Cingal 1x4ml (88mg/4ml)

⚠️ Product does not include a needle. A sterile single-use needle of appropriate gauge (18–21 G, as determined by the physician) must be attached before administration.

What is Cingal and how does it work?

Cingal is a single-use intra-articular injection manufactured by Anika Therapeutics, Inc. — a pioneer in hyaluronic acid technology for orthopaedics. It is a Class III CE medical device indicated for the treatment of osteoarthritis (OA) symptoms. The product's defining feature is its dual mechanism of action:

• Cross-linked hyaluronic acid (22 mg/ml) — viscosupplementation: replenishes natural HA lost from synovial fluid, restores viscosity and elasticity of joint fluid, protecting cartilage from mechanical overload. In OA joints the concentration and quality of HA are reduced, impairing shock absorption.
• Triamcinolone hexacetonide (4.5 mg/ml) — an intra-articular corticosteroid with potent, localised anti-inflammatory action. Inhibits inflammatory mediators inside the joint, rapidly reducing pain, swelling, and morning stiffness.

The synergy of both components delivers rapid pain reduction (within days) via the corticosteroid and lasting (up to 6 months) mechanical and trophic joint support via HA — in a single injection, at a single office visit.

Osteoarthritis – why does viscosupplementation work?

In a healthy joint, synovial fluid rich in hyaluronic acid acts as a precision shock-absorption and lubrication system. In osteoarthritis (OA), both cartilage and HA degrade — synovial fluid becomes thinner and less viscoelastic. Cingal's viscosupplement delivers HA directly into the joint space, restoring viscosity, improving glide, and reducing friction between joint surfaces. Simultaneously, the corticosteroid interrupts the inflammatory cascade, reducing pro-inflammatory cytokines (IL-1β, TNF-α) and prostaglandins responsible for pain.

Cingal vs HA-only products (e.g. Durolane) – key differences

• Durolane and other HA-only products — act purely mechanically and trophically: viscosupplementation, cartilage protection, synovial fluid restoration. Effect builds gradually over 2–4 weeks; no anti-inflammatory component.
• Cingal (HA + triamcinolone) — combines viscosupplementation with immediate anti-inflammatory action. The ideal choice for patients with a pronounced inflammatory component (swelling, effusion) who need rapid relief within days of the procedure.

Clinical benefits

• rapid pain relief — corticosteroid acts within a few days of injection,
• long-lasting effect — relief maintained for up to 6 months,
• improved joint mobility and function,
• protection of articular cartilage from further degradation,
• improved viscoelasticity of synovial fluid,
• reduction of intra-articular inflammation,
• potential to delay knee replacement surgery by 3 or more years,
• return to daily physical activity,
• single-injection therapy — one shot, one clinic visit.

Indications

• viscosupplementation of synovial fluid in osteoarthritis,
• rapid and long-lasting relief of knee pain in OA,
• joint inflammation with pronounced pain and swelling,
• mechanical joint support after injury or overuse.

Administration

The product is administered by a physician via injection into the synovial joint space using a sterile single-use needle (recommended gauge 18–21 G). Aseptic technique is mandatory. Correct needle placement within the synovial space must be confirmed prior to injection. Needle is not included — the physician selects and attaches the appropriate needle.

After the procedure, excessive weight-bearing on the treated joint should be avoided.

Composition and package contents

• Cross-linked hyaluronic acid (HA): 22 mg/ml — viscosupplementation, cartilage protection
• Triamcinolone hexacetonide (TH): 4.5 mg/ml — corticosteroid, anti-inflammatory action
• Dibasic sodium phosphate 0.15%, monobasic sodium phosphate monohydrate 0.03%, polysorbate 80 0.22%, sorbitol 5.30%
• Contents: 1 × prefilled syringe 4 ml (88 mg/4 ml) — needle not included
• EAN: 866142000076
• Manufacturer: Anika Therapeutics, Inc., 32 Wiggins Avenue, MA 01730 Bedford, USA

Main contraindications and warnings

• active infection in or around the joint — absolute contraindication,
• hypersensitivity to hyaluronic acid, triamcinolone, or any excipient,
• caution required in patients with diabetes, hypertension, osteoporosis, immune disorders, peptic ulcer, myasthenia gravis — see full SmPC for details,
• product contains sorbitol — do not use in patients with hereditary fructose intolerance,
• do not administer intravenously, intraocularly, epidurally, or intrathecally,
• single use only; reuse risks infection,
• use in pregnancy and breastfeeding only on clear clinical indication.

FAQ – questions and answers

How does Cingal differ from HA-only products such as Durolane?

HA-only products (such as Durolane) act mechanically and trophically — they replenish synovial fluid, improve shock absorption, and protect cartilage. The effect builds gradually over several weeks with no anti-inflammatory component. Cingal additionally contains triamcinolone hexacetonide, which immediately suppresses intra-articular inflammation — pain relief appears within days. It is the preferred choice for patients with a pronounced inflammatory component or those requiring rapid onset of relief.

How quickly are the effects of Cingal felt?

The corticosteroid (triamcinolone) typically provides pain relief within a few days of injection. The viscosupplementation component (HA) gradually improves joint mechanics — the combined effect of both components is maintained for up to 6 months.

Can Cingal be administered again after 6 months?

The decision to re-administer is always made by the treating physician based on clinical assessment. Cingal is a single-use product (one prefilled syringe = one treatment). Due to the corticosteroid content, the frequency of repeat therapy requires individual medical evaluation.

Does Cingal include a needle?

No — the product contains only a 4 ml prefilled syringe without a needle. The physician attaches a sterile single-use needle of the appropriate gauge (18–21 G recommended) prior to administration.

Which joints can Cingal be used in?

Cingal is primarily used in the knee joint — the indication for which it is most thoroughly studied. The injection is delivered into the synovial joint cavity using aseptic intra-articular techniques. The range of applications in other joints is determined by the treating orthopaedic surgeon or rheumatologist.

This product is intended exclusively for professional use by qualified medical personnel. Intra-articular injection must be performed only by a physician experienced in intra-articular injections, using aseptic technique and in accordance with current instructions. By purchasing this product you confirm that you hold the required professional qualifications.

• What is Cingal and how does it work?
• Osteoarthritis – why does viscosupplementation work?
• Cingal vs HA-only products
• Clinical benefits
• Indications
• Administration
• Composition and package contents
• Main contraindications and warnings
• FAQ – questions and answers