As hundreds of farmers continue to plough on with debilitating joint pain, an innovative and non-invasive treatment is sowing the seeds of hope for significant relief from this all too common occupational hazard

Joint pain (whether caused by progressive osteoarthritis or wear and tear, exacerbated by years of manual work, heavy lifting and prolonged periods of load-bearing on all limbs) has long been accepted as an agricultural occupational hazard.

And, whilst many farmers will go to great lengths to avoid lameness in livestock, their own wellbeing often lags behind in the pecking order. In fact, the industry magazine, “Farmers Weekly”, has even published links to ‘fit to farm’ exercise videos to help farmers improve their mobility, core strength and posture with the aim of avoiding injury.

The other key culprit for the chronic joint problems that inflict pain and misery on farmers is the iconic Wellington Boot, due to the many hours that are spent “trudging around” in them on unforgiving and uneven surfaces, often with little support for feet, ankles and knees.

Les explains, “Farming is really intense, physical labour, working with heavy machinery day in, day out. So, over the years, my joints have begun to suffer. I’ve also been in a couple of accidents at work, and my right knee is particularly sore and swollen. Until recently, I was experiencing pain in my knees every day – taking painkillers to take the edge off the pain and help me get through my working day. On top of all that, the horse drawn carriage side of the business has me climbing up onto the carriages, which is a real strain on both my knees. In the end, I was having to just leap up or heave myself up with my arms – rather than stepping up naturally.”

Les had been considering knee replacement surgery for a couple of years but was worried about the lengthy recovery period and how that might impact his ability to work.

It was only when a friend showed him a newspaper article about a new single-use hydrogel injection called Arthrosamid^® that had just become available in the UK, that he realised he’d heard about this treatment before – but as a treatment for horses! In fact, the hydrogel injection was originally used to treat lame horses with osteoarthritis.

Here’s the history bit…

Back in 2009 (following successful outcomes with small ‘pets’ such as rabbits and cats suffering with joint immobility) the vet, Linus Camitz, injected the hydrogel into a horse suffering severe lameness in two joints —experiencing such pain that its owner was considering having the animal put down.

Within two weeks of a single injection of the hydrogel, the horse had experienced a 90% improvement in lameness and, weeks later, finished a race in fourth position - a result that had seemed impossible just a few months before.¹ This opened the floodgates, with other owners keen to test drive this “life-saving” treatment on their horses.

At the same time, Contura had been considering opportunities for seeking a human indication for the product but the company was conscious it needed more evidence of the potential merits of the hydrogel in joints. With horses’ joints sharing a similar make-up to those in humans, an equine study seemed the obvious way forward and would provide an opportunity to see the effects the hydrogel had on the synovial membrane in knees.

The team subsequently embarked on a 24-month study in horses¹ which provided them with the results they needed —paving the way for the launch of Arthramid Vet to provide a long-acting intra-articular injectable for the treatment of equine and canine lameness.

At the same time a pioneering consultant rheumatologist, Dr Andreas Hatkopp, had embarked on a series of small pilot investigations at his clinic in Denmark, using the product in several of his patients that were destined for knee replacement surgery. He achieved encouraging results.^2-3 And, in 2021, after 10 years of rigorous bench testing, biocompatibility testing and clinical studies, Arthrosamid® was granted European approval for the symptomatic treatment of patients with knee OA.

The team subsequently embarked on a 24-month study in horses¹ which provided them with the results they needed —paving the way for the launch of Arthramid Vet to provide a long-acting intra-articular injectable for the treatment of equine and canine lameness.

At the same time a pioneering consultant rheumatologist, Dr Andreas Hatkopp, had embarked on a series of small pilot investigations at his clinic in Denmark, using the product in several of his patients that were destined for knee replacement surgery. He achieved encouraging results^2-3. And, in 2021, after 10 years of rigorous bench testing, biocompatibility testing and clinical studies, Arthrosamid® was granted European approval for the symptomatic treatment of patients with knee OA.

Back to Les’ story…

So, in December 2022, Les (with the encouragement of his wife, Debbie) decided to go ahead with the treatment under the care of Dr James Thing at The Joint Injection Clinic, Golders Green. Following an analysis of his knee x-rays and approval for the treatment, Les underwent the procedure in both knees.

Les comments, “I was only at the Clinic for an hour – and it was a two-hour round trip – so all very quick and easy. I did experience some discomfort in the 24 hours after the injection – but since then, my recovery has been very positive. The constant pain in my knees has gone and I’m so much more mobile.

“I used to really suffer on long car journeys and flights – but one thing I’ve noticed since the treatment is that I can get out of my seat easily and without pain. And, now that I can bend my knees again, getting up and down from the horse drawn carriages is no longer a problem.

“But as well as improvement to my mobility issues, there’s been a huge impact on my sleep. Due to the agonising pain I’d been experiencing, I was unable to sleep properly. In fact, I hadn’t had a decent night’s sleep for over 3 years, which was really affecting my quality of life. There’s no doubt in my mind that Arthrosamid® really has been life-changing.”

He adds; “When my friend’s complain about their joint pain now, I say – just do it! The difference in how I feel on a day-to-day basis is huge. It’s one of the best things I’ve ever done and I wouldn’t hesitate to recommend the injection to other people experiencing as much pain as I was.”

Les is fortunate to be living (and farming) in the UK as Arthrosamid^® is becoming increasingly available, with over 47 clinics across England, Wales and Scotland now offering the treatment (and more than 2,000 injections having been administered to date in Europe, a figure which is growing daily!).

However, many other patients have to travel far and wide, with one Australian sheep farmer recently flying from the other side of the world to receive an Arthrosamid^® injection from the same Consultant who treated Les.

Dr James Thing explains; “Leslie had been suffering with pain in both knees for many years. This pain was particularly aggravated when walking on the flat but also up and down stairs. [The] pain had been interrupting sleep on a nightly basis for at least 3 years prior to the injections.

“Following the injections, Leslie has reported not only a significant improvement in his day-to-day pain but also has been able to sleep comfortably for the first time in years. His capacity to undertake more physically taxing roles at work has improved dramatically.

“Similarly, Joseph is a 77-year-old farmer from Western Australia who had been suffering with pain in both knees for years. X-rays demonstrated advanced knee osteoarthritis and he was advised to have total knee replacements. He was told about Arthrosamid by one of his relatives in the UK and flew over for the injections in Autumn 2022. Since that time, he has noticed a dramatic improvement in daily pain, has been able to walk further and with less discomfort and has been able to return to work on the farm.

He adds; “In my experience to date, I believe that Arthrosamid can offer patients an effective option before considering a total knee replacement. We have seen patients with both mild and severe knee arthritis respond to Arthrosamid injections and the results seem to be long-lasting. It offers patients an exciting alternative to the standard injection options that have been available for years."

And finally, here’s the science bit…

Using technology pioneered by Contura International Ltd, Arthrosamid^® is an injectable polyacrylamide hydrogel (iPAAG) for intra-articular administration. Consisting of 2.5% cross-linked polyacrylamide and 97.5% non-pyrogenic water, a single 6ml dose of Arthrosamid®(2.5 iPAAG) is injected into the joint space, becoming embedded in the synovial membrane⁴ and can relieve pain in one single treatment². Patients can expect to see improved mobility and pain relief within a few weeks⁵.

New data (first released at the Annual Congress of OA Research International, OARSI, in March 2023) highlights impressive 3-year results, showing that a single injection of 6 ml 2.5% polyacrylamide hydrogel, Arthrosamid^® continued to be “well-tolerated and demonstrated clinically relevant and statistically significant effectiveness in reducing pain, at 3 years after treatment”.⁶

Contura - which launched 23 years ago - has developed its 2.5 iPAAG technology with the potential to revolutionise the treatment of joint disorders in both humans and animals.

Common to all 2.5 iPAAG products [using the technology pioneered by the company] is the capability to provide non-surgical alternatives for conditions traditionally treated with surgery. Such approaches might include open knee surgery / total knee replacement, which can be risky, requiring hospital stays and lengthy recovery periods for patients.

To find out more about how Arthrosamid^® is improving the quality of life for those suffering from knee osteoarthritis, check out our patient testimonials from both the UK and beyond as well as research highlights and thought leadership content by vising Arthrosamid's news page.

References

^{1. Tnibar, A., Schougaard, H., Koene, M., Christensen, L.H., Markussen, B., A controlled clinical trial on the efficacy of an intra-articular polyacrylamide hydrogel in horses with osteoarthritis. 23rd Annual Scientific Meeting of the European College of Veterinary Surgeons (ECVS), Copenhagen, July 2014.}

^{2. Henriksen M et al. Intra-articular 2.5% polyacrylamide hydrogel for the treatment of knee osteoarthritis: an observational proof-of-concept cohort study. Clin Exp Rheumatol. 2018;36(6):1082-5.}

^{3. Overgaard A et al Safety of Intra-Articular Polyacrylamide Hydrogel for the Treatment of Knee Osteoarthritis Symptoms: A Retrospective Case Series. Clin Ortho (2019) Adv Res J: COARJ-100001.}

^{4. Christensen, L., et al. (2016). “Synovial incorporation of polyacrylamide hydrogel after injection into normal and osteoarthritic animal joints.” Osteoarthritis and cartilage vol.24, 11:1999-2002. DOI:10.1016/j.joca.2016.07.007.}

^{5. Bliddal, H., et al. (2021). Polyacrylamide Hydrogel Injection for Knee Osteoarthritis: A 6 Months Prospective Study. J Orthop Res Ther. 6(2). 1188. ISSN 2575-8241.}

^{6. Henriksen, M. et al. (2023). 3-year results from a prospective study of polyacrylamide hydrogel for knee osteoarthritis. Osteoarthritis and Cartilage, Vol 31(5): P682–683. DOI:10.1016/j.joca.2023.02.023}

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