedic surgeon Robert Nirschl, in Arlington, Virginia, who’s given the shots in shoulders and thumbs. But insurance won’t cover the cost, since it’s an off-label use.
Risks: Side effects are uncommon, as are complications. In rare instances, some patients have a severe inflammatory reaction to Synvisc, and the joint swells, says Theodosakis. When that happens, it’s typically after the second or third injection. Usually ice and an anti-inflammatory will ease the flare-up, but if an infection develops, antibiotics might be required.
Plumping Up Wrinkles
HA got its big breaks as a wrinkle-fighter in December 2003 and again last April, when the FDA approved injectable Restylane and Hylaform, respectively, for use in filling in wrinkles around the nose and mouth. The big advantage of Restylane is that its effects last longer than collagen’s—four to six months, compared to collagen’s three. Plus, an allergy test is required before you can be treated with collagen.
“It’s good for someone who doesn’t have a lot of sagging and doesn’t need a lot of volume added,” says Joshua Fox, director of Advanced Dermatology in Roslyn, New York, and a spokesperson for the American Academy of Dermatology. “And for some people, it provides a more natural look than collagen,” he adds. (Hylaform has similar effects, though it doesn’t always last as long as Restylane.)
Whatever your anti-wrinkle regimen, be wary of any HA cream or lotion whose label claims it can do the same thing for that an injection would. “They’re not going to reduce your wrinkles any more than any other type of moisturizer,” says Theodosakis. “Using these creams topically makes as much scientific sense as putting your head on a dictionary to read it. The active ingredient can’t be absorbed—its molecules are too big.”
Who it’s good for: Those who want a safe wrinkle-reducer with longer-lasting results than you can get from collagen. (It probably goes without saying that you should have some money to spend, since insurance companies won’t cover the injections.)
How to use it: Find a cosmetic surgeon who uses Restylane a lot in her practice, and plan for a day or two out of the public eye in case you do experience redness or swelling. Be sure, too, to stop taking Saint-John’s-wort, ginkgo biloba, or high doses of vitamin E before a treatment because of their blood-thinning effects. “Many people don’t realize these cause more bruising,” says Naomi Lawrence, a dermatologic surgeon at Cooper University Hospital in Camden, New Jersey.
Aspirin can do that too, Lawrence adds, so unless it’s medically necessary, stop taking it two weeks before going in. Expect to pay about $600 per shot, but one is usually enough.
Risks: About 25 to 50 percent of patients experience some tenderness, redness, and/or swelling at the injection sites, but these side effects are usually gone in less than a week.