At the age of 46, Delhi-based homemaker Smita Awasthi found herself shuttling between hospitals, popping pills and visiting doctors on a daily basis to get respite from the ordeal of knee pain because of osteoarthritis.
‘Household chores had become difficult. Even simple activities like climbing stairs had become tyrannous because of the tremendous pain in the knees,’ Awasthi told IANS. India is said to have the second largest number of osteoarthritis patients in the world.
Just when Awasthi had made up her mind for a knee surgery in March this year even though it was too early for her age, doctors at the All India Institute of Medical Sciences (AIIMS) opted for viscosupplementation, a technique of giving injections at regular intervals to provide relief from pain and delay surgery for osteoarthritis patients.
‘In osteoarthritis, the outer layer of the knee joint called synovium membrane stops producing the synovial fluid in the knees. This fluid is very necessary for nourishment of the joints, and supporting smooth joint movement through lubrication,’ said Buddhadev Choudhary, associate professor at the department of orthopedics at the J.P. Narayan Apex Trauma Centre, AIIMS.
In the absence of synovial fluid, the knee cartilage starts reducing in thickness and the joint becomes unstable while drying up.
‘Viscosupplementation compensates for the lack of synovial fluid in the patient’s knees. A loaded syringe of a similar gel-like fluid is injected into the patient’s knees at a minimum gap of six months,’ explained Choudhary, who sees around 50 such patients in a month.
The technique that came to India over five years ago, say experts, is now gaining popularity among people as osteoarthritis cases are also coming at an early age.
‘It is not unusual to see women in their early 40s coming up with osteoarthritis and joint pain. Blame it on the sedentary lifestyle or corporate work culture, we have the second largest number (around 15 million) of osteoarthritis patients in the world,’ said Rajeev Sharma, senior consultant orthopaedic and joint replacement surgeon at Apollo Hospital.
Women are especially susceptible to arthritis as there is a tendency for degeneration of joints in the later stages of life in them.
While patients in early stages of the disease are resorting to the considerably easy mode of treatment, doctors also cite benefits of viscosupplementation over anti-inflammation medicines given earlier.
Sharma explains: ‘Patients in stage two or three of osteoarthritis who fail to see any change from analgesics, oral medication of painkillers or physiotherapy are advised to go for viscosupplementation. An added advantage of viscosupplementation is that it has lesser side effects than the anti-inflammation medicines that used to harm the joints directly.’
The injection, priced at around Rs.15,000 per dose, has to be repeated within a time span of six to eight months, say experts.
Choudhary also cautions patients who seek viscosupplementation as an alternative to knee surgery: ‘Viscosupplementation should not be considered as an alternative to surgery because if you have reached the late stages of arthritis, knee surgery is suggested.
‘In early stages, the injection doses will provide relief if they are complemented with physical exercise and proper diet.’
Though viscosupplementation is a procedure that helps reduce dependence on steroids and painkillers, it needs to be supplemented with regular exercise and efforts to strengthen muscles around the knee joint.
Not only this, the doctors also have to follow a series of precautions before injecting the fluid into the joint.
‘We have to make sure that the joint is clean from within, the site of injection is carefully chosen to make sure the fluid reaches at the right point in the joint. We have to be very exact as there are chances of further damage if we go wrong,’ Sharma added.
The injections are mild and the patient is able to walk out after just one visit in six months.
‘Minimal side effects such as redness, itching, swelling are there, but they also subside after medicines are given,’ Choudhary said.
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