Managing the pain and functional limitations caused by knee osteoarthritis (OA) often requires a multimodal approach. While exercise, weight management, and oral medications form the initial steps, many patients benefit from intra-articular injections. These can include hyaluronic acid (HA) viscosupplements or corticosteroids. Cingal®, developed by Anika Therapeutics, offers a unique evolution in this space: a single injection combining both cross-linked hyaluronic acid and a corticosteroid (triamcinolone hexacetonide). This approach aims to provide a dual benefit in one convenient treatment.
This guide explores why a combination approach makes sense for knee OA, the specific features of Cingal®, and essential considerations for practitioners using this single-injection therapy.
This information is for trained medical professionals experienced in intra-articular injection techniques. Adherence to local regulations and product instructions is mandatory. This content is not a substitute for specific training.
Why Combine HA and Steroid for Knee OA? The Synergy Concept
Individually, intra-articular steroids and HA viscosupplements target different aspects of OA pathology. Steroids (like triamcinolone hexacetonide) primarily reduce inflammation and associated pain and swelling. HA viscosupplements primarily act by supplementing the joint’s natural lubrication and shock absorption, aiming to improve mechanics and reduce pain over time. The rationale behind combining them in a single injection is to leverage their complementary actions:
- Rapid Relief: The corticosteroid component is designed to provide relatively fast anti-inflammatory effects, offering quicker pain relief for patients, often within days.
- Potentially Sustained Support: As the steroid’s effects wane, the cross-linked HA component remains in the joint longer, continuing to provide viscosupplementation and potentially other biological benefits, aiming for sustained pain reduction and improved function.
- Bridging the Gap: The rapid steroid effect can bridge the initial period until the full benefits of viscosupplementation may become apparent.
This combined approach in one syringe aims to provide patients with both immediate comfort and potentially longer-lasting symptomatic relief compared to either therapy administered alone.
Cingal®: A Single-Injection Combination
Cingal® stands out because it delivers both its components – cross-linked HA and Triamcinolone Hexacetonide (TH) – in a single 4ml intra-articular injection. This provides a practical advantage for both patients and practitioners:
- Composition: Contains cross-linked HA (often 88mg/4ml) from a non-avian source (reducing potential avian allergy risk) and TH (often 18mg/4ml).
- Mechanism: The TH provides rapid anti-inflammatory action. The cross-linked HA provides viscosupplementation and cushioning effects.
- The Single-Injection Benefit: The most obvious advantage is convenience. It reduces the number of clinic visits for the patient compared to multi-injection HA regimens (which require 3-5 visits). This can improve patient adherence and satisfaction, and also streamlines clinic workflow.
Mechanism in Action: Immediate Relief, Sustained Support
When Cingal® is injected into the knee joint, both active components begin working:
- Immediate Action (TH): The triamcinolone hexacetonide starts reducing inflammation and swelling rapidly by suppressing inflammatory pathways. Patients often notice a decrease in pain and stiffness within days.
- Sustained Action (HA): The cross-linked HA supplements the joint fluid, improving its viscoelastic properties. This mechanical support helps protect the joint surfaces and improve function. While the steroid effect is more immediate, the HA remains in the joint longer, contributing to potentially more prolonged symptomatic relief.
The combination aims to provide continuous symptom management, starting with quick relief from inflammation and transitioning to ongoing support from viscosupplementation.
Clinical Application: Focus on Knee OA
Cingal® is well-established and often approved for the symptomatic treatment of osteoarthritis (OA) of the knee. It is typically used for patients with mild to moderate knee OA pain and stiffness who haven’t found sufficient relief from more conservative treatments.
While the product is specifically formulated and approved for knee OA, practitioners may consider using similar combination therapies or individual components in other joints based on clinical judgment, evidence extrapolation, and local regulations. However, the specific clinical trials and formulation properties of Cingal® are tailored to its established knee indication.
Administration & Safety Considerations
Administering Cingal® requires strict adherence to safe intra-articular injection practices:
- Aseptic Technique is Paramount: Strict sterile technique is mandatory for every intra-articular injection to prevent septic arthritis, the most severe potential complication. This includes proper skin preparation, sterile field setup, and using sterile, single-use equipment.
- Intra-Articular Placement: Accurate injection directly into the joint space is crucial for Cingal’s efficacy and safety.
- Post-Injection Flare: A transient increase in pain or inflammation can occur after injection with combination products containing steroids; it typically resolves within 24-48 hours.
- General Contraindications: Avoid use in patients with known hypersensitivity to HA or TH, active joint infection, or skin infection at the injection site. Screen for potential avian allergies due to the HA source (though non-avian reduces this risk compared to rooster-comb derived products).
- Risk Awareness: Be aware of potential, though rare, serious risks associated with intra-articular injections, including septic arthritis, allergic reactions, and neurovascular injury (though less of a concern with a standard knee injection approach compared to more complex joints).
Always consult the full product Instructions For Use relevant to your region for comprehensive safety and administration details.
Evidence and Expectations
Clinical studies support the efficacy of Cingal® in providing pain relief and improving function in knee OA patients, with effects often lasting up to 6 months. Some studies suggest benefits of the combination product over HA alone or steroid alone. Managing patient expectations is key – explain that it provides symptomatic relief, not a cure, and the duration of effect can vary between individuals.
Sourcing Authentic Product
Ensuring the authenticity, sterility, and quality of Cingal® is critical for patient safety and achieving the expected results from the combination therapy. Always purchase genuine Cingal® from established and reputable suppliers, such as Health Supplies Plus. Be vigilant against counterfeit or improperly stored medical injectables.
Conclusion: Cingal® as a Valuable Single-Injection Option for Knee OA
Cingal® provides a convenient single-injection solution for knee OA, combining rapid steroid relief with longer-lasting HA support. This dual-action treatment requires proper patient selection, strict sterile technique, and authentic product sourcing. When used appropriately, it offers an efficient option for symptom management in qualified patients.
About the Author: Doris Dickson is a specialist writer for Health Supplies Plus, focusing on the aesthetic medicine industry. She diligently researches cosmetic treatments and products to provide clear, concise information relevant to licensed medical professionals. Her work supports Health Supplies Plus’s commitment to being a reliable informational resource and trusted supplier for the aesthetic community.
Disclaimer: The content provided in this article is intended for informational purposes only and is directed towards licensed medical professionals. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment, nor does it constitute an endorsement of any specific product or technique. Practitioners must rely on their own professional judgment, clinical experience, and knowledge of patient needs, and should always consult the full product prescribing information and relevant clinical guidelines before use. Health Supplies Plus does not provide medical advice.