Joint Injection of Sodium Hyaluronate (Hyaluronic Acid) Combined with Corticosteroid (Cingal) for the Symptomatic Relief of Osteoarthritis of the Knee.
A Randomised, Double-Blind, Placebo-Controlled Multicenter Clinical Trial
Osteoarthritis (OA) is the most common joint disorder in the world, affecting around 40 million people in Europe. It is characterised by a reduced concentration of hyaluronic acid
(HA) in the joint synovial fluid and a slow progressive degradation of joint cartilage. Thus, often relating in inflammation, joint pain and significant functional impairment. This then brings huge economic burden, with health
care expenditures well into the billions annually due to OA. Furthermore, the incidence of OA is thought to rise significantly and nearly 1 in 2 people are projected to develop symptomatic OA by age 85 leading to estimated 3.5 million joint replacement surgeries by 2030.
Intraarticular joint corticosteroid injections to treat knee OA are frequently recommended in clinical practice, which does have pros and cons associated. Clinical trials have found good short-term pain reduction for up to 3 weeks post injection, but it is important to understand and appreciate that this is often short term. Joint injections of hyaluronic acid (HA) are also very frequently used, more so within private practice, to reduce joint pain associated with osteoarthritis, and improve joint function by supplementing the synovial fluid with exogenous HA to provide joint lubrication and mechanical support. A meta-analysis of 54 randomised clinical trials of joint HA versus placebo to treat OA knee pain demonstrated that HA was a beneficial treatment and provided longer lasting benefits.
Combining corticosteroid with HA has been shown to alleviate OA pain more immediately in those receiving just HA prior to the onset of pain relief with. Furthermore, studies have shown that the combination of a corticosteroid and HA versus HA alone results in improved short-term pain relief from the corticosteroid with the longer term pain relief from the HA.
A popular product, now automatically combines the two treatments, Cingal. This was originally developed to deliver short-term pain relief of an approved corticosteroid with the sustained pain relief of high quality HA, Monovisc. The objective of this clinical trial was to demonstrate the safety and effectiveness of the combined treatment for relief of joint pain and symptoms OA patients.
In total, 386 participants were involved in this trial over 40 different centres, and the safety and efficacy was measured. The effective combination of HA and cortisone resulted in both rapid and long-term beneficial effects in a significant reduction in pain and improved function compared with saline as early as 1-3 weeks after injection treatment. This beneficial effect was then maintained until 12 months. The rapid pain relief provided by this combination of treatment, demonstrated a 60% improvement in pain at week 1 and 70% improvement at 3 weeks.
In conclusion of this study, the results identified to strongly confirm the safety and effectiveness of a single intraarticular injection of combined cortisone and hyaluronic acid (Cingal) for rapid and long-term relief of joint pain and symptoms in patients with OA of the knee.
Our clinical opinion
Here at the Dynamic Clinic in Birmingham, it is the upmost importance that we provide the best quality of treatment for our patients. Osteoarthritis is one of the biggest complaints that we see and treat on a daily basis, and have been treating thousands of patients for many years with ongoing success. We ultimately believe in joint preservation, health and function. The beauty with this treatment is a combination effort of a good anti-inflammatory and a joint lubricant. We know and understand that cortisone by itself is not a good long-term solution for a degenerative condition such as osteoarthritis. It is relatively good at providing short-term pain relief but he’s not good to cartilage health long-term. However, a slightly milder form of steroid, with the combination of hyaluronic acid is a very good option at preserving cartilage health at the same time as reducing pain. This is allowing our patients to calm the pain at the same time as optimising joint function.
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Don’t let joint pain, joint damage, sports injuries or arthritis get in the way of allowing you to do what you want. Schedule a consultation at Dynamic Regenerative Medicine today, and let us treat your condition, provide pain relief and get you back to your full and active lifestyle. We have clinics operating out of Solihull (Henley-In-Arden) and Birmingham (Edgbaston).
Call us today 01564 330773