Cingal injection for knee osteoarthritis pain explained

What is Cingal®?

One injection. Two proven treatments working together.

Cingal® combines a corticosteroid for fast pain relief with hyaluronic acid for longer-lasting relief from osteoarthritis symptoms.

Calms inflammation with a targeted corticosteroid.
Supports joint lubrication and cushioning with hyaluronic acid.
Helps improve movement and comfort with a single injection.

Level 1 randomised control studies have proven;

89% responded to the treatment at 1 week
92% responded to treatment at 6 months
A pain reduction of over 70%

How does Cingal work?

With osteoarthritis, the fluid inside your joint can become less effective at lubricating and cushioning movement, often creating pain. Inflammation further, swelling and stiffness. Cingal uniquely and safely targets all the key aspects involved in arthritic joint pain.

Settles inflammation first

The corticosteroid reduces inflammation inside the joint, helping ease pain and swelling in the first few days.

Supports the joints health

Hyaluronic acid (HA) is naturally found in joint fluid. It helps lubricate and cushion the joint, making movement more comfortable. The high dose of optimised HA within Cingal is very effective at supporting the joint's natural fluid.

Longer lasting effect

The HA supports the joint’s cells to make their own HA again, a natural process usually halted in arthritis. This combined with the inflammation now under control, gives Cingal a lasting effect beyond 6 months.

Helps you get moving again

Less pain and stiffness can make everyday activities easier and help you take part in the exercises recommended by your clinician. Being able to stay active will further support your joint health and keep pain lower for longer.

A stable formulation

The micronised formulation keeps the steroid and HA fully stable, which is not the case when they are mixed or injected separately. Cingal is the safest way, and the only option with level 1 studies, to combine both steroid and HA.

What happens

Assessment

You may have already have had an MRI or X-ray, although this is not needed to agree that Cingal is a good option for your joint pain. A clinician may also offer ultrasound in the clinic to show signs of inflammation, although symptoms tend to be easy to spot.

The injection

Cingal is injected directly into the knee during a clinic appointment. It takes less than a minute for the full contents (4mL) to be administered. Patient feedback is generally that this is a comfortable experience with minimal pain.

The first days

Rest the knee from strenuous activity for one to two days. Some people feel better quickly; for others, it takes several days. Even if you feel pain-free in the first 24 hours, to avoid a painful flare, maintain sensible activity levels in the first 48 hours.

Then keep moving

Continue your rehabilitation exercises, as they help you get the most from the injection. A stronger active joint is a healthier joint.

If symptoms return

A repeat injection can be considered, or hyaluronic acid alone if inflammation is minimal. Your clinician will guide the timing. It is worth contacting your clinician as soon as you notice any slight return in symptoms.

Can a brace or support help?

A brace is not a necessary option alongside an injection. But sometimes adding a supportive compression sleeve or supportive brace can help with confidence in returning to activity and achieving the best results from an injection.

Who Cingal may suit

Cingal may suit people with mild to moderate knee osteoarthritis who:

Have ongoing knee pain

Despite physiotherapy or medication.

Have swelling

Linked to their arthritis.

Want to delay surgery

And are not ready for a joint replacement.

Have more advanced arthritis

As a temporary option, after a clinician’s assessment.

Cingal FAQs and fast facts

What is Cingal?

A single injection combining hyaluronic acid, which restores cushioning and lubrication in joints such as the knee, with a corticosteroid (triamcinolone hexacetonide) that quickly reduces inflammation and pain. It treats the swelling, pain and stiffness of knee osteoarthritis.

How is Cingal different from other injections?

It is the first treatment to combine high-concentration crosslinked hyaluronic acid with a fast-acting corticosteroid in one injection.

How does Cingal compare with a steroid injection?

A steroid injection reduces inflammation and often works quickly, but relief may last weeks to a few months, it does not restore lubrication, and repeated use should be avoided.

Cingal also reduces inflammation, but adds back lost lubrication and cushioning, typically lasts at least six months and supports longer-term joint health.

How long does Cingal last?

In clinical studies many patients improved within the first week. Relief commonly lasts beyond six months; how much longer depends on the severity of arthritis and activity levels.

Is Cingal safe?

Both ingredients have long histories of use in knee osteoarthritis and most people tolerate Cingal well. As with any injection there are potential risks, which your clinician will discuss with you.

Are there any risks or side effects?

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

– Temporary discomfort for 24 to 48 hours

– Mild swelling, redness or bruising

– Raised blood sugar in people with diabetes

– A very rare allergic reaction

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

When should Cingal not be used?

Do not have the injection if you have an infection anywhere in your body, feel unwell, are pregnant, are under 18 or do not wish to proceed.

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 LB, 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. Shahabfard Z, et al. Hyaluronic acid compared with corticosteroid injections for the treatment of osteoarthritis of the knee: a randomised control trial.

Supports that may help

Knee cold compress

Cold and compression together can be a powerful way to calm an irritated knee. This easy-to-use knee wrap combines a reusable ice gel pack with gentle adjustable compression to help reduce swelling and ease discomfort after activity, injury, or arthritis flare-ups. Simple to freeze, quick to apply, and designed to comfortably support the knee when it needs it most.

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