Is your older horse developing a hitch in his get-along? Equine osteoarthritis is a common condition in the aging horse.

Osteoarthritis (also known as Degenerative Joint Disease) involves joint inflammation and progressive degeneration of the cartilage lining. It also involves changes in the bone and soft tissues of the joint.

Arthritis is thought to affect more than half of all horses over the age of 15. It is also the leading cause of lameness in horses. [1]

Horses engaged in high-intensity exercise, such as racing, may develop osteoarthritis at an earlier age due to wear-and-tear. [2]

There is no cure for arthritis, but with proper management, many horses can continue to live comfortably and maintain a good level of fitness.

A balanced feeding program that provides anti-inflammatory nutrients can help to support healthy joints. In addition, modified exercise routines, medications and therapeutic bodywork can also manage arthritic pain in your horse.

If you suspect your horse has arthritis, submit your horse’s diet online for free guidance from our equine nutritionists. Addressing this issue early on is critical to support your horse’s comfort and ease of movement.

Arthritis in Horses

Equine osteoarthritis is defined as a group of disorders characterized by progressive deterioration of the articular cartilage and other components of the joint. [2]

The major symptom of osteoarthritis in horses is pain manifesting as lameness, leading to a loss of functionality. Horses may also experience muscle stiffness, loss of performance, reluctance to work or swelling in the joints.

Osteoarthritis is not the only type of arthritis in equines, but it is the most prevalent and is what most laypeople mean when they refer to arthritis in horses.

Arthritis may also be caused by repetitive strain on the joints, such as the heavy workloads of performance horses, which can causes cartilage damage and erosion. In these horses, the metacarpophalangeal joint (fetlock) is the most likely to be affected.

Other types of arthritis include:

  • Septic arthritis: a potentially life-threatening condition that occurs when a joint becomes infected as a result of an injection, injury or surgery [3]
  • Traumatic arthritis: occurs after an injury, such as synovitis, or inflammation of the synovial membrane, joint capsule inflammation, chip fractures within the joint, ligament, or meniscus tears. Gradually, osteoarthritis can develop in the affected areas [3]

If you suspect your horse has arthritis or issues affecting joint mobility, seek out veterinary attention for an accurate diagnosis and appropriate treatment plan.

Osteoarthritis Diagnosis in Horses

To diagnose osteoarthritis, the veterinarian observes the horse’s movement and conducts a physical examination. Questions are asked about the horse’s history, including current and former exercise programs. [6]

Diagnosis also typically involves flexion tests, in which pressure is applied to the limbs. These tests will temporarily make any existing joint pain more obvious.

Once the affected joint is identified, the horse receives a nerve block to anesthetize a part of the leg. After each block, the horse is prompted to move. When the lameness improves after a certain block, that indicates the problem joint.

Your veterinarian will also take X-rays of the affected joint. In some cases, the vet may recommend ultrasounds to get a better view of soft tissues.

Once the veterinarian has determined which joints are affected and how severely, a treatment plan is devised.

Causes of Arthritis

While horses as young as two years of age can develop arthritis, older animals are more often affected due to cumulative joint wear and tear.

Causes of arthritis in horses may include:

  • Constant concussive force during exercise
  • Improper shoeing
  • Joint trauma
  • Poor conformation

Some horses are conformationally predisposed to arthritis. Animals that toe in, toe out, or have upright pasterns or sickle hocks are more likely to develop arthritis.

Racehorses and other equine athletes are also at greater risk of developing joint problems. In one study, 33% of 2- and 3-year old Thoroughbred racehorses were found to have osteoarthritis and lesions in their articular cartilage. [4]

However, appropriate exercise is necessary for supporting proper joint development in young horses. Growing horses that are confined to stalls also have impaired cartilage formation and stunted joint development. [5]

Arthritis Symptoms

Lameness is the most common symptom of equine osteoarthritis, as well as swollen or tender joints.

Suspect possible arthritis if any of these signs are visible: [6]

  • Asymmetrical hoof wear
  • Bony bumps developing on a joint
  • Gait unevenness
  • Heat in the joints
  • Lead change issues
  • Popping or crackling noise from a joint
  • Shortened stride

These signs are not exclusive to osteoarthritis. They may also indicate soft tissue damage, such as ligament tears or a bone fracture.

Accurate diagnosis by a veterinarian is required before deciding on the best strategy for managing pain and limiting damage.

Prevention of Joint Problems

There is no fail-safe way to prevent arthritis in your horse, but there are steps you can take to help slow the progression of deterioration and keep your horse sound.

  1. Maintain appropriate hoof care: Keep your horse on a regular farrier schedule. Hoof care and proper trimming support biomechanics and help to reduce the concussive force on joints when moving. In contrast, imbalanced shoeing or inappropriate trimming can increase the risk of osteoarthritis by changing the load distribution and increasing pressure in the joints. [7]
  2. Include adequate conditioning in your exercise program: Chronic joint trauma, which can occur when the horse is in heavy, demanding work, contributes to degenerative joint disease. Ease your horse into heavy exercise by starting with low-intensity work and building up intensity and duration over a period of weeks or months.
  3. Allow young animals to exercise: Incorporate light exercise into your foal’s lifestyle. The light concussive impact of exercise stimulates cartilage formation and healthy bone development. This includex allowing free access to pasture, which has been shown to support optimal bone development. [5]
  4. Maintain a healthy body condition: Carrying too much weight puts excess stress on the joints. Obesity also increases inflammation in the body which can contribute to the development of arthritis. Keep your horse at a healthy body condition to reduce the odds of developing arthritis. [8]
  5. Develop a sound nutrition plan: It is important to provide appropriate levels of energy, protein, vitamins and minerals for optimal bone and joint development and to support horses with arthritis. Key nutrients to consider are amino acids, zinc, copper, calcium and phosphorus
  6. Consider joint health supplements: Feeding your horse supplements – such as MSM, DHA, and hyaluronic acid – that are backed by research can support mobility and joint health.

As the saying goes, an ounce of prevention is worth a pound of cure. Optimal joint health begins with proper nutrition and exercise in young animals.

If your horse displays signs of arthritis, consult with your veterinarian for an accurate diagnosis and contact an equine nutritionist to develop an appropriate diet plan for your horse.

Treating Arthritis in Horses

Before beginning to treat your horse for arthritis, make sure that you have an accurate diagnosis. If your horse is lame, it is important to identify any other potential issues contributing to your horse’s lameness.

Some horse owners think that if an older horse is lame, arthritis is automatically the culprit. That’s simply not true and you could make the situation worse without an accurate assessment of the problem.

Many common hoof health issues can cause lameness and may or may not coincide with joint health issues.

Always have a veterinarian conduct an examination to determine whether joint degeneration is the source of your horse’s lameness or whether they have another injury.

With careful management, many arthritic horses can continue to be ridden and used in sport disciplines, although often at a lower level of use.

Exercising Horses with Osteoarthritis

Some horses may benefit from short-term stall rest during flare-ups of symptoms. But, generally, regular low-impact exercise supports bone and joint health.

Arthritic animals benefit from lots of turnout and minimal time kept in a stall. Try to give your horse as much turnout as available.

Hyaline cartilage is a collagen-rich durable connective tissue found in synovial joints that assists with movement. Research shows that hyaline cartilage thickness is greater in trained compared to untrained horses. [9]

In one study of 2-year-old horses, training on sand and grass tracks improved the thickness of cartilage in joints after 13 weeks. [9]

Another study found that horses confined to box stalls had lower rates of cartilage protein synthesis compared to horses on a 6-week exercise program. [10]

Unexercised horses produced lower amounts of proteoglycans, which are heavily glycosylated proteins that make up the extracellular matrix of joint tissue.

Regular turnout is particularly important for younger, developing horses. In growing foals under the age of 5 months, free access to pasture supports optimal development of the musculoskeletal system. [11]

Pain Medications and other Pharmaceutical Treatments

Pharmaceutical interventions can help to manage the pain associated with osteoarthritis and reduce inflammation. Consult with your veterinarian to determine an appropriate treatment protocol involving medications.

Your vet may prescribe a non-steroidal anti-inflammatory drug (NSAID) to relieve inflamed joints.

Phenylbutazone

Phenylbutazone (bute, PBZ) is a commonly prescribed NSAID for arthritic horses that works as a cyclooxygenase inhibitor.

It inhibits the COX-1 enzyme that produces prostaglandins, which promote inflammation and fever. However, COX-1 is also found in the digestive tract where it is important for protecting the gastrointestinal cells from damage by acids. [12]

While bute has strong anti-inflammatory and analgesic (pain-relieving) properties, long-term use can cause ulcers in the gastrointestinal tract.

Equioxx & Previcox

Newer NSAIDs such as Equioxx and Previcox, are designed to be safer and have a lower risk of gut problems. These drugs are referred to as coxibs and they work by selectively inhibiting the COX-2 enzyme – or cyclooxygenase-2.

COX-2 also generates prostaglandins, the chemical responsible for pain and inflammation. However, COX-2 inhibition has less of a negative effect on the gastric mucosa lining the stomach. Long-term use of Equioxx and Previcox is less likely to cause ulcers. [13]

Tildren

Horses with distal hock pain may also benefit from Tildren® (Tiludronate disodium), a bisphosphonate compound. This drug works by inhibiting bone resorption to reduce bone degradation.

Intravenous infusion of tiludronate disodium in horses with osteoarthritis improved lameness scores and inhibited progression of osteoarthritis. However, it did not change markers of joint inflammation nor did it repair cartilage damage that already existed. [14]

Joint Injections

Regular joint injections help many horses manage arthritic pain, although they come with a higher cost. Your veterinarian can determine if your horse would benefit from this therapy.

Intraarticular injections take many different forms, including:

  • Corticosteroids
  • Hyaluronic acid
  • Polysulfated glycosaminoglycans (PSGAGs)
  • Platelet-rich plasma
  • Interleukin-1 receptor antagonist protein (IRAP)
  • Polyacrylamide hydrogel

Adequan

Adequan® is an FDA-approved equine PSGAG (polysulfated glycosaminoglycan) for the treatment of degenerative joint disease. Along with reducing lameness and swelling, Adequan® restores synovial lubrication.

PSGAGs work by stimulating the production of new cartilage in joints and by reducing inflammation. PSGAGs also appear to block enzymes that break down connective tissue and can reverse the cycle leading to cartilage component loss.

Adequan is indicated for intramuscular treatment of non-infectious degenerative and/or traumatic joint dysfunction and associated lameness of the carpal and hock joints in horses.

Adequan® administration consists of one vial (5 cc) of an intramuscular injection every four days for 28 days.

Topical Treatments

Liniments and other topical ointments were previously the primary treatment for horses with arthritis. They still hold an important place in equine care today.

A rubdown with a liniment helps soft tissues by increasing blood flow to the muscles. This helps improve nutrient uptake by tissues and supports healing.

Liniments are available in various forms including liquid, gel, and foam applications which allows horse owners to choose their preference.

Surpass

Diclofenac sodium, marketed under the brand name Surpass, is a topical NSAID approved by the FDA used for osteoarthritis symptoms.

The topical solution is applied directly to the affected area, such as the equine hock, knee, fetlock, and pastern joints. It helps to relieve inflammation and pain, supporting mobility. [15][16]

Formerly available only by prescription, diclofenac sodium is now available over-the-counter, but it is recommended to ask your veterinarian before using this NSAID.

Do not use diclofenac sodium if your horse receives another form of NSAID, such as Equioxx. Always wear gloves when applying diclofenac sodium.

Dimethyl Sulfoxide

Dimethyl sulfoxide (DMSO) is also used as a topical anti-inflammatory in horses, although it is not approved by the FDA for that purpose. It has been reported to have anti-inflammatory and antioxidant properties. [17]

Equine vets use it off-label for many purposes, including intravenously in the early stages of laminitis to slow down inflammation.

While it is frequently used to treat arthritis in horses, relatively few studies exist and those that do are contradictory.

In one study, horses with experimentally-induced joint inflammation were treated with topical application of DMSO. The compound was shown to penetrate into the joint and decrease markers of inflammation. This suggests DMSO can be beneficial for reducing inflammatory processes in arthritis. [18]

However, based on studies performed in vitro, prolonged exposure to DMSO could affect the metabolic activity of cells in the joint capsule. [19]

Do not use DMSO on your horse without discussing this therapy with your vet. As with any topical ointment, always wear gloves when applying DMSO.

Chiropractic & Acupuncture Therapy

Acupuncture and chiropractic therapy may be helpful in managing mild to moderate joint osteoarthritis in horses, according to Dr. James D. Kenney, DVM, a consulting veterinarian at the New Jersey Equine Clinic in Millstone, New Jersey.

Dr. Kenney says, “they are helpful modalities for compensatory upper body soreness and chronic pain.”

He notes that other modalities, such as Pulsed Electro-Magnetic Field (PEMF) therapies like the Magna Wave, along with topical non-steroidal anti-inflammatory drugs, topical capsaicin, and laser therapy also appear to be helpful.

Dr. Kenney adds that these therapies are a complement to conventional and routine veterinary care, not a replacement. Adjunct treatments help with the overall management of a horse living with osteoarthritis, but are not a cure for the condition.

Accupuncture in Horses

There are only a few studies published on the use of acupuncture in horses. In a pilot study using eight sound or mildly lame horses, acupuncture improved some parameters of gait analysis suggesting it may improve comfort. [20]

Chronic back pain in horses is another common reason to try acupuncture. This condition could arise from muscle pain, arthritis or both.

In one study, 10 out of 14 horses with chronic back pain showed improvements in clinical signs after approximately 11 treatments of stimulation of acupuncture points with an infrared laser. [21]

Chiropractic Care for Horses

Chiropractic treatment is most commonly used to support performance or following injuries in the neck, back or generalized muscle strain. [22]

Whether chiropractic treatment is effective for osteoarthritis has not been studied in horses. However, in healthy horses, chiropractic treatment applied to the neck, back, pelvis and front feet improved range-of-motion and symmetry in a walk and trot.

Most importantly, researchers found improvements in range-of-motion in the tarsus (hock) and carpus (knee) – two joints that can be affected by arthritis. This suggests that chiropractic treatment could be a beneficial add-on to regular osteoarthritis care. [23]

Joint Supplements for Arthritic Horses

A well-balanced, forage-first diet with adequate vitamin and mineral inclusion is the best thing you can do to support your horse’s joint function.

Before looking at equine joint supplements, making sure there are no gaps in the diet is a priority. A hay analysis is highly recommended.

Several vitamins and minerals are known to support joint health based on research in humans and other species. This includes vitamin E, vitamin C and vitamin A which have antioxidant properties.

The trace minerals zinc, copper, selenium and manganese are also important antioxidants that help build healthy joints in young animals and support mobility in older animals.

Mad Barn’s Omneity is a comprehensive equine vitamin and mineral supplement that contains optimal levels of the key micronutrients required for healthy joints. Omneity provides 100% organic trace minerals and should form the base of any nutrition program for a horse with arthritis.

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  • Complete B-vitamin fortification
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Equine Joint Supplements

Many over-the-counter joint supplements have good evidence to support their use in arthritic horses.

But there are also some commonly-used supplements with poor evidence of efficacy or with no reliable research in horses.

Below we provide a brief overview of 5 popular joint supplements for horses and discuss which one can help keep your horse comfortable and serviceable.

Methylsulfonylmethane (MSM)

MSM is a naturally occurring source of sulfur, which is an important nutrient for maintaining connective tissue.

Sulfur is a key component of glucosamine and collagen, which are proteins found in cartilage and joint tissue. In lab studies, MSM has been shown to protect against inflammation and the breakdown of cartilage. [24]

Research also shows that horses fed MSM experience less oxidative stress and inflammation following exercise. [25]

Bulk MSM Powder Equine Supplement

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  • Supports joint health
  • Cartilage & connective tissue
  • Skin, coat & hoof quality
  • Natural antioxidant

Glucosamine

Glucosamine is a naturally occurring sugar compound that is a building block of cartilage. This popular supplement primarily comes from crustacean shells when used as an ingredient in horse products.

While the glucosamine in your horse’s body plays a role in connective tissue, supplementation with this nutrient does not appear to improve joint health. This may be due to poor bioavailability of this supplement.

Standardbred horses given 4 grams of glucosamine twice per day for 48 weeks did not experience any improvement in key biomarkers for joint comfort or mobility. [26]

Chondroitin sulfate

Chondroitin sulfate is another sugar compound found in cartilage that is generally paired with glucosamine in joint supplements.

Chondroitin is believed to help maintain synovial fluid and improve levels of hyaluronic acid in joints. However, beneficial effects have not been observed in horses given these supplements. [27]

High-dose supplementation with chondroitin sulfate and glucosamine did not alter levels of these nutrients in the horse’s blood, suggesting that the ingredients were not absorbed. [27]

Hyaluronic Acid

Hyaluronic Acid (HA) is an important component of synovial fluid and connective tissue. This ingredient is available both in an oral supplement form or as an intraarticular injection.

Injections of HA directly into the joints of horses with osteoarthritis have been shown to improve joint health and reduce lameness. [28]

Oral supplementation also appears to be beneficial, with improved synovial fluid composition and decreased inflammation in the joints of horses given 100 – 250 mg of HA per day. [29][30]

Omega-3 Fatty Acids

Supplementing your horse’s diet with omega-3 fatty acids can help reduce inflammation and support joint comfort. Horses cannot synthesize these essential polyunsaturated fatty acids on their own, so they must receive them in the diet.

The omega-3 fatty acids with anti-inflammatroy benefits are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Both are derived from marine sources, such as fish oil and microalgae.

Plant-based oils such as flax and camelina oil do not contain EPA or DHA.

A study conducted on twelve mature and six two-year-old Arabian horses showed that fatty acid supplementation increased stride length compared to animals in a control group. [31] This is an indicator of joint health.

In another 90-day study of horses diagnosed with arthritis, supplementing with EPA and DHA reduced levels of pro-inflammatory prostaglandins and improve concentrations of synovial fluid, suggesting strong anti-inflammatory effects. [32]

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  • Skin & coat condition
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Herbal Supplements

Herbs with anti-inflammatory properties may offer relief to arthritic horses, based on positive results seen in human studies. [33]

However, most herbal remedies have not been well-researched in horses. Their use is based on traditional medicine practices and anecdotal reports of efficacy. Herbs found in equine joint health nutraceutical products include:

  • Boswellia
  • Devil’s claw
  • Rosehips
  • White willow
  • Yarrow

These supplements can be used as add-ons to research-backed dietary supplements and conventional therapies, however, they are unlikely to be effective on their own.

Caring for Your Arthritic Horse

There are many ways you can support your horse’s joint health to ease the discomfort of osteoarthritis. Appropriate exercise, nutrition, medication and adjunct therapies can help your arthritic horse to remain mobile and comfortable.

Early detection and treatment improve the prognosis for this condition. If your horse’s osteoarthritis is well-managed, symptoms can be controlled and lameness may be prevented.

Make sure your horse is at a healthy body condition, receives regular hoof care and eats a forage-rich diet with balanced mineral and vitamin content.

Consider feeding W-3 Oil, which contains the omega-3 fatty acid DHA, and MSM to support joint tissues and reduce inflammation.

Wondering which supplements and feeds will work best for your horse? Submit your horse’s diet for analysis online and our nutritionists can provide personalized recommendations.

If your horse is prescribed NSAIDs, ask your veterinarian about COX-2 selective drugs which are less likely to cause gut problems.

You can also explore treatment options such as joint injections, topical medications, acupuncture and chiropractic therapy for horses that require additional support.

Is Your Horse's Diet Missing Anything?

Identify gaps in your horse's nutrition program to optimize their well-being.

References

  1. Clegg, Peter. Booth, Todd. Drugs used to treat osteoarthritis in the horse. In Practice. 2000.
  2. C W. McIlwraith et al. The horse as a model of naturally occurring osteoarthritis. Bone Joint Res. 2012 Nov; 1(11): 297–309.
  3. Brokken, Matthew, et al. Joint Disorders in Horses. Merck Veterinary Manual. Apr 2019.
  4. Neundorf, R.H. et al. Determination of the prevalence and severity of metacarpophalangeal joint osteoarthritis in Thoroughbred racehorses via quantitative macroscopic evaluation. Am J Vet Res. 2010.
  5. Logan, A.A. and Nielsen, B.D. Training Young Horses: The Science behind the Benefits
    . Animals. 2021.
  6. Rose, R.J. The diagnosis and treatment of arthritis in horses. NZ Vet J. 1983.
  7. Viitanen et al. Effect of foot balance on the intra-articular pressure in the distal interphalangeal joint in vitro. Equine Vet J. 2010.
  8. Pearson W. et al. Exploring relationships between body condition score, body fat, activity level and inflammatory biomarkers. J Anim Physiol Anim Nutr, 2018.
  9. Firth E.C. et al. Musculoskeletal responses of 2-year-old thoroughbred horses to early training 1. Study design, and clinical, nutritional, radiological and histological observations. NZ Vet J, 2004.
  10. Palmer J.L. et al. Site-specific proteoglycan characteristics of third carpal articular cartilage in exercised and nonexercised horses. Am J Vet Res, 1995.
  11. Van Weeren P.R. & Barneveld A. Study design to evaluate the influence of exercise on the development of the musculoskeletal system of foals up to age 11 months. Equine Vet J Suppl, 1999.
  12. Soma, L. et al. The use of phenylbutazone in the horse. J Vet Pharmacol Ther. 2012.
  13. Knych, Heather K. Nonsteroidal Anti-inflammatory Drug Use in Horses. Vet Clin North Am Equine Pract. 2017.
  14. Bertuglia, Andrea. Effect of intravenous tiludronate disodium administration on the radiographic progression of osteoarthritis of the fetlock joint in Standardbred racehorses. J Am Vet Med Assoc. 2021.
  15. Levine, D.G. et al. Effect of topical application of 1% diclofenac sodium liposomal cream on inflammation in healthy horses undergoing intravenous regional limb perfusion with amikacin sulfate. Am J Vet Res. 2009.
  16. Frisbie, D.D. et al. Evaluation of topically administered diclofenac liposomal cream for treatment of horses with experimentally induced osteoarthritis. Am J Vet Res. 2009.
  17. Schleining, JA. Reinertson, EL. Evidence for dimethyl sulphoxide (DMSO) use in horses. Part 2: DMSO as a parenteral anti-inflammatory agent and as a pharmacological carrier. AAEP. Equine Veterinary Education. December 2007.
  18. Smith, G. et al. Anti-inflammatory effects of topically applied dimethyl sulfoxide gel on endotoxin-induced synovitis in horses. Am J Vet Res. 1998.
  19. Smith, C.L. et al. In Vitro Evaluation of the Effect of Dimethyl Sulfoxide on Equine Articular Cartilage Matrix Metabolism. Vet Surg. 2004.
  20. Dunkel, B. et al. A pilot study of the effects of acupuncture treatment on objective and subjective gait parameters in horses. Vet Anaesth Analg. 2017.
  21. Martin Jr, B.B. and Klide, A.M. Treatment of chronic back pain in horses. Stimulation of acupuncture points with a low powered infrared laser. Vet Surg. 1987.
  22. Wilson, J.M. et al. International Survey Regarding the Use of Rehabilitation Modalities in Horses. Front Vet Sci. 2018.
  23. Guest, J. and Cunliffe, C. The Effects of Chiropractic Treatment on The Range of Motion of the Carpus and Tarsus of Horses. Equine Vet J. 2014.
  24. Butawan, M. et al. Methylsulfonylmethane: Applications and safety of a novel dietary supplement. Nutrients. 2017.
  25. Marañón, G. et al. The effect of methylsulphonylmethane supplementation on biomarkers of oxidative stress in sport horses following jumping exercise. Acta Vet Scand. 2008.
  26. Caron, J.P. et al. Serum concentrations of keratan sulfate, osteocalcin, and pyridinoline crosslinks after oral administration of glucosamine to Standardbred horses during race training. Am J Vet Res. 2002.
  27. Welch, C.A. et al. Plasma concentration of glucosamine and chondroitin sulfate in horses after an oral dose. J Equine Vet Sci. 2012.
  28. Gupta, R.C. et al. Hyaluronic acid: molecular mechanisms and therapeutic trajectory. Front Vet Sci. 2019.
  29. Bergin, B.J. et al. Oral hyaluronan gel reduces post-operative tarsocrural effusion in the yearling thoroughbred. Equine Vet J. 2006.
  30. Carmona, J.U. et al. Effect of the administration of an oral hyaluronan formulation on clinical and biochemical parameters in young horses with osteochondrosis. Vet Comp Ortho Traumatol. 2009.
  31. Woodward, A.D. et al. Supplementation of dietary long-chain polyunsaturated omega-3 fatty acids high in docosahexaenoic acid (DHA) increases plasma DHA concentration and may increase trot stride lengths in horses. Equine and Comparative Exercise Physiology. 2007.
  32. Manhart, D.R. et al. Markers of inflammation in arthritic horses fed omega-3 fatty acids. Prof Anim Sci. 2009.
  33. Henrotin, Y. and Mobasheri, A. Natural Products for Promoting Joint Health and Managing Osteoarthritis. Comp Altern Med. 2018.