Cingal: The best of both worlds
Cingal 4ml by Anika Therapeutics is the world's only intra-articular injection that combines highly cross-linked hyaluronic acid (HA) with triamcinolone acetonide (a corticosteroid) in a single pre-filled syringe. This unique combination provides both immediate pain relief and long-lasting joint lubrication – in a single injection.
Active ingredients and mechanism
Hyaluronic acid component
Cingal contains 88 mg of highly cross-linked hyaluronic acid (22 mg/ml in 4 ml). This HA component is identical to that in Monovisc 88mg/4ml and offers:
- Viscoelastic joint lubrication
- Shock absorption and cartilage protection
- Long-lasting effect for up to 6 months
- Stimulation of endogenous HA production
Corticosteroid component
Cingal also contains 18 mg of triamcinolone acetonide – a proven intra-articular corticosteroid with a strong anti-inflammatory effect:
- Immediate pain relief within 1–3 days
- Strong anti-inflammatory action
- Reduction of joint effusion
- Duration of action of the corticosteroid component: 4–6 weeks
Why combination instead of single preparations?
Previously, doctors had to either inject a corticosteroid first and then hyaluronic acid in a second session, or forgo one of the two therapies altogether, for patients with inflammatory osteoarthritis. Cingal elegantly solves this problem: one injection, two mechanisms of action, immediate and long-lasting effect.
Clinical study data
Cingal is the only combination product with a randomized, controlled Phase III study (FLEXI study):
- Significantly better pain reduction in the first weeks vs. HA alone
- Long-lasting effect comparable to Monovisc (HA component)
- High safety: side effect profile comparable to single components
- Particularly effective in patients with an inflammatory component
Indications: When is Cingal the first choice?
- Knee osteoarthritis with acute inflammation – joint effusion, warmth, swelling
- Patients with high levels of suffering – who need immediate pain relief
- Working professionals – who need to return to work quickly
- Athletes – who want to return to training quickly
- Patients before planned events – travel, weddings, sports competitions
Comparison: Cingal vs. pure HA preparations
| Feature | Cingal 4ml | Monovisc 88mg/4ml | Durolane 60mg/3ml |
|---|---|---|---|
| HA amount | 88 mg | 88 mg | 60 mg |
| Corticosteroid | Triamcinolone 18 mg | No | No |
| Immediate effect | Yes (1–3 days) | No | No |
| Long-term effect | Up to 6 months | Up to 6 months | Up to 6 months |
| Injections | 1 | 1 | 1 |
| Best indication | Osteoarthritis + inflammation | Osteoarthritis without inflammation | Knee & hip |
Contraindications and precautions
Due to the corticosteroid component, additional contraindications apply:
- Active joint infection (absolute contraindication)
- Systemic fungal infections
- Known corticosteroid allergy
- Diabetes mellitus: blood sugar control recommended after injection (corticosteroids can increase blood sugar)
- Not more than 3–4 corticosteroid injections per year into the same joint
Practical notes for practitioners
- Storage: 2–8°C, do not freeze, protect from light
- Application: Intra-articular, strictly aseptic
- In case of effusion: joint aspiration recommended before injection
- Aftercare: 48 hours of rest, monitor blood sugar in diabetics
- Repetition: At the earliest after 6 months, max. 3–4x/year (observe corticosteroid limit)
Conclusion for practitioners
Cingal 4ml is the first choice for knee osteoarthritis with an inflammatory component. The unique combination of immediate corticosteroid action and long-lasting HA lubrication makes it the most effective single-shot preparation for patients with acute suffering.
Order now: Buy Cingal 4ml – in the Novamedo shop, CE-certified, fast delivery, for medical professionals.
