Dr. Keith Roach

DEAR DR. ROACH: A friend recommended hyaluronic acid for joint pain in my wrist and hand. I have been taking 180 mg once a day for a couple months now and have experienced notable success. I also feel that my neck pain and range of motion in my neck have improved. My question is, what exactly is hyaluronic acid? Is it safe, and are there any side effects I should be aware of? — T.E.
ANSWER: Hyaluronic acid is a naturally occurring substance composed of long strings of sugar. Because of this structure, it carries with it a great deal of water, so it acts as a shock absorber and lubricant in several places in the body, including the joints. Hyaluronic supplements are usually purified from chicken cartilage, but can also be produced by bacterial fermentation. The body makes about 5,000 mg of hyaluronic acid daily.
Multiple studies on injection of hyaluronic acid have shown that it is only slightly better than a placebo at treating arthritis, especially of the knee, and I have stopped recommending injection treatment to my patients with knee arthritis, as the injections are quite expensive. Oral hyaluronic acid, however, is inexpensive. There have been several small studies showing benefit (again, mostly for the knee rather than the neck), but no well-done large studies that I find convincing.
There is very little harm from hyaluronic acid. None of the studies I’ve read found any serious side effects; however, that doesn’t mean it is completely safe, and supplements are not regulated the way prescription medicines are. I would conclude that oral hyaluronic acid is possibly effective and probably safe for treatment of osteoarthritis.
The studies have mostly used doses in the 100-200 mg range, but I have seen supplements for sale that have 20 mg or less of hyaluronic acid. So I’m glad you are taking a similar dosage to what is shown to be effective.
DEAR DR. ROACH: I have had muscle twitches in virtually every part of my body for about 50 years now. These fasciculations are usually occurring somewhere on my body every day. My legs and arms are most common, but other body parts also participate. There is no discomfort, and they rarely last more than a minute or two. Why do these occur, and should they be of any concern? I am an active, healthy 58-year-old male who isn’t on any medication. — D.I.
ANSWER: Muscle fasciculations are common. Most people get them from time to time, sometimes in the small muscles like the eyelid and sometimes in the large muscles like your legs and arms. Fasciculation can be the sign of a serious neurological problem, such as a lower motor neuron disease. If the muscle doesn’t receive proper neurological signals, it increases its receptors so that the muscle can be easily stimulated, causing the twitching.
If you had suddenly developed this, especially with weakness or atrophy of the muscles, that would be very worrisome, and you should see a neurologist right away. However, since it has been going on so long, it is very unlikely to be a serious disease. You probably have benign fasciculation syndrome, which, as its name suggests, is not a worrisome condition and usually does not worsen over time.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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