Cingal®

Longer-lasting hyaluronic acid, uniquely combined with a safer steroid.

Relief from knee pain, without rushing to surgery. If knee pain is starting to limit your walking, exercise, or confidence in day-to-day movement, treatments like Cingal can help.

Cingal is an injection used for knee osteoarthritis that aims to reduce pain, calm inflammation, and support smoother joint movement, often within days, with benefits that can last for several months and treatment that can be repeated

FInd a clinic

Cingal®

Longer-lasting hyaluronic acid, uniquely combined with a safer steroid.

If knee pain is starting to limit your walking, exercise, or confidence in day-to-day movement, treatments like Cingal may help.

FInd a clinic

What is Cingal®?

Cingal is a single-injection treatment used to manage pain from knee osteoarthritis. It combines two established components in one injection, which is delivered straight into the joint, and takes less than 5 minutes, but appointment times tend to last longer.

• Cingal is an anti-inflammatory treatment to help settle irritation inside the joint.

• And a hyaluronic acid, a substance naturally found in healthy joints that supports lubrication, cushioning and joint health longevity.

This combination is designed to provide earlier pain relief, followed by longer-lasting joint support, with results showing greater depth of overall pain relief over a 6 month peroid.

Repeated steroid injections can actually cause further damage to your joint over time and should be avoided. The same concerns are not present in Cingal. Offering the benefits of steroid and hyaluronic acid treatments, but with the added safety of proven protection of the healthy cartilage in the joint (ref 2)

Stage 1 Doubtful

Minimum disruption but already 10% cartilage loss, which starts the cascade or worsening damage within the joint

Stage 2 Mild

Joint-space narrowing. The cartilage begins breaking down with the bone roughening underneath

Stage 3 Moderate

Joint space is now reduced with gaps in the cartilage forming through to the bone causing greater pain on movement

Stage 4 Severe

Joint-space greatly reduced and 60% of the cartilage is now, lost with roughened bone surface visible

Because of the combination of treatments within Cingal, it can be effective in patients at all stages, while hyaluronic acid is more suitable to earlier stages. You can safely repeat Cingal injections or alternate with pure hyaluronic acid Monovisc over your treatment time. To learn more about Hyaluronic Acid in general, please read our resource page – Hyaluronic Acid

How does Cingal work?

The anti-inflammatory component works in the first days after the injection, helping to reduce inflammation that contributes to pain and stiffness.

Ongoing support is then taken over by the hyaluronic acid as it remains in the joint for longer, improving lubrication and cushioning. This helps many people move more comfortably for months afterwards. The hyaluronic acid also plays an important role in supporting the cells in the joint to create their own hyaluronic acid, a natural process typicallyy halted in arthritis.

Cingal offers the best of both a strong anti-inflammatory, and longer lasting hyaluronic acid

People respond differently to injection treatments, but many notice:

→ Improvement in pain within the first week

→ Continued improvement over the following month

→ Relief that can last for several months from a single injection

Your clinician will discuss what is realistic for you based on your symptoms, activity level, and stage of arthritis.

Clinical studies used from the Graph, references 1 and 4 below.

Why do clinicians worldwide believe in Cingal for knee arthritis patients?

Key Cingal Facts and Data

Cingal is trusted worldwide to effectively and safely manage your Inflammation and arthritis. The level one data is from the strongest level of human clinical trials. For those who like to understand the data, the key numbers are below, taken from the level one study (ref 1)

The key points are:

→ 59% reduction in pain in week 1

→ 72% reduction in pain by week 26

→ From week 1 to week 26, 9 out of 10 patients respond positively to treatment

Cingal was developed with purpose, and over 1 million patients have now benefited.

Powerful and Safe

The formulation gives an anti-inflammatory and joint protective effect. Even though there is a steroid to Cingal, the concern of unwanted side effects is greatly diminished.² The upside is a hyaluronic acid that works immediately, whereas typically, it is around 3-4 weeks for other HA options. Repeated injections are a safe option.

Cushioning and Protection

The viscous HA also provides lubrication, shock absorption, chondroprotection, and a further anti-inflammatory effect. With the inflammatory environment managed by the steroid, the HA is allowed to work to it’s maximum potential and longevity, beyond 6 months.

Cushioning and Protection

Balanced formulation

The unique micronised formulation offers full stability of the steroid and HA, which isn’t the case if they are mixed or injected into the joint at the same time. Cingal has a proven anti-inflammatory effect on inflamed cytokines (the enzymes that cause inflammation and pain during OA, causing further breakdown in the joint).

Cingal FAQ’s and Fast Facts

What is Cingal?

Cingal is a single-injection treatment that combines two powerful ingredients:

Hyaluronic Acid (HA): Helps restore the natural cushioning and lubrication in your knee joint, which is found within synovial joints such as the knee.
Corticosteroid: Provides fast relief by reducing inflammation and pain. The Corticosteroid is Triamcinolone Hexacetonide (TH)

Cingal is designed to treat the symptoms of knee Osteoarthritis (OA), including swelling, pain and stiffness, offering both quick and lasting relief.

How is Cingal different from other injections?

Cingal is the first treatment to combine high-concentration crosslinked hyaluronic acid with a fast-acting corticosteroid in a single injection. The steroid component works quickly to reduce inflammation, while the hyaluronic acid provides longer-term joint support and lubrication.

How does Cingal work?

In healthy joints, hyaluronic acid helps maintain smooth movement and cushioning.

With osteoarthritis, natural hyaluronic acid levels reduce, leading to stiffness and pain. Cingal supplements this reduced hyaluronic acid while also reducing inflammation inside the joint. This combination aims to provide both early pain relief and longer-lasting support.

Who is Cingal suitable for?

Cingal may be suitable for people with mild to moderate knee osteoarthritis who:

Have ongoing knee pain despite physiotherapy or medication.
Have swelling linked to arthritis.
Want relief while delaying surgery.
Are not ready for joint replacement

It may also be used in more advanced arthritis as a temporary option. A clinician will assess whether it is appropriate for you.

How long does Cingal last?

In clinical studies, many patients experienced improvement within the first week.

Relief commonly lasts beyond 6 months, and how much longer is depending on the severity of arthritis and activity levels.

Is Cingal safe?

Both hyaluronic acid and corticosteroids have long histories of use in knee osteoarthritis.

Most people tolerate Cingal well. As with any injection, there are potential risks, and your clinician will discuss these with you before treatment.

Can I have repeat injections?

Yes, repeat injections may be considered if symptoms return.

In some cases, a hyaluronic acid injection alone (without steroid) may be appropriate for future treatments if inflammation is minimal. Your clinician will guide the timing and suitability of repeat treatment.

What happens during the procedure?

Cingal is injected directly into the knee joint during a clinic appointment. Some people feel improvement quickly. For others, it may take several days. You may be advised to reduce strenuous activity for 1–2 days afterwards.

Are there any risks or side effects?

Most people have no significant side effects. Possible effects include:

Temporary post-injection discomfort (24–48 hours)
Mild swelling or redness
Bruising
Raised blood sugar levels (in people with diabetes)
Very rare allergic reaction

If the joint becomes hot, very swollen, or you feel unwell after injection, seek medical advice.

When should Cingal not be used?

You should not have the injection if you:

Have an infection anywhere in your body
Feel unwell
Are pregnant
Are under 18
Do not wish to proceed

If you are diabetic, taking blood thinners, awaiting joint replacement, or have recently had a vaccination or infection, this should be discussed with your clinician first.

What should I do after the injection?

Rest the knee from strenuous activity for 1–2 days. Continue with prescribed rehabilitation exercises, as these help maximise the benefit of the injection.

Cingal vs Steroid Injection for Knee Osteoarthritis

What’s the Difference?

If you’re considering an injection for knee osteoarthritis, you may be choosing between a standard steroid injection and Cingal. Both reduce pain. They just work differently.

Steroid Injection

Reduces inflammation inside the knee joint
Often works quickly
Relief may last weeks to a few months
Does not restore joint lubrication
Steroid injections are commonly used for short-term flare-ups.
Repeated use should be avoided to preserve joint health

Cingal Injection

Contains a corticosteroid and hyaluronic acid
Reduces inflammation
Supplements lost joint lubrication and cushioning
Typically lasts minimum of 6 months (varies by individual)
Enhances longer-term joint health

Cingal aims to address both inflammation and the reduced hyaluronic acid seen in osteoarthritis.

Cingal® supports careful, non-surgical management of knee joint arthritis.

Free patient downloads, including the Cingal leaflet, are available in our resources and shop area, alongside braces, supplements, cold therapy and more.

All resources

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References:

1: Hangody L, et al. Intraarticular Injection of a Cross-Linked Sodium Hyaluronate Combined with Triamcinolone Hexacetonide (Cingal) to Provide Symptomatic Relief of Osteoarthritis of the Knee: A Randomized, Double-Blind, Placebo-Controlled Multicenter Clinical Trial.

2: Bauer, C.; Moser, L.B.; Jeyakumar, V.; Niculescu-Morzsa, E.; Kern, D.; Nehrer, S. Increased Chondroprotective Effect of Combining Hyaluronic Acid with a Glucocorticoid Compared to Separate Administration on Cytokine-Treated Osteoarthritic Chondrocytes in a 2D Culture.

3) Individual manufacturer-published data from Ostenil Plus, Durolane, SynviscOne

4) Zahra Shahabfard et al – Hyaluronic acid compared with corticosteroid injections for the treatment of osteoarthritis of the knee: a randomised control trail