About OA of the Knee
Learn more about osteoarthritis (OA) of the knee
If you have been diagnosed with OA of the knee, you are not alone–more than 10 million Americans have OA of the knee. Although there is no cure for OA of the knee, there are treatments available, like Euflexxa®, which can reduce pain and help you stay active.

Signs & Symptoms
The main symptoms commonly associated with osteoarthritis (OA) of the knee are:

• Knee pain that worsens when you are active and improves when you rest
• Stiffness, with reduced ability to move the knee
• Swelling around the knee
• Cracking (crepitus) when moving the knee

Other possible symptoms of OA of the knee include:

• Buckling or instability of the knee
• Bony enlargement of the knee
• Deformity of the knee

If you have any of these symptoms or signs, see your doctor and talk with him or her about your symptoms — where the pain is, how long you’ve had it, and what types of things make it better or worse. Your doctor will perform tests to determine the cause of your knee pain or may refer you to a specialist for further evaluation. If the cause of your pain is OA of the knee, there are numerous treatment options available.

Causes
Although doctors are not completely certain what causes OA of the knee, some possible contributors are:

• Advancing age
• Wear and tear on the knee over many years
• Previous injury
• Excessive weight
• Genetics: It may “run in the family”
• Gender: Women are more likely than men to have OA of the knee

Diagnosis and progression
Diagnosing osteoarthritis (OA) of the knee
The first thing your doctor will do is talk with you about your symptoms. He or she will ask you where the pain is, how long you’ve had it, and what types of things make it better or worse. He or she will also probably perform a physical exam of your knee. Following that, there are several tests that can aid your doctor in making a final diagnosis:

• X-ray: An x-ray can give your doctor a good view of the bones and cartilage in your joint–if the space between the bones is narrower than usual, it may indicate damage to the cartilage, a sign of OA
• MRI: An MRI may be used if an x-ray is not providing a clear indication of the cause of your knee pain
• Blood test: A blood test can rule out rheumatoid arthritis (RA) and other possible causes of joint pain

Other, less common tests include:

• Joint fluid analysis: A needle is used to draw fluid from your joint; the fluid is then checked for signs of infection or other conditions
• Arthroscopy: A tiny camera is inserted through small incisions around your knee to look directly at the joint

Progression
OA of the knee is a chronic condition that gradually worsens over time.
Normal knee: Cartilage covers the ends of the bones and keeps them from rubbing together. A small space between the bones contains synovial fluid, which lubricates and protects the joint.
Mild OA: Tiny cracks and pits may begin to form in the cartilage as its surface begins to break down.
Moderate OA: Large sections of cartilage lose their flexibility and start to wear down, making the cartilage even more likely to be damaged by daily wear and tear or injury. Bone spurs may form on the edges of the bones. The synovial fluid also starts to break down, losing its effectiveness.
Severe OA: Sections of cartilage completely wear away, leaving the bones unprotected so that they rub against each other. Tiny bits of cartilage may also float freely in the joint, causing further damage and pain.
The good news: OA of the knee is manageable, especially if detected early, and there are many treatment options. So, if you experience pain, stiffness, or any of the symptoms listed above, see your doctor. Only your doctor can diagnose OA of the knee. If it is OA, you and your doctor will work together to find a treatment that is right for you.
Please Note: This information should not be used for self-diagnosis.

Treatment
Although osteoarthritis (OA) of the knee is not curable, there are many treatment options available that can help you to control pain and maintain an active lifestyle. OA is usually managed with a combination of approaches, including medications, lifestyle changes, and sometimes surgery.

Lifestyle changes
There are changes you can make to your lifestyle that may help with the management of OA of the knee:

• Exercise/physical therapy: Your doctor can help you design an exercise plan that is right for you or recommend a physical therapist
• Weight loss (if you are overweight)
• Physical therapy

Oral and topical medications
If you suspect that you have OA of the knee, you will probably first see your primary care doctor. He or she may then refer you to a specialist. Specialists who have expertise in OA include:

• Over-the-counter pain relievers, such as:
  • Aspirin
  • Acetaminophen (Tylenol®)
  • Ibuprofen (Motrin® or Advil®)
  • Naproxen (Aleve®)
• Topical pain relievers (creams, rubs, sprays)
• Prescription pain medications, such as:
  • Celecoxib® (Celebrex)
  • Mild narcotic pain relievers (usually for short-term use only, as they may be addictive)

Injections
There are two types of injections commonly used in the treatment of OA knee pain:

• Corticosteroid injections: Anti-inflammatory hormones that can decrease pain
• Hyaluronic acid (HA) injections (such as Euflexxa®): Injections of HA similar to the natural HA found in the fluid that surrounds a healthy knee

Surgery
Surgery may also be an option in treating OA of the knee. A surgeon can remove loose bone and cartilage, and reposition or smooth out bones. In addition, a surgeon can perform a total or partial knee replacement, in which all or some of a joint is replaced with an artificial one.
The best thing to do is to talk with your doctor. Together, you will be able to work out a plan that can help you manage the symptoms of OA of the knee.

About Hyaluronic Acid
Hyaluronic acid (HA) is a natural substance found in the fluid that surrounds a healthy knee. This fluid is called synovial fluid, and it helps cushion, lubricate, and protect the knee. In people with osteoarthritis (OA) of the knee, the synovial fluid becomes thinner and less able to do its job.

About Euflexxa®
Euflexxa® is similar to the HA found in healthy knees. When Euflexxa® is injected into the knee, it replenishes the HA in the knee and helps restore the ability of the synovial fluid to cushion, lubricate, and protect the knee.

What to Expect from Treatment with Euflexxa®
Discover what happens when Euflexxa is administered in this animation. See it fill the joint space and restore the synovial fluid’s ability to cushion, lubricate, and protect the knee.

Is Euflexxa® right for me?
Euflexxa® may be right for you if you have osteoarthritis (OA) of the knee and you are not getting enough relief from simple pain medications. Similarly, Euflexxa® may also be an option if you are allergic to or have side effects from pain medications commonly used to treat OA of the knee, including:

• Aspirin
• Nonsteroidal anti-inflammatory drugs
  • These are sometimes called NSAIDs, and include medications such as ibuprofen (Motrin® or Advil®) and naproxen (Aleve®)
• COX-2 inhibitor [Celebrex® (celecoxib)]
  • This is a special type of NSAID prescribed by your doctor

Euflexxa® may not be an option for you if you have:

• A known allergy to hyaluronate preparations
• A knee joint infection
• Infection or skin disease in the area where Euflexxa® is injected

Take the Euflexxa® Self-Assessment Quiz.

Why choose Euflexxa®?
Euflexxa® delivers SATISFUNCTION™
Euflexxa® is a hyaluronic acid (HA) therapy — a different kind of treatment for mild to moderate pain from osteoarthritis (OA) of the knee. Euflexxa® is a safe, effective injection that can provide pain relief for several months. Unlike pills, Euflexxa® is localized therapy. This means it goes right to the source of pain and is not distributed throughout your entire body.

Euflexxa® is an injection that treats osteoarthritis (OA) pain at its source. This means that, unlike pills, Euflexxa® is not distributed throughout your entire body. Euflexxa®is a safe and effective hyaluronic acid (HA) that is proven to benefit both pain and function. Most people who received Euflexxa® in a clinical trial were “satisfied” or “very satisfied“ with treatment.
In a clinical trial, Euflexxa® has been proven to1:
Decrease OA knee pain

• On average, people who received Euflexxa® had about a 60% decrease in their level of pain
• Almost 2 out of 3 people who received Euflexxa® found that they had little or no OA pain after treatment

Increase a person’s ability to perform everyday activities

• Almost 2 out of 3 people who received Euflexxa® found that their OA had little impact on a range of everyday activities

Provide high levels of satisfaction

• More than 4 out of 5 people who received Euflexxa® were “satisfied” or “very satisfied” with treatment

Work safely

How is Euflexxa® different?
Euflexxa® is different from some other HA therapies because it is not made from processed rooster combs, which may be problematic in people who are allergic to poultry products (including eggs and feathers). Euflexxa®, however, is made differently, from a non-avian, all-natural source. It is free of animal proteins and is therefore safe to use in people who are allergic to poultry products.
Also, unlike other HA therapies that may require 5 injections, Euflexxa® is proven to work in just 3 injections (once a week for 3 weeks)1.

Reference:
1. Kirchner M, Marshall D. A double-blind randomized controlled trial comparing alternate forms of high molecular weight hyaluronan for the treatment of osteoarthritis of the knee. Osteoarthr Cartil. 2006;14:154-162.

Euflexxa FAQs
Treatment with Euflexxa®
It’s a good idea to learn as much as you can about any new treatment or medication your doctor prescribes. The questions and answers below are designed to help you better understand what to expect from treatment with Euflexxa®.

What is Euflexxa®?
Euflexxa® is a highly purified hyaluronan, also called hyaluronic acid (HA) or sodium hyaluronate. HA is a natural substance found in the fluid that surrounds a healthy knee. This fluid is called synovial fluid and it helps cushion, lubricate, and protect the knee. In people with osteoarthritis (OA) of the knee, the synovial fluid becomes thinner and less able to do its job.
Euflexxa® is similar to the HA found in healthy knees. When Euflexxa® is injected into the knee, it replenishes the HA in the knee and helps restore the ability of the synovial fluid to cushion, lubricate, and protect the knee. Euflexxa® is different from pills because it works right at the source of pain and is not distributed throughout your body.

How is Euflexxa® given?
Euflexxa® is injected into the space in your knee joint. Treatment consists of 3 injections–1 injection per week for 3 weeks2.

How quickly does Euflexxa® work?
Some people experience pain relief after the first or second injection of Euflexxa®, but most people experience significant relief after the third (last) injection.

How long does Euflexxa® last?
Every person is different. The duration of pain relief with Euflexxa® varies from one person to the next, but in general you can expect to have many months of pain relief.

What side effects are seen with Euflexxa®?
Euflexxa® is highly purified HA and is similar to the HA that occurs naturally in your body. In clinical trials, few side effects were reported, and those that did occur tended to be mild and transient (ie, they did not last long). The only side effect reported by more than 5% of the people who received Euflexxa® was arthralgia (joint pain)–in 8.75% of people.

Is Euflexxa® covered by insurance?
Euflexxa® is covered by most insurance providers. The process of obtaining reimbursement varies from plan to plan. Talk with your doctor’s office and your insurance provider before you begin treatment to find out if Euflexxa® is covered and to learn how to get reimbursed.
You can receive a repeat course of Euflexxa® once every 6 months.

Medicare: For Medicare coverage, Euflexxa® must be purchased directly by a doctor for a specific person. Medicare will not cover the cost of individual prescriptions written by doctors and filled by people receiving treatment.

What else should I know about Euflexxa®?
You should avoid strenuous activities, such as jogging or tennis, for 48 hours after your Euflexxa® injection.

References:
1. Data on file. Ferring Pharmaceuticals Inc. 2 Kirchner M, Marshall D. A double-blind randomized controlled trial comparing alternate forms of high molecular weight hyaluronan for the treatment of osteoarthritis of the knee. Osteoarthr Cartil. 2006;14:154-162.