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    Arthritis "Chicken Shots" May Not Work

    Analysis Finds Osteoarthritis Knee Treatment Only Slightly More Effective Than Placebo

    Support Not Justified

    Lo says the findings should lead arthritis groups to re-evaluate their position on the treatment. The American College of Rheumatology recommends hyaluronic acid injections for patients who cannot take nonsteroidal anti-inflammatory drugs because of an increased risk of gastrointestinal side effects.

    She adds that the high cost of the therapy -- between $300 and $500 per treatment course for the injections alone -- also argues against its use.

    "That is pretty expensive for something that is only marginally effective, if it works at all," she says.

    Researcher Disagrees

    Orthopaedic surgeon and researcher David Waddell, MD, has treated many patients with hyaluronic acid injections, and does not believe that the results he has seen are caused by a placebo effect.

    Waddell says he had one patient who was able to delay knee surgery for five years by having the injections, and many of his patients have had more modest, but measurable, results.

    "I have a personal bias here because I have osteoarthritis and have had two courses of this treatment," the Shreveport, La., physician tells WebMD. " I felt dramatic relief in a very short period of time. It was not complete relief, but this treatment has worked better than taking nonsteroidal medications."

    Waddell says his laboratory studies at Louisiana State University may help explain why hyaluronic acid works. He expects to publish the findings from these studies soon.

    American College of Rheumatology spokesman Oscar S. Gluck, MD, says there was tremendous excitement about hyaluronic acid when the treatment was first approved, but it became clear pretty quickly that the reality did not live up to the hype for many patients.

    He says he only uses the treatment now for patients who have no other nonsurgical therapeutic options and do not want to undergo knee surgery.

    "Patients basically have to talk me into it," he says. "I tell them up front that this therapy is considered marginally effective, but if they understand this and still want to put off surgery as long as possible they may try it."

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