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Cingal® – Patient Guide

Knowledge Hub

7 mins readFact Checked
Author of post icon

Written By:

Atif Riaz

Medically Reviewed By:

Mr M. Usman

Cingal® is the first and only approved combination viscosupplement formulated to provide the benefit of a cross-linked hyaluronic acid and fast acting steroid.

Cingal® Joint Injection

CINGAL® combines Anika’s proprietary cross-linked hyaluronic acid formulation, with proven effects through 6 months, with a well-established FDA-approved steroid.

Triamcinolone Hexacetonide (steroid)

Triamcinolone Hexacetonide injections have been used for over 45 years for their potent anti-inflammatory effects, to reduce pain quickly and allow earlier motion. While steroids provide rapid pain relief, the effects are typically short-lived.

Hyaluronic acid (HA)

Hyaluronic acid (HA) is a naturally occurring biocompatible molecule found throughout the
body and is a vital component of healthy joint and tissue function. HA viscosupplements have
been used for more than 25 years to reduce pain associated with osteoarthritis (OA), improve
viscoelastic properties of the synovial fluid and protect the surface of articular cartilage.4,5,6,7
While traditional HA injections can deliver long lasting pain relief, the patient does not typically
experience the peak effects until 8 weeks after the final injection.

Only CINGAL® works by combining the best of fast acting steroids with a long-lasting
viscosupplement to deliver rapid pain relief proven to last through 6 months.

The science behind Cingal®

Micronized particles of the water-insoluble steroid are suspended in the viscoelastic HA gel and reside within CINGAL® as a separate solid phase. Both the HA and steroid remain unchanged by incorporation into the CINGAL® formulation and by sterilisation.

cingal knee joint injection

Fast acting. Lond Lasting.

CINGAL® is a powerful, first in class treatment that combines the proven benefits of Anika’s proprietary high concentration cross-linked hyaluronic acid formulation, approved for long-term pain relief, with a well-established FDA-approved steroid to treat inflammation.
This unique combination provides rapid pain relief that lasts through 6 months.

cingal long lasting knee pain relief


  • Fast-acting pain relief
  • Long-lasting pain relief
  • Convenient single-injection treatment
  • Highly concentrated, non-animal-based HA
  • Safe and effective

The first and only combination HA + Steroid


CINGAL® is a novel combination HA plus steroid single-injection treatment for the pain associated with osteoarthritis. CINGAL® combines the high molecular weight cross-linked hyaluronic acid (HA) formulation of MONOVISC® with a corticosteroid for additional short-term pain relief.


CINGAL® is indicated as a viscoelastic supplement or a replacement for synovial fluid in human joints. CINGAL® is well suited for rapid and long term relief of the symptoms of human joint dysfunctions such as osteoarthritis. The actions of CINGAL®are long term relief of symptoms by lubrication and mechanical
support supplemented by short-term pain relief provided by triamcinolone hexacetonide.

Directions for use

Only medical professionals trained in accepted injection techniques for delivering agents into the knee joint should inject CINGAL® for the indicated use.


The product contains 22 mg/mL high molecular weight crosslinked hyaluronic acid produced from bacterial fermentation, 4.5 mg/mL triamcinolone hexacetonide.

Treatment options for Osteoarthritis (OA) Knee Pain

There are several things you can do to help reduce knee pain due to osteoarthritis (OA).

Lifestyle changes

  • Losing weight, if you are overweight, to alleviate some of the stress on your knees
  • Practising low-impact exercises (e.g., walking, biking, swimming) to strengthen your muscles
  • Resting when you experience any pain or swelling in your knee
  • Applying heat or ice to reduce knee pain


Over-the-counter painkillers like acetaminophen can help reduce pain. Your doctor might also recommend ibuprofen, acetylsalicylic acid, or topical medications to soothe aching knee joints. If your condition escalates, non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin may be prescribed to relieve the pain and inflammation.


Viscosupplementation, such as Cingal®, is the injection of a clear gel-like substance containing hyaluronic acid into the knee. Hyaluronic acid is a naturally occurring substance found in the synovial fluid of the knee joint. The injection of hyaluronic acid into the joint is thought to lubricate the cartilage (much like oil lubricates an engine), thereby reducing pain. A single injection of
Cingal® and Monovisc® or three injections of Orthovisc® can help alleviate OA knee pain for up to 6 months. In addition, the corticosteroid found in Cingal® can relieve pain rapidly.

Corticosteroid injections

Corticosteroid (or cortisone) injections, such as triamcinolone hexacetonide, which is present in Cingal®,
may be used to relieve pain from OA of the knee by reducing swelling in the joint. Relief is often felt quickly following an injection and can last from a few days to a couple of months, depending on the individual. Most injections typically take 24–48 hours to take full effect.

Combination of viscosupplementation and corticosteroid injection

A corticosteroid and viscosupplementation combination treatment like Cingal® is a single intra-articular injection that provides the quick pain relief of a corticosteroid with the long-term pain relief of a viscosupplement.


Knee replacement surgery is a last resort option for patients with OA pain that cannot be relieved by
the above-mentioned options. The decision to perform surgery depends on many factors, including pain
tolerance, disability, and the risks and benefits of surgery.

What leads to osteoarthritis knee pain?

A healthy knee contains synovial fluid, a viscous liquid that is responsible for lubricating the joint and absorbing shocks. Synovial fluid also has anabolic anti-inflammatory and analgesic effects.
Hyaluronic acid is a major component of normal synovial fluid and contributes to the fluid’s viscoelastic properties. Changes in the synovial fluid and degeneration of joint structures may lead to OA knee pain. Pain from OA of the knee may be worse during weight-bearing activities, particularly when climbing stairs or bending. For some people, pain may be present even at rest.

cingal knee joint relief pain treatment
Osteoarthritis pain caused by changes in synovial fluid and joint structures

How can Cingal® provide relief from Osteoarthritis knee pain?

Cingal® is the first single-injection treatment that quickly relieves your OA knee pain while providing
sustained pain reduction. It is used for patients who do not get adequate pain relief from simple
pain relievers like acetaminophen or from exercise and physical therapy.

Cingal® combines the benefits of a trusted anti-inflammatory with Monovisc® to relieve OA knee
pain. The anti-inflammatory component offers fast pain relief generally beginning 24 hours after
administration and the hyaluronan in Monovisc® offers effective OA pain relief for up to 6 months. Cingal® was generally well tolerated; no serious adverse events were reported.

Can Exercise help my Osteoarthritis knee pain?

Arthritis could be a perfect excuse not to exercise, but in reality, an exercise program developed and supervised by a professional who specializes in patients with OA knee pain could help decrease pain while improving your flexibility and fitness level.

Recommended exercises:

For people with OA, 3 types of exercise are recommended:

  • Range of motion exercises (known as flexibility exercises)
  • Endurance or aerobic exercises
  • Strengthening exercises

Each plays a role in maintaining flexibility and improving movement and function.

Low impact activities

Exercises such as biking, swimming and water aerobics are easy on your knees.

  • Exercising in water takes weight off your painful joints. Enquire about classes for people with arthritis at your local community and hospital wellness centres, gyms and pools.
  • Losing weight by being active also reduces pressure on your joints. Even a small amount can make a big difference.
  • 5 lb. of weight loss represents 20 lb. less wear and tear.

To safely participate in activities such as golf, which includes moves that may hurt your joints, speak to your doctor or physical therapist.

30 Minutes of exercise a day is an ideal goal

  • Start slowly, about 10 minutes a day. If you are pain-free, gradually increase frequency and intensity until you reach your goal.
  • It is normal to have mild muscle soreness. Speak to your doctor before using over-the-counter pain relievers such as acetaminophen, ibuprofen, or naproxen to ease muscle pain. Ice can also help. Mention any joint pain to your doctor.

It is recommended that you add simple exercises to your routine, specifically exercises that will help strengthen your quadriceps, hamstrings, and glutes, the muscles that help your knees function.

Knee pain due to osteoarthritis (OA) can impact your lifestyle and daily activities. This guide is intended to help answer your questions and determine, along with your doctor, whether you are a candidate for Cingal®, the first and only single injection treatment that quickly relieves your OA knee pain while providing sustained pain reduction.

Uses of Cingal

Cingal® is indicated for the treatment of pain in OA of the knee in patients who have failed to respond
adequately to conservative nonpharmacologic therapy and to simple analgesics (e.g., acetaminophen).
Cingal® includes an ancillary steroid to provide additional short-term pain relief.

Cingal® is a registered trademark of Anika Therapeutics Inc. Copyright Anika Therapeutics Inc.

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