Mark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University.

Anita Chandrasekaran, MD, MPH, is board-certified in internal medicine and rheumatology and currently works as a rheumatologist at Hartford Healthcare Medical Group in Connecticut.

Gel-One (cross-linked hyaluronate) is a treatment option for osteoarthritis (OA) of the knee. It is an injection that helps manage the associated pain.

It’s derived from a protein (hyaluronan) extracted from the combs, or crests, of chickens, which the human body naturally produces to lubricate joints. It works by restoring levels of this protein.

First approved by the Food and Drug Administration (FDA) in 2001, Gel-One was only evaluated in a single clinical trial and was shown to be effective for up to 13 weeks in reducing pain scores, but other endpoints, including stiffness and physical function, were not found to be statistically different than placebo.

There is no outright cure for OA. This treatment is typically only given after other means of management, such as taking medications or adjusting lifestyle, have been attempted.

As with any medication, Gel-One injections aren’t without their side effects and risks. If you have OA, it’s important to understand as much as you can about your treatment options.

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Gel-One is indicated for OA of the knee, which is characterized by the wearing down of joints, leading to pain. OA is the most common form of arthritis, and while it can affect anyone, it’s most often seen in those over 65.

Primarily, Gel-One will be attempted when other treatments, such as taking nonsteroidal anti-inflammatory drugs (NSAIDs) or physical therapy, aren’t yielding results. Since OA is a progressive and irreversible condition, while surgery may be an option, treating it typically means managing symptoms. This injection represents a solid, additional therapy.

Proper diagnosis of OA is essential before Gel-One injections are considered as treatment. How is this condition assessed? Here’s a quick breakdown:

As with any medication, Gel-One isn’t recommended for certain classes of patients, including:

Talk to your healthcare provider about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration of whether the pros of treatment outweigh the cons in your case.

Derivatives of hyaluronic acids, sold under names including Restylane, Juvéderm, and Perlane, are facial fillers used to smooth wrinkles or perform lip augmentation. As in joints, hyaluronic acid levels decrease as you age, loosening the skin. By injecting these into the face, the skin fills in and becomes tighter.

Also, dentists may use a topical version of hyaluronic acid as part of the treatment regimen for chronic gum inflammation. Alongside other courses of treatment, it will help reduce this inflammation in these areas, helping treat gingivitis, periodontitis, and other issues.

Gel-One injections are only ever administered by healthcare providers in the hospital setting, and, as mentioned, more than one such treatment per knee isn’t recommended. It comes in a pre-filled glass syringe containing 3 milliliters (mL) of the solution, which has 30 milligrams (mg) of hyaluronic acid.

The Seigaku Corporation, which manufactures Gel-One, and the FDA emphasize that multiple doses or alterations to the prescription are not recommended. Still, if you’re unsure, be sure to talk to your practitioner about the right dosage for you.

Though administration and storage are up to your healthcare provider, it’s important to understand what this should look like. Proper Gel-One use looks like this:

The more common side effects of Gel-One injection tend to resolve; however, you should let your healthcare provider know if these persist or become problematic. They include:

After treatment, be mindful of how you’re feeling. Don’t hesitate to seek help if you think you need it.

Severe reactions to Gel-One are rare, with most arising from allergic reactions to the medication. If you experience any of the following, get help immediately:

What makes Gel-One generally very tolerable is that this medication is administered by a healthcare provider, thus reducing the chance of overdose. Since it’s also typically not administered multiple times (at least in the same knee), the chances of a poor interaction between this drug and others you’re taking are very low.

Significantly, though, you should not undergo Gel-One injection if your skin has been cleaned with disinfections made with quaternary ammonium salts. There is a chance that the medication may react to this type of solution.

The Food and Drug Administration (FDA) considers the Gel-One injection to be reasonably safe. In a study conducted on different groups of participants, there were no serious adverse effects reported by either group. However, it is always a good idea to have a conversation with your healthcare provider about whether the Gel-One injection is right for you. In addition, the Gel-One injection hasn't been studied in people younger than 21 or pregnant women, so people belonging to these groups should have a conversation with their doctor first.

Gel-One is considered an effective long-term treatment for osteoarthritis. However, it may not be as effective in the short-term; an analysis on corticosteroid injections versus hyaluronic acid injections found that the corticosteroids were more effective in the short-term period, while hyaluronic injections had longer-lasting effectiveness but were more slow in their effectiveness.

Learn tips for managing arthrits pain, medications, and daily challenges.

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Food and Drug Administration (FDA). Package Insert: Gel-One (Cross-Linked Hyaluronate).

Food and Drug Administration (FDA). Summary of Safety and Effectiveness Data: Hyaluronic Acid.

Sinusis K. Osteoarthritis: Diagnosis and treatment. Am Fam Physician. 2012;85(1):49-56.

Seigaku Corporation. Patient Information: Gel One.

Casale M, Moffa A, Vella P, et al. Hyaluronic acid: Perspectives in dentistry. A systematic review. Int J Immunopathol Pharmacol. 2016;29(4):572-582.

Sinusas K. Osteoarthritis: diagnosis and treatment. Erratum in: Am Fam Physician. 2012;86(10):893. PMID:22230308

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