What Is Euflexxa? How Does It Work?

Osteoarthritis pain, particularly in the knee, is a common issue affecting millions of individuals. In fact, up to 14.7% of patients receive at least one hyaluronic acid (HA) injection each year before considering joint replacement surgery, with HA injections becoming the second most commonly used therapy after imaging. These injections aim to improve pain, restore joint function, and provide relief for up to 26 weeks.

One such product leading the way in this therapy is Euflexxa, a nonavian sodium hyaluronate gel designed to lubricate the knee joint and improve ease of movement. Euflexxa is typically recommended when other treatment options, such as corticosteroids, have failed to provide lasting relief. It offers a potentially longer-term alternative, improving mobility and comfort for many individuals suffering from osteoarthritis.

In this article, we will delve into what Euflexxa is, how it works to relieve knee pain, and what patients can expect in terms of its benefits, treatment protocol, and safety. 

Key Takeaways

• Euflexxa is an injectable hyaluronic acid product designed to provide relief for knee osteoarthritis by replenishing synovial fluid and improving joint lubrication.
• It increases viscosity in the joint, helping to reduce friction, improve shock absorption, and alleviate pain and stiffness.
• The product is non-steroidal, making it a favorable alternative for patients looking to avoid corticosteroids or surgery.
• Clinicians administer Euflexxa as a series of three weekly injections, with full benefits typically seen after 4-6 weeks.
• The treatment provides long-lasting relief, often for up to 6 months, making it a great option for those who need extended pain management.
• Euflexxa is generally safe for most patients, with minimal side effects, including mild swelling or bruising at the injection site.
• It is beneficial for patients with severe cartilage damage or who wish to delay knee replacement surgery.
• Compared to other injectables like PRP or corticosteroids, Euflexxa offers a clean, non-avian formulation, providing a gentler and more biocompatible solution.

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Composition and Formulation Insights

Euflexxa contains sodium hyaluronate, a purified form of hyaluronic acid (HA), a substance naturally found in synovial fluid. This viscous fluid is responsible for lubricating and cushioning joints, and in osteoarthritis (OA), the natural HA levels drop, leading to pain and stiffness.

What sets Euflexxa apart is its non-avian, bioengineered origin. Unlike many HA products derived from animal sources, Euflexxa is produced through bacterial fermentation, making it a safer option for patients with avian allergies. This formulation ensures a cleaner product, reducing the risk of allergic reactions and contamination.

Euflexxa is administered via an injection into the knee joint, typically once a week for three consecutive weeks. Each prefilled syringe contains 2 mL of a 1% sodium hyaluronate solution, which is designed for consistent and precise delivery. The product’s formulation is well-tolerated by most patients, making it a suitable option for individuals who seek long-term joint relief without immune suppression.

Biomechanical and Biologic Effects

Euflexxa supplements the depleted hyaluronic acid in the knee’s synovial fluid. By increasing the viscosity of the fluid, it enhances joint lubrication and shock absorption, which can help reduce friction between the bones and improve the overall joint function. This results in less discomfort and stiffness, particularly after periods of inactivity.

Key biomechanical effects include enhanced lubrication, which improves joint mobility. It also reduces discomfort during daily activities, such as walking, bending, or standing. Additionally, by restoring the knee’s ability to absorb shock during weight-bearing activities, Euflexxa helps slow the progression of cartilage wear, protecting against further tissue damage.

While Euflexxa isn’t a cure for OA, it provides temporary pain relief that can last up to 6 months for many patients. This relief delays the need for more invasive procedures, such as knee replacement surgery, offering a non-invasive alternative for those seeking to improve functionality and quality of life.

Indication and Clinical Use Rationale

Euflexxa is FDA-approved for patients with knee osteoarthritis who have not responded adequately to more conservative treatments, such as NSAIDs, weight loss, or physical therapy. It’s particularly useful when symptoms persist or worsen, and when a patient doesn’t need or want surgery.

Ideal candidates for Euflexxa include patients who show visible signs of cartilage thinning or joint space narrowing on their X-rays. Those who wish to avoid corticosteroids due to their long-term risks or previous side effects can also benefit from Euflexxa, which provides symptom relief without compromising the immune system.

Before beginning treatment, healthcare providers have their patients undergo an assessment to check the following:

• Severity 
• Mobility limitations
• Overall health status 

This ensures Euflexxa is appropriate and safe for their condition. It’s particularly valuable for patients who are not yet ready for surgery but want to relieve pain and maintain joint function.

Onset and Duration of Benefit

Unlike corticosteroid injections, which often provide rapid pain relief, Euflexxa takes longer to show its full effects. Patients usually experience improvement after the second or third injection, with maximum therapeutic benefit generally achieved between 4 to 6 weeks after completing the treatment series.

The typical timeline is as follows:

• Weeks 1–2: Mild relief or no noticeable change.
  
• Weeks 3–4: Gradual reduction in joint stiffness and pain.
  
• Week 6 and beyond: Full therapeutic effect for most patients.

The relief can last up to 6 months, making Euflexxa an effective solution for those who require long-term pain management without the need for frequent injections.

Comparisons with Other Injectables

When considering Euflexxa for joint pain relief, it’s useful to compare it with other injectable treatments commonly used for knee osteoarthritis. Corticosteroids, platelet-rich plasma (PRP), and other HA products all serve similar purposes but vary in mechanisms, duration of benefit, and patient preference.

• Euflexxa offers a non-steroidal, biocompatible option that provides gradual and lasting pain relief, without immune suppression.
  
• Corticosteroid injections provide rapid relief but may cause cartilage breakdown over time, especially with repeated use.
  
• PRP injections, which utilize the patient’s own blood to promote healing, may offer longer-term benefits but come with higher variability and require more invasive procedures.
  
• Other HA products may offer faster onset of relief but can come with risks like inconsistent quality.

Those looking for long-term pain relief with minimal risk of Euflexxa’s side effects and the added advantage of a clean, non-avian formulation prefer this treatment.

Conclusion

Euflexxa is a proven, non-steroidal injectable therapy designed to relieve the symptoms of knee osteoarthritis by replenishing hyaluronic acid in the joint. With a strong safety profile, gradual onset, and lasting pain relief, it remains an excellent option for those looking to delay surgery while improving joint function and mobility.

This sodium hyaluronate treatment is particularly suitable for patients who want an alternative to corticosteroids and who may not yet be candidates for knee replacement. Its ability to reduce pain, improve function, and provide long-lasting relief has made it a trusted solution in osteoarthritis management.

FAQs

1. What is Euflexxa made of?

Euflexxa contains sodium hyaluronate, a purified form of hyaluronic acid made through bacterial fermentation. It mimics natural joint fluid and is injected directly into the knee to restore cushioning and lubrication.

2. How many injections of Euflexxa do I need?

A complete course consists of three injections, given once per week for three consecutive weeks. This schedule optimizes pain relief and joint function over time.

3. What are the common side effects of Euflexxa?

Most side effects are mild and localized, such as swelling, pain, or stiffness at the injection site. Severe adverse reactions are rare. 

4. Can I use Euflexxa with other arthritis treatments?

Yes, practitioners can combine Euflexxa with physical therapy, oral medications, and lifestyle changes. However, patients cannot get Euflexxa treatments with other intra-articular injections without a doctor’s approval.

References

Weick JW, Bawa HS, Dirschl DR. Hyaluronic acid injections for treatment of advanced osteoarthritis of the knee. Journal of Bone and Joint Surgery. 2016;98(17):1429-1435. doi:10.2106/jbjs.15.01358

Centers for Medicare and Medicaid Services. Hyaluronic Acid Injections for Knee Osteoarthritis (L39260). https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=39260

Euflexxa (Sodium hyaluronate intra-articular injection, 1%): side effects, uses, dosage, interactions, warnings. RxList. Published June 29, 2022. https://www.rxlist.com/euflexxa-drug.htm