The effects of an oral preparation containing hyaluronic acid (Oralvisc®) on obese knee osteoarthritis patients determined by pain, function, bradykinin, leptin, inflammatory cytokines, and heavy water analyses.

The purpose of this study was to determine the effects of an oral preparation containing hyaluronic acid on osteoarthritic knee joint pain and function as well as changes in inflammatory cytokines, bradykinin, and leptin. We also used heavy water to determine the turnover rates of glycosaminoglycans in synovial fluid. This was a double-blind, randomized, placebo-controlled study of 40 subjects over a period of 3 months. Visual analog scale, Western Ontario McMaster pain, and WOMAC function scores were recorded. Serum and synovial fluid were measured by enzyme-linked immunosorbent assays for inflammatory cytokines, bradykinin, and leptin. In 20 subjects, terminal heavy water ingestion was used for spectral analyses of serum and joint fluid samples. There were statistically significant improvements in pain and function. Both serum and synovial fluid samples showed significant decreases for a majority of inflammatory cytokines, leptin, and bradykinin in the oral hyaluronic acid preparation group. Heavy water analyses revealed a significant decrease in hyaluronic acid turnover in the synovial fluid of the treatment group. A preparation containing hyaluronic acid and other glycosaminoglycans holds promise for a safe and effective agent for the treatment for patients with knee osteoarthritis and who are overweight. Further studies will be required to see whether this is a disease-modifying agent.

Upper extremity injuries in snow skiers.

All skiers with upper extremity injuries seen at the Henry Ford Hospital between 1983 and 1986 were evaluated in terms of age, sex, skill of the skier, type of snow conditions, pole type, grip type, direction of fall, and mechanism of injury. Our primary objective was to evaluate whether the type of pole used had an effect on the injury rate. We found that the strap handled pole without any platform had the lowest injury rate. The saber type pole handle had the highest injury rate. Other observations showed ulnar collateral ligament injury of the thumb to be the most common upper extremity injury to skiers. A proportionally high number of skiers with upper extremity injuries were advanced skiers.

A Ganglion Arising over the Acromioclavicular Joint: A Case Report.

Ganglion cysts are a common entity arising around joints and tendon sheaths. We present a previously unreported location for a ganglion and review the various theories on etiology, pathogenesis, and treatment. With yet another unusual location for ganglia, over the acromioclavicular joint, we propose ganglia should be considered in the differential diagnosis of masses arising near any synovial joint or tendon sheath.