Ostenil - Jab of Horse Bacteria eases agony of arthritis

Authors: Angela Brooks

References: Daily Mail - 20 June 2005

A new injection for osteoarthritis and pain in the shoulder is as effective as steroids – but comes without the risks of permanent damage to muscles and tendons often associated with steroid jabs.

The injection, known as Ostenil, is a synthetic form of Hyaluronic acid or hyaluronan – a natural lubricant found in all healthy joints. Normally the body replenishes its stores, but disease and injury can cripple the body’s ability to boost its own supply, leading to intense pain.

The new drug is made from a highly purified form of a bacteria originally found in the guts of horses. This was cultured in laboratories and subjected to a purification and sterilisation process.

‘Ostenil coats the joint cavity and creates a barrier between the pain receptors and the pain stimulators,’ says Mr Lennard Funk, an orthopaedic surgeon and shoulder specialist at Hope Hospital in Greater Manchester. ‘It also kick-starts the joint back into producing its own lubricant’.

Unlike similar compounds which have been used on knee joints, it is licensed for use in any joint in the body, not just the knee, which makes it particularly useful for shoulder problems.

Next to back complaints, more people consult their GP with shoulder trouble than any other joint problems.

At present, Ostenil is used mostly on those whose arthritis is not severe enough to warrant surgery or who may be too young for a joint replacement, or the elderly, with advanced arthritis, who are unfit for surgery.

In these cases, treatment consists of a course of injections given weekly for three weeks and the benefits last for six months to a year.

But increasingly, Ostenil is being used by specialists as a one-off, either to stall the need for surgery in younger patients, particularly those with sports-related injuries – or to make it unnecessary.

Mike Forshaw, an adviser for the Rugby Football League, was injected with the drug after damaging his shoulder in a rugby match.

‘I was carrying the ball and I was tackled and fell to the ground shoulder first.’

‘Two players dropped on top of me at the same time and it crunched my shoulder up. I knew I’d done some damage but I managed to play to the end of the game,’ says the father of two from Wigan, Lancs.

‘That night I couldn’t sleep because the pain was so bad, but I didn’t go to the doctor because I was hoping it would settle down.’

‘A week later I was still in agony and my doctor referred me to Lennard Funk. He told me I had impingement of the rotator cuff, which is a trapped tendon that has been caught on an overgrowth of shoulder bone’.

‘Normally, the first step would be to have a steroid injection and if that failed, surgery to shave off some of the bone. But Mr Funk said I should have this new injection first’.

‘I was willing to try anything, because I was desperate to keep playing rugby until the end of the season. The injection itself was pretty painful and for the first couple of weeks I didn’t notice any difference. But after about two-and-a-half weeks my shoulder felt much better.’

‘I was also having physiotherapy, but I’m sure the injection speeded everything up. Normally, it would have taken much longer to get back to normal.’

Results of a study of 31 patients at Hope Hospital showed the injection to be as effective as steroids – but it didn’t increase pain levels in the two days following the jab, as often happens with steroids.

Some orthopaedic surgeons have also long harboured misgivings about the effects of steroid jabs on the joints.

‘Steroids are bad news for shoulders. They damage the collagen in the tendon – the protein that gives tendons their strength,’ say Mr Funk.

‘If this is damaged, tendons and tendon cells are weakened, which means cells can’t regenerate the damage. Although there isn’t sufficient hard evidence to prove this is unquestionably, there is a lot of circumstantial evidence.’

‘Surgeons can see just from looking inside shoulders the damage they do.’

‘We don’t know how many injections it takes to do this sort of damage, so my own feeling is that doctors should never give more than one steroid injection.’

Ostenil is now available at some NHS hospitals. It is ten times more expensive than steroids, but Mr Funk believes it could reduce the need for early surgery in 80 percent of complaints. If the pain recurs, however, surgery would still be necessary.’

‘Ostenil is not a cure,’ says Mr Funk. ‘It will never sort out the underlying problem. It is essentially a local anti inflammatory and painkiller – but what it does do is to safely give patients sufficient pain relief to get their muscles back in order.’

Original Article

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