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By Mariya Greeley
After CJ Swanson, 57, Melinda Shore, 69, and Joe West, 68, were diagnosed with osteoarthritis of the knee—a wearing-down of cartilage that causes pain, swelling, stiffness, decreased ability to move and, sometimes, the formation of bone spurs—they each found the disease progressed quickly, impacting many of the activities they love. Even worse, the knee pain was disrupting those activities with the people they love. Read their entire journey to a diagnosis in the first article of this series.
There is no cure for osteoarthritis of the knee, which affects about 15 million people in the United States, but it’s possible to reduce its effects through lifestyle changes, medical intervention, and a combination of the two. Knee replacement surgery is considered a last resort for people with this chronic, progressive condition.
.A treatment plan
As the youngest of four siblings, Swanson wouldn’t accept the possibility that she might be the first among them to get a joint replacement surgery. She stocked her medicine cabinet with over-the-counter solutions and relied on the relief they provided to manage each day’s responsibilities—being a single mother caring for two young foster children and working full time as a customer representative at an orthopedic practice. “I had creams [and] lotions,” she says. “I thought ‘there’s got to be something in here that will work.’”
Michael Langworthy, a clinical research surgeon at Southcoast Health Systems in North Dartmouth, Massachusetts, treats osteoarthritis of the knee patients by putting them on a six-week treatment regimen of ibuprofen and physical therapy. The muscles around the knee can act as cushions, absorbing micro-shocks to the knee the way cartilage in healthy knee joints does, if they’re developed enough during physical therapy.
Langworthy then moves his patients to pain-reducing injections so they can continue their progress in physical therapy.
This phase of treatment is where Swanson hit a wall. As an insulin-dependent type 2 diabetic, she wasn’t a good candidate for immediate-release intra-articular corticosteroid injections (the main type of injection available at the time) because they are known to substantially elevate blood glucose levels. Many face the same dilemma: Of the 29 million Americans living with type 2 diabetes, about 30% also suffer from osteoarthritis of the knee.
Swanson started to feel like a knee replacement was inevitable.
.An injection of relief
When Swanson’s doctor asked her if she wanted to try a new kind of injection, her only questions were “when can I get it and how much can it help,” she says. The injection, called ZILRETTA® (triamcinolone acetonide extended-release injectable suspension), is also a corticosteroid and may increase blood glucose concentrations. But in a small clinical trial of people with osteoarthritis knee pain and controlled type 2 diabetes, the treatment showed minimal elevation in blood glucose levels compared to an immediate-release injection.
ZILRETTA is the first and only FDA-approved treatment for osteoarthritis knee pain that slowly releases medicine into the knee joint for an extended period of time. Once ZILRETTA is injected into the knee, tiny microspheres, that are invisible to the naked eye, latch onto the soft tissue that lines the spaces of the joint and release the medicine.
Within a couple days of receiving the injection at her doctor’s office, Swanson noticed she wasn’t waking up in as much pain and could get out of a chair with less pain.
“Even my dogs noticed that I just had this different sense about me…I was going out with my friends more often and not always thinking about my knee pain.” Swanson says. “In today’s society we dismiss knee pain as just part of the aging process. Instead, you can think, ‘I’m going to go to the doctor to get my health looked at and taken care of, and move on.’”
.A sister’s relief
Melinda Shore, Swanson’s older sister, was still struggling with her own pain from osteoarthritis of the knee, but felt an emotional sense of relief seeing Swanson’s dry sense of humor and get-up-and-go attitude return. “She had all but given up,” Shore says, “so when you saw the spark was back, it was enough as an older sister that I could take a deep breath and say, ‘good, she’s back.’”
Shore decided to try the injection for herself.
She could see why her sister’s transformation had been so dramatic. “It was like ‘oh my gosh I have no knee pain,’” she says.
Shore just wishes that something like ZILRETTA had existed for her father, who they believe struggled with osteoarthritis knee pain for most of his adult life. “He was very cognizant of what he could and could not do,” Shore says. “Poor daddy, he never got any relief. I just can’t imagine.”
.Young for a season
Improved knee pain and function means you can “get people moving,” Langworthy says, and with an extended-release injection like ZILRETTA, patients can do so with less pain, for longer.
Joe West, from Appleton, Wisconsin, spent about five years trying various treatments for his osteoarthritis knee pain but, for him, nothing worked for more than a few weeks. He had almost lost hope when he tried ZILRETTA right before a flight to Florida in January 2018.
When he landed in Daytona Beach a few days after the injection, he remarked, “this [treatment] was working remarkably well.” West almost felt like his old self again for that winter in Florida. He and his wife could walk together in the mornings or after dinner the way they used to. During Daytona Bike Week, a celebration that includes motorcycle racing, concerts, and street festivals, they even went for an eight-mile jaunt through the celebrations with less knee pain. It’s something West doesn’t think he’ll ever forget.
Though ZILRETTA can reduce pain for some time, like all treatments currently available, it isn’t a cure, West’s doctor told him.
.Living to the fullest
Shore and Swanson, meanwhile, know the knee pain relief from osteoarthritis won’t last forever, but they are taking advantage of it while it does.
Swanson continues to care for foster children—nine have called her house home in the last five years—and she volunteers to help teach teens in the foster system life skills, like how to balance a checkbook.
Shore enjoys taking day trips with her husband to absorb the atmosphere of other Oklahoma towns and longer trips to visit their daughter, who lives outside of Atlanta. She is walking her rescued chihuahua, Brody, around the neighborhood and tending to her beloved Zinnia flowers with noticeably less knee pain.
They still have osteoarthritis of the knee, but they’re able to live the way they like to—to the fullest, with less pain, together.
To learn more about how ZILRETTA works to help reduce OA knee pain, visit ZILRETTA.com or talk to your doctor for more information.
Sponsored by Flexion Therapeutics, Inc.
Osteoarthritis knee pain hurts more than just those afflicted
Families carry the weight of the chronic condition together.