Cingal versus Steroid

Managing osteoarthritis (OA) can be challenging, for both clinicians and patients. Among the many treatment options, injections are widely used to reduce pain and improve mobility giving a physio a window of time where the pain is less and manual therapy more possible. Steroid injections have long been a standard choice, but combination treatments like Cingal are growing in popularity for their unique benefits.

Both steroid alone and Cingal should have a place in the discussion of OA…

Steroid Injections

Steroid injections are a well-established treatment for reducing inflammation and pain in OA joints. They work by delivering a potent anti-inflammatory agent directly to the affected joint, providing temporary relief for patients experiencing significant discomfort.

The advantages of this are clear;

• Rapid pain relief, especially in acutely inflamed joints.
• Cost-effective and widely available.

However, there are limitations and concerns;

• Short duration of effect, typically lasting weeks to a few months.
• Repeated use may increase the risk of cartilage damage and joint degeneration.
• Does not address the underlying mechanics of joint health or long-term disease progression.
• Offers nothing once the steroid has worn off that addresses synovial health for longer-term benefit.

What about Cingal?

Cingal is an advanced and unique single-injection treatment combining hyaluronic acid (HA) with a fast-acting steroid. The two combine to offer the best of both, which has been proven in safety and efficacy studies.

• High concentration Hyaluronic Acid: A high concentration (88mg) helps to restore the viscosity and health of the synovial fluid, improving joint lubrication and cushioning.
• Optimised Hyaluronic Acid: Crosslinking profile allows a longer residence time in the joint. A longer-term benefit is also possible by binding to synoviocytes to support their ongoing production of endogenous HA.
• Steroid: Provides immediate anti-inflammatory action, much like a standalone steroid injection, clearing the way for an improved environment for the HA to work.

This helps to deliver the following

• Rapid relief (steroid) and long-term joint health benefits (HA).
• Proven to improve pain and function over 6 months or more.
• Reduces the need for frequent injections, minimising risks associated with repetitive steroid use.
• The steroid type (Triamcinolone Hexacetonide) is less aggressive to the chondral surface (and typically used in paediatrics)
• The combination is proven to manage inflammatory cytokines still, while protecting chondrocytes (cartilage) – Best of both!

However, why has Cingal not become commonplace in the UK until recently?

• The majority of clinics in the UK have become more familiar with combining their own steroid and HA, this is often a mode of what is typically available on the shelf
• In a self-paying patient market, Cingal would fit into a best practice bracket but increases the cost by around £30 per injection.

Why should clinicians avoid mixing their own steroid and HA?

Some clinicians attempt to replicate the benefits of Cingal by mixing hyaluronic acid (HA) with a steroid in the same syringe. While this may seem like a cost-effective or practical solution, it introduces several challenges:

1. Incompatibility: Many HA and steroid formulations are chemically incompatible, leading to a reduction in efficacy for both components.
2. Inconsistent Mixing: Ensuring a uniform mixture is difficult to do as combining a steroid with a HA without a specific formulation and manufacturing is like mixing oil and water. This can result in uneven distribution of the active ingredients within the joint.
3. Lack of Data: There is minimal clinical evidence to support the safety or effectiveness of mixing HA and steroids manually when you consider the range HA brands and types across the market
4. What works best?: There is a lack of data to suggest the type of HA (crosslinking and molecular weight profile) that would work best when combined inside a joint as two separate components if mixed in a syringe.

So Why Cingal Is Better:
Cingal is specifically formulated to overcome these issues. The unique formulation ensures:

• Optimal Stability: Both HA and steroid retain their individual effectiveness within the same injection.
• Proven Clinical Results: Extensive data supports its safety, efficacy, and ability to provide both short- and long-term benefits.
• Convenience: A single pre-mixed syringe eliminates the need for additional preparation, ensuring consistency and sterility.

When steroid is needed to control the pain from inflammation, and the patient is looking or a longer-term outcome, Cingal is the best-practise approach.

Marketing your practice:
We offer full support with clinically-referenced brochures and booklets aimed to help patients make an informed choice with data. While you may have a long-standing, tried and trusted option for helping your OA patients with injection therapies on the shelf, Cingal can still be included in the discussion for all the reasons above. We respect patients’ choices and differing price points, so for circa £30 extra, they are getting the premium OA pain management injection therapy backed by science and data.