There are a handful of truly effective options for treating arthritis that both reduce inflammation and help the joint heal. In cases of advanced knee arthritis, however, where the joint has very little cartilage left, attempting to heal the joint isn’t an option. In these situations most clinicians will suggest joint replacement. In advanced stages of joint degeneration, called grade 3 or 4 osteoarthritis, pain and limitation are usually severe and affect one’s ability to work, sleep, exercise and can profoundly impact quality of life.
In these cases there is one treatment that stands out as an effective option. It is the injection of hyaluronic acid combined with a steroid called Triamcinolone, also known as Kenalog. Hyaluronic acid is a naturally occurring molecule normally found in healthy joints that is slippery and acts as a shock absorbing cushion protecting each joint surface. As we age, and as arthritis progresses, the quality and amount of hyaluronic acid diminishes.
Hyaluronic acid can be used on its own, without the added steroid, when arthritis is mild or moderate. In these situations PRP, a concentrate of your own platelets, can also be considered. Steroids, like that found in Cingal, are very effective at controlling pain and inflammation quickly. When added to hyaluronic acid, the steroid give fast pain relief while the hyaluronic acid gives long lasting pain relief, up to 26 weeks.
When steroids are used on their own, and in high doses, they accelerate the degenerative process in the joint. When combined with hyaluronic acid in low dose, however, the steroid does not cause the same long term harm. It seems to be the case that the combination is a much safer option for someone suffering from arthritic pain. Cingal is very well tolerated and can give pain relief within 24 hours and can last up to 6 months.
It is also covered under the pharmaceutical portion of most extended health care plans making it a very affordable option.