Supartz Injections for Knee Osteoarthritis

Supartz injection is a therapy that is used to treat symptoms of knee osteoarthritis. The Supartz solution is injected directly into the knee joint to restore the cushioning and lubricating properties of the synovial fluid (joint fluid).

Supartz, a solution of sodium hyaluronate, is one of the hyaluronates used in viscosupplementation, which is another name for these injections.

A patient getting a knee injection

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The sodium hyaluronate used in Supartz is extracted from chicken combs. Sodium hyaluronate is a polysaccharide (a type of sugar molecule) that contains glucuronic acid (which helps eliminate toxins) and N-acetylglucosamine (which has anti-inflammatory properties).

Approval of Supartz and Supartz Fx

Supartz has been approved by the Food and Drug Administration for the treatment of knee osteoarthritis in patients who have not obtained sufficient relief with conservative treatments, such as exercise, physical therapy, pain medications, mobility aids, and hot or cold packs. Supartz was approved by the FDA on January 24, 2001, and it has been used in Japan since 1987.

Supartz is injected once a week for a 5-week cycle. Some patients may have a good response after 3 weeks. Its use in other joints is being investigated.

In 2015, Bioventus, the maker of Supartz, announced the launch of Supartz Fx, which contains 10 milligrams (mg) sodium hyaluronate dissolved in 1.0% physiological saline. Supartz Fx has an expanded safety label compared to the original Supartz, allowing for repeat injection cycles.

Recommendations

The American College of Rheumatology (ACR) has the following recommendations:

  1. The ACR conditionally recommends against the use of intra-articular (into the joint) hyaluronic acid injection for the treatment of osteoarthritis of the knee in adults.
  2. However, hyaluronic acid injections are considered better than no therapy at all in patients who have not responded to other treatment options.

Research on Efficacy

While clinical studies have upheld the safety of Supartz and the other viscosupplements, their effectiveness has been debated. The ACR's 2019 conditional recommendation against viscosupplementation was based on their conclusion that better-quality research showed little benefit. It was a reversal of their prior recommendation in favor of the injections.

Then, a randomized trial published in 2021 found that an intra-articular injection of hyaluronic acid provided pain relief and improved joint function in patients with mild to medium knee osteoarthritis. However, further studies are required to substantiate these claims.

Supartz Warnings and Precautions

You should not receive Supartz injections if you have a hypersensitivity to sodium hyaluronate products. Your healthcare provider should use caution when considering this treatment for you if you are allergic to avian proteins, eggs, or feathers. And you should not have an injection in an area of skin affected by an infection or skin disease.

The safety and effectiveness of Supartz have not been established in pregnant women, nor in lactating women. Its use has not been studied in children.

Common Side Effects of Supartz Injections

Common side effects or adverse events associated with Supartz include:

  • Joint pain with/without inflammation
  • Back pain
  • Non-specific pain
  • Injection site pain/reaction
  • Headache

Transient swelling or pain can occur in a joint that has been injected with Supartz.

However, an analysis of five well-designed clinical trials revealed no significant difference between Supartz and control groups regarding adverse events.

Patients are advised to avoid strenuous or weight-bearing activities in the 48 hours following injection.

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6 Sources
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  2. Bioventus. Supartz Fx prescribing information. Updated April 2015.

  3. Bannuru RR, Brodie CR, Sullivan MC, McAlindon TE. Safety of repeated injections of sodium hyaluronate (SUPARTZ) for knee osteoarthritis: A systematic review and meta-analysis. Cartilage. 2016;7(4):322-332. doi:10.1177/1947603516642271

  4. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol. 2020;72(2):220-233. doi:10.1002/art.41142

  5. Xiao J, Hu Y, Huang L, et al. Injection route affects intra-articular hyaluronic acid distribution and clinical outcome in viscosupplementation treatment for knee osteoarthritis: A combined cadaver study and randomized clinical trial. Drug Deliv Transl Res. 2021;11(1):279-291. doi:10.1007/s13346-020-00793-6

  6. Drugs.com. Supartz (injection). Reviewed March 17, 2020.