In this excerpt from a recent issue of the Johns Hopkins Arthritis Bulletin, Dr. Joan Balthon and colleagues answer readers questions about botox and hyaluronic injections for arthritis pain relief.
Q. I have had arthritis in my shoulders for six years, but I get by with daily flexibility exercises that I perform and a Celebrex [celecoxib] pill. I recently read that doctors are now experimenting with Botox [Botulinum toxin type A] as a treatment for arthritis pain. What is the latest research showing with Botox as an arthritis therapy? Towson, MD
A. Botox, said to be useful for more than 50 medical conditions including excessive sweating, constipation, headache, clubfoot, and even hiccups, acts by binding to the nerve endings of muscles, blocking the release of the chemical that causes muscles to contract.
When injected into a specific muscle, Botox paralyzes or weakens the muscle but leaves surrounding muscles unaffected, allowing for normal muscle function. Early reports of Botox use for treating arthritis do suggest efficacy but the studies were very small. We need much larger studies before we know for sure if Botox will play a role in arthritis therapy.
Q. I have had arthritis in my hips for five years and while I am still able to get by and complete my daily activities, the pain is gradually worsening. Since hyaluronic acid (HA) injections are used to lubricate the knees of people with severe arthritis, can they be used in the hips as well? Your help is appreciated. Dover, DE
A. Some HA is already in the fluid in your joints, where it serves as a lubricating agent. In people with knee arthritis, the HA gets thinner. When this occurs, there isn't enough HA to protect the joint and the knee becomes painful.
HA injections can put more of the acid into the knee joint to help protect it. HA injections have been approved by the Food and Drug Administration for the treatment of knee arthritis. In theory, HA can be used in the hips but injecting into the hips isn't nearly as easy as injecting into the knee. Overlying the hip joint (which is located in the groin) are a very large artery, nerve, and vein. Because of the potential danger of hitting one of these, it is important that the injection be guided by x-ray imaging during the procedure (fluoroscopy).
