An extended-release formula called Zilretta to treat osteoarthritis (OA) pain in the knee provides three months of symptom relief. Some people will have a temporary flare of pain in the injected joint, which should resolve in 48 hours.
The new treatment, known as LEVI-04, developed by UK-based Levicept, is the first of a new class of drug known as neurotrophin receptor fusion proteins. These work in a different way from other painkillers, acting on a compound called nerve growth factor (NGF).
PRP injections and cell therapy
The most common and best studied orthobiologic is called platelet-rich plasma (PRP). The process of PRP injections involves taking your blood, isolating and concentrating the platelets, and injecting billions of platelets into your joint, ligament, or tendon.
Genicular nerve radiofrequency ablation is a minimally invasive treatment for knee pain due to osteoarthritis of the knee, and can significantly reduce pain, especially for adults who are 50 and older.
Steroid injections are often recommended for people with rheumatoid arthritis and other types of inflammatory arthritis. They may also be recommended for osteoarthritis if your joints are very painful or if you need extra pain relief for a time. The injection can reduce inflammation, which in turn should reduce pain.
There's concern that repeated cortisone shots might damage the cartilage within a joint. So doctors typically limit the number of cortisone shots into a joint. In general, you shouldn't get cortisone injections more often than every six weeks and usually not more than three or four times a year.
Hyaluronic acid injections
Hyaluronic acid (HA) injections often are used when corticosteroid injections don't work. But they usually are approved only for use in the knee. In some instances, doctors consider HA injections first if you don't have obvious signs of inflammation.
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How long the effects last varies. Some patients report pain relieving effects for several months following the injections. If the injections are effective they may be repeated after a period of time, usually 6 months.
How Does Medicare Cover Knee Injection Treatment? Medicare will cover knee injections once every six months if they are medically necessary. The injections are covered under Medicare Part B and subject to the annual Part B deductible.
The Downsides
According to the National Institutes of Health, the side effects from cortisone shots include: Dizziness or headaches. Skin issues, including dryness, thinness, acne, dry skin, and red or purple blotches. Fatigue and trouble sleeping.
Administered as a series of 3 injections directly into the knee (one every 7 days), GELSYN-3 works to increase the levels of healthy hyaluronic acid in the affected joint. The hyaluronic acid in GELSYN-3 safely reduces joint pain and stiffness.
Steroid injections come in short-acting (triamcinolone acetonide) and extended-release (Zilretta) forms. Zilretta may provide longer lasting relief than other options (3 months), but more studies are needed to confirm this.
Do knee injections hurt? Receiving knee injections is similar to receiving any other kind of shot. There may be a slight pinch followed by mild discomfort, but overall the injection takes very little time and isn't very painful.
"It (corticosteroids) costs around Rs 800-Rs 1200 whereas one injection of visco-supplementation costs nearly Rs 14,000,'' said Dr Maheshwari.
Chronic knee pain as you get older is usually the result of osteoarthritis. Your menisci – tough, fibrous tissues that lie between the knee bones and prevent direct bone-on-bone contact – get thinner, more brittle, and can tear more easily as you age.
Non-Invasive Treatments
Ice and over-the-counter pain medication like acetaminophen or ibuprofen can help. Sometimes physical therapy or a guided exercise program can provide bone-on-bone knee pain relief by strengthening the muscles that support the knee, particularly the quadriceps.
These injections are typically recommended as an alternative to cortisone injections and can be given every 6 months or so. Medicare covers them every 6 months, and various insurance companies cover them at different intervals.
Common Side Effects
The package insert for the arthritis injections says the most commonly reported problems associated with them include pain, swelling, heat, redness and fluid build-up around the knee. The manufacturer says these reactions are usually mild and don't last long.
Generally, if the first shot doesn't work, we may inject the same area again after 6-8 weeks. However, if a second shot doesn't work, we don't recommend a third shot. But, you can have multiple cortisone shots in different parts of your body.
If your pain is not being caused or aggravated by inflammation, then a cortisone shot likely won't work. Provider error can be another reason. Cortisone shots need to be injected at the site of the problem, often within a joint or a tendon sheathe. Sometimes injections miss their mark.
We recommend viscosupplementation injections for our patients who haven't found relief from more conservative treatments like over-the-counter pain medications, heat and cold therapy, and cortisone injections. Those who get pain relief from viscosupplementation injections often report effectiveness for several months.