Suffering with osteoarthritis knee pain? Take control of your OA knee pain SYNVISC and Synvisc-One can help

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1 Take control of your OA knee pain SYNVISC and Synvisc-One can help SYNVISC provides up to 12 months sustained pain relief Synvisc-One provides up to 6 months of pain relief with just 1 injection More than 15 years of therapy experience and more than 5 million treatments worldwide Use this handy appointment reminder card to help keep yourself on a schedule. Suffering with osteoarthritis knee pain? Find out how SYNVISC and Synvisc-One can help Doctor name First treatment with SYNVISC/Synvisc-One Scheduled follow-up visit Scheduled follow-up visit Scheduled follow-up visit Appointment tracker Suspected side-effects should be reported. Information regarding the reporting of medical device adverse events (side effects) can be found at Adverse incidents (side effects) should also be reported to Genzyme Therapeutics Ltd at UKpharmacovigilance@genzyme.com Kingsgate Cascade Way Oxford Business Park South Oxford OX4 2SU Tel +44 (0) Fax: +44 (0) Synvisc@genzyme.com Authorised Representative: Genzyme Europe BV Gooimeer DD Naarden The Netherlands SYNVISC, Synvisc-One, and Genzyme are registered trademarks of Genzyme Corporation Genzyme Corporation. All rights reserved. Printed in USA. 1011Eusypi01v1 1/2011 SYNV-UK-7/ Date of preparation: July 2011

2 Understand your osteoarthritis If you have been suffering with or were recently diagnosed with osteoarthritis (OA) of the knee, you should know that you are not alone. Millions of people experience symptoms on a daily basis and need relief. OA is the most common type of arthritis and the most common joint disease worldwide. What s happening in your knee In a healthy knee, cartilage and lubricating joint fluid protect and cushion the bones, so it s easy to move and bend. In a knee with OA Slippery tissue that covers and protects the ends of the bones in the joints (cartilage) gradually deteriorates Fluid that cushions and lubricates the joints (synovial fluid) breaks down, losing its ability to absorb shocks and lubricate Bones may start to rub against each other, causing pain, stiffness, and loss of range of movement OA of the knee can become debilitating, making it difficult to do the simplest day-to-day activities. Because there is no known cure, your OA of the knee requires early and ongoing treatment. This brochure will provide you with information about OA of the knee and guide you through your treatment options. Comparing a healthy knee with OA of the knee Doctors classify OA of the knee in different ways. Some may characterise OA as a grade on a scale from 1 (mild) to 4 (severe). Other doctors may describe OA as mild, moderate, or severe. A healthy knee The surface of the cartilage in the knee joint is smooth and protected by joint fluid, allowing for freedom of movement without pain. Mild OA (grade 1) The surface of the cartilage in your knee joint begins to wear down. You may feel symptoms that are generally mild, including occasional pain from exercise and brief morning stiffness. Moderate OA (grade 2-3) Joint cartilage continues to wear away, and joint fluid may lose its ability to lubricate and cushion the knee. Bony growths or spurs may also form on the edges of the knee bones. You may feel that movement is painful. Severe OA (grade 4) Cartilage may wear away completely, causing bones to rub against each other. You may feel your pain is more constant and severe, and your ability to perform daily activities has decreased. 2 3

3 Understand your osteoarthritis What are the signs and symptoms of OA of the knee? Osteoarthritis of the knee usually develops slowly and gradually and worsens over time, so you may notice a change in the degree of your symptoms. Osteoarthritis may develop in one or both knees. The signs and symptoms range from mild to very severe and may include What causes OA of the knee? There is no one cause, but rather several factors that may increase your chance of developing the condition. Age Your risk increases with age; most people develop the condition after age 45 Pain or grating sensation during movement, and even pain at rest Stiffness after periods of rest Joint swelling Loss in function or range of movement Obesity Gender Heredity Injury Extra weight puts strain on the knees Osteoarthritis is more common in women Inherited traits can affect the shape and stability of the joints Previous knee injuries, activities, and occupations that involve a lot of bending increase risk 4 5

4 Know your OA treatment options If you have been diagnosed with osteoarthritis of the knee you will need to see your doctor regularly to successfully manage your condition. Discuss options with your doctor to reduce your pain and increase your ability to do daily activities. Lifestyle changes Moderate exercise and/or physical therapy can help strengthen your muscles and increase your mobility Weight loss is recommended to reduce stress on knee joints if you are overweight Oral therapies Oral pain relievers, such as paracetamol, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs), can provide 4 to 8 hours of pain relief per dose. NSAIDs should not be taken long-term unless under the guidance of your doctor, because they can cause stomach upset and other serious gastrointestinal (GI) side effects Viscosupplements Viscosupplements are intra-articular injections (injections into the joint space) that replace damaged joint fluid. Specifically, SYNVISC and Synvisc-One are designed to mimic young, healthy joint fluid and can provide long-lasting relief, helping you get back to physical activity Viscosupplements (continued) There are fewer chances of systemic side effects (eg, GI bleeding) with viscosupplements, since they are injected directly into the knee. Local side effects are commonly mild and temporary but may involve injection-site pain and temporary swelling A recent, small study examined SYNVISC for over 2 years in patients with OA of the knee and showed that when used regularly, SYNVISC showed less cartilage loss than expected Steroid injections Intra-articular steroid injections, such as cortisone, are typically reported to provide short-term relief. Repeated use may cause damage to your cartilage Surgery Total knee replacement is the last resort for patients whose knee pain is severe and cannot be relieved with other treatment options A new knee joint usually improves mobility and reduces pain, although the new knee will not be able to bend quite as far as a normal knee joint As with any major surgery, it can pose serious health risks and involves a long recovery period, including time off from work 6 7

5 Learn about SYNVISC and Synvisc-One What are SYNVISC and Synvisc-One? SYNVISC and Synvisc-One are viscosupplements that temporarily replace damaged joint fluid with a substance that has cushioning and lubricating abilities, similar to those found in young, healthy joint fluid. How can SYNVISC and Synvisc-One help your OA knee pain? SYNVISC and Synvisc-One supplement or replace your decreased or diseased synovial joint fluid, improving the knee joint s ability to absorb shock SYNVISC and Synvisc-One can reduce pain and help you get back to the daily activities you ve been avoiding What makes SYNVISC and Synvisc-One different? Both SYNVISC and Synvisc-One contain the same unique viscosupplement formulation SYNVISC is delivered in 3 injections and provides up to 12 months of pain relief Only SYNVISC has proven significant symptom relief for up to 12 months Synvisc-One uses just 1 injection for an average of 6 months of pain relief When used in patients with advanced OA, the pain relief of SYNVISC may also help delay the need for knee replacement surgery SYNVISC SYNVISC has been proven to provide significant, long lasting pain relief Are there side effects with SYNVISC and Synvisc-One? Since SYNVISC and Synvisc-One are injected directly into the knee, there are fewer chances of general side effects, such as GI bleeding, than with oral therapies like NSAIDs. The side effects from SYNVISC and Synvisc-One are usually mild and temporary, but may include pain in the injected knee or temporary swelling. How are SYNVISC and Synvisc-One given? SYNVISC is injected directly into the knee joint intra-articularly by your doctor once weekly in 3 clinic visits. Synvisc-One is also administered directly into the knee joint by your doctor, in 1 intra-articular injection. Both procedures are simple and only take a few minutes. After the injection, you can resume normal day-to-day activities, but your doctor may recommend that you avoid any strenuous exercise for 24 to 48 hours. How long does it take for SYNVISC and Synvisc-One to work? Some patients have reported feeling improvement in pain during the first few days after treatment, but most experienced the greatest pain relief starting within the first few weeks. 8 9

6 What to expect with SYNVISC or Synvisc-One treatment Once you and your doctor have agreed that SYNVISC or Synvisc-One is right for you, you should be prepared for the procedure and how to manage your condition afterwards. What will happen during the procedure? To prepare your knee for injection, your doctor may 1. Clean your knee with a disinfectant. 2. Apply a local anesthetic to your knee. 3. Insert a needle into your knee joint. 4. Withdraw any excess fluid from your joint. 5. The doctor will then inject your knee joint with SYNVISC or Synvisc-One. The whole procedure should only take a few minutes, and you should be able to go home immediately after the treatment. What should you do when you get home? If you have any mild pain or swelling at the injection site, you may want to rest and keep an ice pack on your knee for 15 to 20 minutes, or as recommended by your doctor Avoid putting a lot of strain on your knee such as with jogging, heavy lifting, or prolonged standing for 48 hours after the injection, or as recommended by your doctor What are the possible side effects? Before receiving treatment with SYNVISC or Synvisc-One, you should inform your doctor if you have allergies to hyaluronan (sodium hyaluronate) preparations or avian proteins. Side effects from SYNVISC and Synvisc-One are usually mild and temporary. They may include pain, swelling, stiffness, and fluid buildup. Should any symptoms continue or worsen, contact your doctor immediately. How will I know when it is time for another treatment with SYNVISC or Synvisc-One? Since there is no known cure for OA of the knee, and it is a chronic condition that does not go away, it is important that you continue to see your doctor regularly Track your symptoms, and if you notice pain or stiffness returning, speak with your doctor about scheduling your next appointment - Your doctor will decide if and when it s appropriate to repeat treatment Repeat treatment with SYNVISC and Synvisc-One has been proven to be effective and well tolerated OA is a chronic condition, and regular contact with your physician can help you prevent pain from interrupting your daily activities