Info on Synvisc
Question: Do you have any information on the use of Synvisc (Hylan G-F 20) in areas of the body other than the knee? Why is it limited to just that joint?
Answer: Both a product called Hyalgan and Synvisc are formulations of sodium hyaluronate. These agents are used to reduce osteoarthritis pain and functional impairment. It is thought that these agents restore the normal synovial fluid environment to the joint. Both are currently Food and Drug Administration (FDA) approved only for treatment of pain in osteoarthritis of the knee in people who have failed to respond to nonpharmacologic therapy and to analgesic therapy such as acetaminophen (Tylenol).
I am aware of two studies where the safety and efficacy of hyaluronic acid preparations have been studied in patients with painful shoulder and periarthritis (inflammation of the parts surrounding a joint) of the shoulder. These trials were very small and therefore, additional research would need to be conducted to substantiate the findings. In one study, 29 patients with painful shoulder received 3 intra-articular injections given at 3 day intervals. The patients showed improvement in joint mobility, decreased pain, and decreased need for analgesics without any reported side effects. In the second study, 62 patients with periarthritis of the shoulder, receiving sodium hyaluronate once weekly for a minimum of 5 weeks, were evaluated. Increases in joint range of motion and improvement in activities of daily living were reported. No adverse reactions were observed.
As with all medications, the FDA has requirements that companies must meet in order for medications to be approved for certain uses. In the cases of Hyalgan and Synvisc, the information submitted by the companies supporting the use of these medications resulted in only an approval for treating osteoarthritis of the knee. At this time, I am not aware if these companies are conducting additional trials in other joints. However, the use of these agents in joints other than the knee is not strongly supported in the medical literature to date.
Sondra K. May, Pharm D, Director, Drug Information Center; University of Colorado School of Pharmacy, Denver. 1998
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