Guidelines from the American College of Rheumatology conditionally recommend the use of intra-articular corticosteroid injections for treatment of knee osteoarthritis. 51 The duration of pain relief is one to two weeks in most trials, with a few showing improvements lasting three to four weeks. 60 – 63 Research uniformly supports the safety of intra-articular corticosteroid injections for treatment of knee osteoarthritis; however, these studies are limited by lack of histologic data and poor long-term follow-up. 64 A Cochrane review found weak evidence for the use of corticosteroid injections for the treatment of knee rheumatoid arthritis. 52
Corticosteroids have been used as drug treatment for some time. Lewis Sarett of Merck & Co. was the first to synthesize cortisone, using a complicated 36-step process that started with deoxycholic acid, which was extracted from ox bile .  The low efficiency of converting deoxycholic acid into cortisone led to a cost of US $200 per gram. Russell Marker , at Syntex , discovered a much cheaper and more convenient starting material, diosgenin from wild Mexican yams . His conversion of diosgenin into progesterone by a four-step process now known as Marker degradation was an important step in mass production of all steroidal hormones, including cortisone and chemicals used in hormonal contraception .  In 1952, . Peterson and . Murray of Upjohn developed a process that used Rhizopus mold to oxidize progesterone into a compound that was readily converted to cortisone.  The ability to cheaply synthesize large quantities of cortisone from the diosgenin in yams resulted in a rapid drop in price to US $6 per gram, falling to $ per gram by 1980. Percy Julian's research also aided progress in the field.  The exact nature of cortisone's anti-inflammatory action remained a mystery for years after, however, until the leukocyte adhesion cascade and the role of phospholipase A2 in the production of prostaglandins and leukotrienes was fully understood in the early 1980s.
Cingal TM , Monovisc ® and Orthovisc ® may not be suitable for everyone. Talk to your doctor if you have questions regarding these products, or for more information on pain associated with osteoarthritis of the knee. Product information is only pertinent for use in Canada. Cingal TM , Monovisc ® and Orthovisc ® are trademarks of Anika Therapeutics Inc., used under licence by Pharmascience Inc. Pendopharm, Division of Pharmascience Inc. Product Licences are pertinent to use in Canada. Product Licences herein are not approved for use in the .