Ask the Doctors December 2010 Issue

Ask The Doctors: December 2010

Hyaluronic Acid . . . Joint Hypermobility Syndrome . . . Purines and Gout

Q. Iíve been taking glucosamine and chondroitin for several months. Now the company that makes the combination has added hyaluronic acid to the supplement. What can you tell me about hyaluronic acid?

Hyaluronic acid is found in normal joint fluid and acts as a lubricant. It is also found in articular cartilage.

Injectable hyaluronic acid is used in the treatment of mild to moderate osteoarthritis (OA) of the knee. It is injected directly into the knee in a series of three or four injections one week apart. Not everyone on this therapy obtains relief, but those who do usually experience pain relief for up to six months.

Hyaluronic acid has also been added to oral combination supplements, but to date there is no evidence that it improves the effectiveness of glucosamine or chondroitin. Oral hyaluronic acid is digested in the gastrointestinal tract and poses no known risks to the patient.

Although glucosamine and chondroitin may act as mild anti-inflammatories, they do not promote the regeneration of articular cartilage.

Q.

I can hyperextend my elbows and my wrists. Iíve been told I may have joint hypermobility syndrome. Is it anything I need to worry about?A hypermobile joint is a joint that moves beyond its normal range of motion. Although it is estimated that 10 to 15 percent of normal children have hypermobile joints, they usually grow up with normal joint function.

A subgroup of people with loose joints, however, have hypermobility joint syndrome. There is a tendency for the condition to run in families. People who have it, because their joints are less stable, are more prone to sprains and dislocations, and an injured joint that is poorly aligned can lead to early arthritis. They also are more likely to have curvature of the spine (scoliosis).

Joint hypermobility syndrome is considered to be a relatively benign condition that does not require specific treatment. The condition can be helped, however, by keeping muscles adjacent to a loose joint as strong as possible to protect the joint against injury.

Q.

I have gout and have been told I should avoid purines. What foods contain purines?Purines are found in large quantities in liver, kidney, brain, and other organ meats. More important to an American diet are the purines found in seafood, such as herring, mackerel, and anchovies; other meats, fish, beans, and vegetables contain smaller amounts of purines.

Patients with a history of gout should avoid purines because they can be converted to uric acid by the body (gout is either the overproduction of uric acid or the underexcretion of uric acid, leading to hyperuricemia). In addition to avoiding foods that contain purines, you should avoid alcohol, since it also can trigger a gout attack.

To a large extent, gout is determined by genetics and gender. Premenopausal women rarely have an attack of gout, but after menopause women are at the same risk as men.

The role of purines has been downplayed in recent years, since dietary management is very restrictive and has been of limited value.

The treatment of gout currently depends on medications that decrease the inflammation (NSAIDs), reduce the production of uric acid (allopurinol), or increase the excretion of uric acid (probenecid).