There are several versions of -- also called viscosupplementation -- that are used to treat osteoarthritis of the knee. They are injected directly into the joint. They include:

Euflexxa
Hyalgan
Orthovisc
Supartz
Synvisc
Nuflexxa

They can help reduce the pain in a knee affected by osteoarthritis, increasing mobility and allowing more activity.

How Do These Osteoarthritis Injections Work?

Normal joint fluid contains a substance called hyaluronan. It acts like a shock absorber and lubricant in your joint and is needed to help the joint work properly. Hyaluronan is highly viscous, allowing the cartilage surfaces of the bones to glide upon each other smoothly. This leads to decreased symptoms of osteoarthritis.

What Joints Can Be Treated With These Osteoarthritis Injections?

Currently, these drugs are only approved for treatment of mild to moderate knee arthritis.

Candidates for These Treatments

These drugs are used to treat osteoarthritis pain in the knee in people who have not found significant relief of their symptoms from:

Physical therapy
Exercise
Heat or cold
Over-the-counter pain relievers

These drugs can be injected into both knees or just a single knee joint.

Side Effects

Potential side effects include joint swelling and pain. They can't be used by people with skin or joint infections. In addition, most varieties are made from processed chicken or rooster combs and should not be used in people with egg or poultry allergies. Euflexxa, however, is safe to use in people with egg allergies.

Occasionally, a severe reaction with swelling, redness, and pain, called a pseudoseptic reaction, can occur with some forms of these viscosupplementation materials.

What to Expect From Treatment

Treatment ranges from a one-time injection to weekly injections for three to five weeks. Pain relief is usually obtained by four to 12 weeks, and the effect has been shown to last for up to several months. The treatment can be repeated as necessary.

WebMD Medical Reference

SOURCES: The Cleveland Clinic Department of Orthopaedic Surgery. Arthritis Foundation.

Reviewed by Brunilda Nazario, MD, MD on June 11, 2009

Osteoarthritis Guide

We want to hear from you.

Please send us your feedback.

Do You Have Fibromyalgia Pain?

Cymbalta is approved for the management of fibromyalgia.

Important Safety Information

Cymbalta^® (duloxetine HCl) is approved for the treatment of depression and generalized anxiety disorder, and for the management of diabetic peripheral neuropathic pain and fibromyalgia.

What should I talk about with my healthcare provider?

Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, unusual changes in behavior, thoughts of suicide, anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or extreme hyperactivity. Call your healthcare provider right away if you have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant within the first few months of antidepressant treatment or whenever there is a change in dose.

You should also know that:

Suicide is a known risk of depression and some other psychiatric disorders.
Antidepressants may increase suicidal thoughts or behaviors in some children, adolescents, and young adults especially within the first few months of treatment or when changing the dose. No increased risk has been shown for adults over age 24, and risk decreased for those over age 65.
All patients starting therapy should be monitored appropriately and observed closely for new or worsening depression symptoms, suicidal thoughts or behavior, or unusual changes in behavior.
Cymbalta^® is not approved for use in patients under age 18.

Who should NOT take Cymbalta?
You should not take Cymbalta if:

You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
You have uncontrolled narrow-angle glaucoma (an eye disease)
You are taking Mellaril^® (thioridazine)

What other important information should I discuss with my healthcare provider?
Before starting Cymbalta, tell your healthcare provider:

about all of your medical conditions, including kidney problems, glaucoma, or diabetes
about your alcohol use
if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life threatening condition
if you are taking NSAID pain relievers, aspirin, or blood thinners. Use with Cymbalta may increase bleeding risk
if you are pregnant, plan to become pregnant during therapy, or are breastfeeding an infant

While taking Cymbalta, tell your healthcare provider:

if you have itching, right upper belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported
if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
before stopping Cymbalta or changing your dose
if you experience dizziness or fainting upon standing, especially when first starting Cymbalta or when increasing the dose. Your healthcare provider may periodically check your blood pressure while you are taking Cymbalta

If you have any questions, talk to your healthcare provider before taking Cymbalta.

What are the possible side effects of Cymbalta?

The most common side effect of Cymbalta was nausea. For most people who had it, the nausea was mild to moderate. Other common side effects included dry mouth, sleepiness, constipation, decreased appetite, and, increased sweating. This is not a complete list of side effects.

Safety Information and Boxed Warning | Prescribing Information | Medication Guide