About Osteoarthritis

What is Osteoarthritis?

Osteoarthritis (OA) is the most common type of arthritis, also known as degenerative joint disease, for which there is no cure. It is a common, chronic, progressive musculoskeletal disorder.

In an osteoarthritic joint, the surface layer of cartilage gradually breaks down and wears away. The bones in the joint that are now exposed and rubbing against each other, causing pain, swelling, and loss of motion. Over time, the joint may lose its normal shape. In addition, small deposits of bone, called bone spurs, may grow on the edges of the joint. These can break off and float inside the joint space, causing even more pain and damage.

80% of the population over 65 years old has radiographic evidence of OA1. Patients suffering from OA often face chronic pain that worsens over time. Most commonly affecting middle-aged and older people, OA can range from very mild to very severe. There are certain factors that can increase a person’s risk for developing osteoarthritis.


  • Aging: as a person gets older, the body’s ability to heal damaged or lost cartilage decreases 2
  • Joint injury:younger people can also develop OA due to joint injury, for example, athletes who have suffered from a sports-related knee injury3
  • Heredity: if there is a family history of OA, the risk for developing the disease increases4
  • Repeated joint stress: excess weight or overuse of the joint causes stress or increased wear and tear on the joint2
  • Muscle weakness: if the muscles that surround the joint are weak, added stress is placed on the joint5
  • Joint disorder: if there is a joint malformation or a genetic defect in the joint cartilage


Osteoarthritis is the most prevalent joint disorder worldwide and is associated with significant pain and disability6. It is a progressive disease that can affect any joint, but most often involves the weight bearing joints

Joints that can be affected include:

  • Knees
  • Hips
  • Ankles
  • Spine – neck and lower back
  • Hands – fingers and thumbs
  • Shoulders

Knee OsteoarthritisA significant proportion of the world’s population is afflicted by OA of the knee. And the disease ranks as either the top or second leading cause of disability.7


  • Pain
  • Swelling
  • Stiffness
  • Limitation or Loss of physical function
  • A crackling sound when moving the joint


Living with osteoarthritis can not only be painful, but can also be discouraging. Osteoarthritis is the most common cause of knee pain. Patients who think they may have OA should talk to their doctor. Although there is no cure for the disease, the sooner patients start treatment, the more manageable their OA may become, and the longer they may be able to delay surgery or total knee replacement.8

Current Treatment Options for Osteoarthritis

For patients who have been diagnosed with osteoarthritis (OA), their physician will determine the best way to treat their condition based on the severity, the pain, and their lifestyle limitations due to OA.

While there is no cure for OA, there are a number of treatment options that can be explored depending on osteoarthritis severity.

  • Lifestyle: weight loss, exercise, protecting your knees from excess stress, physical therapy
  • Analgesics: simple pain relievers, such as acetaminophen
  • NSAIDS (non-steroidal anti-inflammatory drugs), such as ibuprofen or aspirin
  • Steroids, also called corticosteroids
  • Viscosupplements: hyaluronic acid (HA), also called sodium hyaluronate or hyaluronan
  • Opioids: powerful pain relievers, such as morphine
  • Surgery, such as total knee replacement

When conservative approaches to treating pain due to osteoarthritis, such as physical therapy, weight loss, exercise, or pain relievers are no longer effective, alternative non-surgical treatment options may be beneficial, such as steroids or viscosupplements.


Corticosteroid injections have been used for over 45 years for their potent anti-inflammatory effects to reduce pain quickly. While steroids provide rapid pain relief, the effects are typically short lived.7,8


Viscosupplements have been used globally for more than 25 years to reduce pain associated with osteoarthritis by improving the viscosity and function of the synovial fluid in the joint. While injections of HA alone can provide you with up to six weeks of pain relief, the patient does not typically experience the peak effects until 8 weeks after the final injection.9

Only CINGAL® works by combining a fast-acting steroid with a long lasting viscosupplement to deliver rapid pain relief proven to last through six months.10

CINGAL®: A Powerful New Treatment for the Pain of Osteoarthritis

The Patient Experience

CINGAL® is a simple, physician-administered injection that delivers fast acting and long-lasting pain relief for osteoarthritis so patients can once again enjoy daily physical activities with reduced pain.

Simple Procedure

CINGAL is a simple injection that may be done in the convenience of a clinician’s office. The physician injects CINGAL directly into the joint space where it combines with the synovial fluid to relieve the pain of osteoarthritis (OA) in the knee.

CINGAL has been specially formulated as a single injection procedure. Unlike other hyaluronic acid (HA) viscosupplementation treatment regimens that may require up to five injections, CINGAL only requires a single injection to achieve fast-acting and long-lasting pain relief.

The CINGAL injection may be administered by an orthopedic surgeon, rheumatologist, or other qualified health professional.

What to Expect

Your doctor will identify the injection site and prepare it by cleaning and sterilizing the skin and may utilize a numbing agent to minimize any discomfort that might occur during the injection.

If there is a lot of articular fluid present in the knee joint space, some of the excess may be removed prior to administering CINGAL. The physician will then inject CINGAL into the synovial joint space. There may be some pressure during the injection. The injection procedure will only take a few minutes.

How Quickly Will Pain Relief Occur?

Every patient’s experience is slightly different. For some, pain relief for osteoarthritis happens almost immediately, while it may take a few days for others. In a clinical study, CINGAL patients experienced statistically significant reduction in knee pain in the first week.11

How Long Will Pain Relief Last?

In a CINGAL clinical study, significant knee pain relief was sustained through 6 months.



AML 900-108/B


  1. Sen R, Hurley J. Osteoarthritis –- https://www.ncbi.nlm.nih.gov/books/NBK482326/
  2. YongPing Li, XiaoChun Wei, JingMing Zhou, Lei Wei. The Age-Related Changes in Cartilage and Osteoarthritis. BioMed Research International, Volume 2013, Article ID 916530
  3. Amoako and Pujalte. Osteoarthritis in Young, Active, and Athletic Individuals. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders 2014:7 27–32 doi: 10.4137/CMAMD.S14386.
  4. Berran Yucesoya, Luenda E. Charlesb,Brent Bakera, Cecil M. Burchfielb. Occupational and genetic risk factors for osteoarthritis: A review. Work. 2015 January 1; 50(2): 261–273. doi:10.3233/WOR-131739
  5. Ali H. Alnahdi, PT, MS, Joseph A. Zeni, PT, PhD, Lynn Snyder-Mackler, PT, ScD. Muscle Impairments in Patients With Knee Osteoarthritis. Sports Health Vol 4, No. 4. Jul-Aug 2012
  6. Tuhina Neogi, The Epidemiology and Impact of Pain in Osteoarthritis. Osteoarthritis Cartilage. Author manuscript; available in PMC 2014 September 01.
  7. Bellamy N, Campbell J, Robinson V, et al. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD005328.
  8. Ozturk C, Atamaz F, Hepguler S, et al. The safety and efficacy of Intra-articular hyaluronan with/without corticosteroid in knee osteoarthritis: 1-year, single-blind, randomized study. Rheumatol Int. 2006 Feb;26(4):314-9.
  9. Triamcinolone hexacetonide 20 mg/ml suspension for injection. Intrapharm Laboratories Limited. May 2016. Web: https://www.medicines.org.uk/emc/medicine/28913
  10. Bannuru R, Natov N, Dasi U, et al. Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis – meta-analysis. Osteoarthritis and Cartilage 19 (2011) 611-619.
  11. Hangody L, Szody R, Lukasik P, 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; place-controlled multicenter clinical trial [published online ahead of print May 1, 2017]. Cartilage. doi: 10.1177/1947603517703732
  12. Daley, M. Clinical Efficacy and Safety of MONOVISC™: A lightly cross-linked highly concentrated hyaluronan specially formulated for single injection in osteoarthritis.(2013) 2.
  13. Anika data on file