Intra-articular injection in horses involves the administration of therapeutic agents directly into a joint space. This technique is used to manage joint diseases, such as osteoarthritis, by delivering medications like corticosteroids, hyaluronic acid, or biologic therapies directly to the affected area. The procedure aims to reduce inflammation, alleviate pain, and improve joint function. Intra-articular injections are commonly performed under sterile conditions to minimize the risk of infection. This page compiles peer-reviewed research studies and scholarly articles that explore the methods, efficacy, and safety of intra-articular injections in equine medicine, as well as their impact on joint health and performance in horses.
Tobin T, Blake JW.Since procaine has both local anaesthetic and central stimulant actions its presence in the blood or urine of racing horses is forbidden. After rapid intravenous injection of procaine HC1 (2.5 mg/Kg) in thoroughbred mares plasma levels of this drug fell rapidly (t 1/2 alpha = 5 min) and then more slowly (t 1/2 beta = 50.2 min). These kinetics were well fitted by a two compartment open model (Model I). This model gave an apparent Vdbeta for procaine in the horse of about 3,500 litres. Since procaine was about 45% bound to equine plasma protein this gives a true Vdbeta for procaine of about 6,50...
McKay AG, Milne FJ.A project to determine if intraarticular corticosteroid therapy was deleterious to the racing Thoroughbred was carried out in the 1971, 1972, and 1973 racing seasons. Of 22 horses available for follow-up examination, 6 had radiographic evidence of deterioration; 1 of these was destroyed because of probable corticosteroid-induced arthropathy. The remaining 16 horses did not have any evidence of deterioration. One of the 16, a stakes winner, had been given 12 injections into the left front fetlock during the 3-year period. It was concluded that if proper and careful aftercare is adhered to, intr...
Asheim A, Lindblad G.Forty-five race-horses with arthritis of non-in-fectious type in 54 joints were treated with sodium hyaluronate intra-articularly. All joints had previously been treated without lasting success by conventional methods, such as firing, blistering or intraarticular injection of cortisone. In most cases only 1 injection of 2 ml (20 mg) sodium hyaluronate was needed. To avoid subjective evaluation, the effects of the treatment were based on the joint’s capacity of withstanding extreme stress, which means that the horse should be able to train and race again. The treatment was concentrated on the...
Butler J, Rydell NW, Balazs EA.Twelve horses with traumatic arthritis were treated with intraarticular injection of hyaluronic acid mixed with cortisone and the results compared with 6 horses treated only with cortisone. There was a significantly better improvement in the group injected with a mixture of hyaluronic acid and cortisone. Further studies have given the same results in traumatic arthritis in horses if hyaluronic acid alone is injected. After injection of hyaluronic acid a large number of granulated monocytes appeared in the synovial fluid, but no inflammatory signs were observed. It is possible that this macroph...
Degenerative joint disease is one of the main causes of equine early retirement from pleasure riding or a performance career. The disease is initially triggered by an abnormal loading of normal cartilage or a normal loading of abnormal cartilage. This primary insult is accompanied with joint inflammation, which leads to further progressive degeneration of the articular cartilage and changes in the surrounding tissues. Therefore, in search for an effective treatment, 75 adult horses with early signs of degenerative fetlock joint disease were enrolled in a randomized, multicenter, double-blinded...
Hardy J, Bertone AL, Muir WW.We measured regional blood flow in synovial tissue of the antebrachiocarpal, midcarpal, and metacarpophalangeal joints of six normal adult anesthetized horses by using 15-microns-diameter polystyrene colored microspheres. The midcarpal fibrous capsule and synovial membrane blood flows (SMBF) were compared, and the effect of increased intra-articular pressure (30 and 60 mmHg) on midcarpal SMBF was investigated. Dorsal, medial palmar, and lateral palmar midcarpal SMBF measured 108 +/- 36, 61 +/- 12, and 50 +/- 11 microliters.min-1.g-1, respectively. Antebrachiocarpal, dorsal, and palmar metacarp...
Auer J.Degenerative joint disease is the most frequently diagnosed problem of the carpus. Horses afflicted with this disease should not be injected with corticosteroids, but should be rested for several months. Swimming exercise and intra-articular injections of hyaluronic acid during this time help to restore the integrity of the involved joints. Chip fractures of the various carpal bones and the distal radius are commonly diagnosed as the cause of the lameness. Not all horses with carpal fractures are candidates for surgery. It is important that the severity of the problem be realized and that the ...
Davidson EJ, Stefanovski D, Slack J, Manzi TJ.Cervical articular process joint (CAPJ) therapy is advocated for horses with neck disorders. Several ultrasound-guided CAPJ techniques have been described in cadaver studies with 72%-89% intra-articular injection accuracy; however, the CAPJ injection accuracy in clinical equine practice has not been extensively reported. Objective: To describe a modified cranial approach for ultrasound-guided caudal CAPJ injections, to investigate the accuracy of this CAPJ injection technique in live horses, and to assess the effect of CAPJ injection location, laterality, operator, and radiographic CAPJ enlarg...
Osborne C, Elce YA, Byrant B, Meehan-Howard L.To determine with mechanical nociceptive threshold (MNT) testing whether distal limb skin sensation is affected by intra-articular anesthesia of the tarsometatarsal joint (TMTJ). Unassigned: This was a prospective cohort study. Ten client-owned horses that had intra-articular TMTJ anesthesia were included in the study. The MNT was measured at 6 sites on the distal limb at 3 time points: before anesthesia (T0) and at 10 min (T10) and 30 min (T30) post-injection. Linear mixed-model analyses were done, with the significance level set at P < 0.05. Unassigned: There was an increase in MNT (P = 0.00...
Fukuda K, Mita H, Kuroda T, Tamura N, Kuwano A, Sato F, Takahashi T.To clarify the anti-inflammatory effect of platelet lysate (PL) on equine persistent synovitis by using a model of synovitis induced by monoiodoacetic acid (MIA). Methods: Nonseptic synovitis was induced by administering MIA into both antebrachiocarpal joints of 6 clinically healthy horses on day 0. On days 23, 30, and 37, carpal circumference measurement and synovial fluid collection for assays (leucocytes, LDH, tumor necrosis factor-α, and TGF-β1) were performed, after which PL was injected into 1 antebrachiocarpal joint and saline into the contralateral joint. Synovium and synovial fluid ...
Charles A, Peeters X, Verbrugghe C, Vandersmissen M, Evrard L, Busoni V.The Pivot Point (PP) method is commonly used in the radiographic assessment of carpal deformities in young foals, as the range of deviation may influence treatment choice. The aims of this study were to assess the intra- and interobserver reproducibility of the PP method and subjective radiographic evaluation without line drawing to establish the anatomical site responsible for carpal deviation in foals and to evaluate the agreement between these two techniques. Unassigned: Anonymized radiographs of foals presented for investigation of carpal deformity or prematurity were retrospectively and i...
Seabaugh K, Rao S, Koenig JB, Pezzanite L, Dow S, Koch TG, Russell KA, Mehrpouyan S, Alizadeh AH, Goodrich LR.Synovitis is present before and during osteoarthritis in horses and can result in performance-limiting lameness. Twenty-four horses with lameness localized to the metacarpo-/metatarsophalangeal joint or a single joint of the carpus were enrolled in this study. We evaluated the response of intra-articular injection with 10 million activated (aMSC) or non-activated (naMSC) allogeneic equine umbilical cord blood-derived mesenchymal stromal cells (MSCs). Subjective and objective lameness was assessed on Days 0, 1, 21, and 42. The treatment injection was randomly assigned and performed following th...
Story MR, King M, Nout-Lomas YS, Barrett MF, Kawcak C, Frisbie D, McIlwraith CW, Haussler KK.To develop and define a model of acute neck pain in an equine cervical articular process joint (APJ) using recombinant equine IL-1β (reIL-1β). Unassigned: 12 horses in this experimental study received a randomly assigned, unilateral intra-articular injection of 50 ng (n = 6) or 100 ng (n = 6) of reIL-1β and saline (contralateral side as control) into the C5-to-C6 APJ. Blinded ultrasonographic, clinical, and biomechanical parameters were evaluated between 4 hours and 14 days. Unassigned: There was a significant increase in APJ effusion on ultrasonographic examination that peaked at 24 hours ...
Yu R, Jusko WJ.This study assesses the pharmacokinetics (PK) of published methylprednisolone (MPL) data in horses following intra-articular (IA) administration of MPL acetate (MPA) and the associated adrenal suppression. The concentrations of MPL/MPA in synovial fluid, blood, and urine, as well as hydrocortisone (HC) in plasma, were digitized from multiple sources in the literature. A minimal physiologically based pharmacokinetic model and a linked indirect response model with a circadian rhythm baseline were applied. Concentrations of MPA in joints followed a triexponential decay, converting to MPL. The cle...
Luque RM, Henderson B, McCorkell TC, Alizadeh AH, Russell KA, Koch TG, Koenig J.Mesenchymal stromal cells (MSCs) are widely used to treat osteoarthritis (OA). Optimising dose, timing, and safety while comparing efficacy with standard therapies like hyaluronic acid (HA) is essential for their standardisation. Objective: To assess the safety and efficacy of equine umbilical cord-derived (eCB) MSCs in client-owned horses with fetlock or carpus OA. Methods: Prospective single-blinded randomised clinical study. Methods: Horses diagnosed with fetlock or carpus OA via intra-articular (IA) anaesthesia were randomly assigned to receive either 10 or 20 million eCB-MSCs in HA or 3â€...
Beck AA, Paz LB, Frank MI, Pereira RCF, De La Côrte FD.To evaluate the effect of IA injections of botulinum toxin type A (BoNT-A) in horses with chronic, naturally occurring distal tarsal osteoarthritis. Unassigned: 9 horses were selected after physical and radiographic assessments. Horses also underwent an objective lameness examination and were included if they had a hindlimb impact lameness (Pmin ≥ 3 mm), which positively responded (≥ 50%) to the tarsometatarsal and centrodistal joints' anesthetic block. Horses randomly received an intra-articular injection of BoNT-A or an equivalent volume of saline solution. Horses were reevaluated at pos...
Shokry M, Ali LB, El-Sharkawy M.Showjumping athletic horses are frequently affected by back pain, which in turn influences their performance and equestrian activities. Unassigned: The aim of the present study was to determine the etiological factors predisposing to back problems in show jumping horses and how to diagnose, and manage them. Unassigned: A total of 75 cases (45 geldings and 30 mares, aged between 8 and 23 years and weighing 420-550 Kg) with histories suggestive of back problems and low competitive ability as show jumping were used in this study. The evaluation of data was based on the inputs of case history, cli...
Moore GE, Leatherwood JL, Glass KG, Arnold CE, Paris BL, Carter MM, George JM, Fontenot AB, Martinez RE, Franklin MA, Norton SA, Bradbery AN....The objective was to evaluate dietary fermentation product (SCFP) on joint inflammation and cartilage metabolism in exercising yearlings challenged with intra-articular lipopolysaccharide (LPS), hypothesizing dietary SCFP (TruEquineC, Diamond V Mills, Inc.) would ameliorate joint inflammation and increase cartilage metabolism. Thirty Quarter Horse yearlings were stratified by bodyweight (BW), age, sex, and randomly assigned to dietary treatments (n = 10/treatment): control (0), 46, or 92 mg/kg BW/d SCFP. Treatments were top-dressed to 1% BW/d concentrate void of added microbials. Horses ...
Rinnovati R, Spadari A, Malpighi A, Meistro F, Ralletti MV, Marcucci E, Tarasconi MA, Chiatto RL, Tommasa SD.Numerous treatment strategies have been proposed to manage osteoarthritis (OA) in sport horses. Carboxymethylcellulose (CMC), is used in veterinary medicine for various purposes. Objective: This study aimed to assess the efficacy of a CMC hydrogel in reducing clinical lameness in horses with OA affecting joint. The hypothesis was that intra-articular CMC would produce a sustained reduction in lameness compared to a control treatment. Methods: Thirty client-owned horses diagnosed with OA-related lameness in the metacarpophalangeal joint were enrolled. Horses were randomly assigned to two groups...
Pluim M, Frippiat T.Polyacrylamide gel is increasingly used in equine veterinary medicine for osteoarthritis and other joint disorders. This study aimed to document the indications, treatment protocols, rehabilitation plans, outcomes, and satisfaction with intra-articular polyacrylamide gel in horses, as reported by equine veterinarians. An online questionnaire was distributed to practitioners through the European and American Colleges of Veterinary Sports Medicine and Rehabilitation mailing lists, social media, and direct contact. Of 197 respondents, 160 completed the survey, forming the basis for the descriptiv...
Khaliji E, Marycz K, Horna M, Morgan JM, Galuppo LD, Vapniarsky N, Cassano JM.To evaluate IA autologous platelet-derived mitochondrial preparation versus vehicle control in a bilateral lipopolysaccharide (LPS)-induced model of equine synovitis. Unassigned: 2 ng of LPS was injected into bilateral intercarpal joints of 6 horses over 3 months. Autologous mitochondria, isolated with a commercial kit, were injected into one joint, while the contralateral joint received a vehicle control, a within-subject controlled experimental design. Mitochondrial organelle appearance was visualized on transmission electron microscopy. Outcome measures included synovial fluid and whole-blo...
Kooy S, Constant J, Cole R, Boone L.Clinical use of blood-derived intra-articular therapies, such as platelet-rich plasma (PRP), have increased in equine athletes due to their proposed disease-modifying effects. Need for a shelf-stable, allogeneic PRP product with known composition for standardized treatment exists. The objective of this study was to compare systemic and local effects of a single intra-articular injection of equine leucoreduced allogeneic pooled freeze-dried PRP (alloPRP) to a placebo control (saline) in normal, healthy equine joints. Unassigned: Twelve healthy horses were randomly assigned to either control (sa...
Korac L, St George L, MacNicol J, McCrae P, Jung L, Golestani N, Karrow N, Cánovas A, Pearson W.Low-dose intra-articular injection of recombinant equine interleukin-1β (reIL-1β) may offer a useful model for studying early onset or subclinical joint inflammation in horses. This pilot study aimed to determine the lowest intra-articular dose of reIL-1β required to produce biochemical evidence of synovitis, and to correlate synovitis biomarkers with functional, upper-body asymmetry parameters. Saline (control) and 50, and 75 ng reIL-1β were injected into the left or right intercarpal joint of three ( = 3) horses in a three-way crossover design. Synovial fluid was collected by aseptic art...
Kelley D, Walbornn S, Bartley C, Kaczor J, Premanandan C, Newton N, Holland R, Schnobrich M.Amnion-derived acellular bioscaffold (ADABP) products demonstrate interesting anti-inflammatory and healing properties which could be beneficial for intrauterine use. The objective of this study was to evaluate the safety of intrauterine injection of ADABP on systemic and uterine health. The study design randomly assigned subjects to one of two groups, control mares (n = 3) which received 3 mL injection of sterile saline in the base of each uterine horn, and treatment mares (n = 9) which received 3 mL of ADABP in the base of one uterine horn and 3 mL injection of sterile saline in the base of ...
Cormier KV, Fontenot RL, Eddy A, Williams ML, Wills RW, Jumper WI, Mochal-King CA.The objective of the study was to evaluate effects of intra-articular decellularized porcine amnion/chorion suspension (dPACLS) in horses. Methods: Controlled, randomized, prospective study. Methods: A total of 10 adult horses. Methods: One randomly selected radiocarpal joint (RCJ) was injected with a high dose (HD) of 50 mg (n = 5) or low dose (LD) of 5 mg of dPACLS (n = 5). The contralateral RCJ received saline as control. Systemic serum amyloid A (SAA), synovial fluid analysis (including SAA) and subjective lameness evaluation were performed prior to injection (time 0) and 24, 4...
Dörner C, Lagos N, Oyaneder L, Menarim BC, RamÃrez-Toloza G.Osteoarthritis (OA) is an inflammatory joint disease and the leading cause of musculoskeletal disability affecting human and veterinary patients. New therapeutics halting inflammation while preserving joint homeostasis remain a critical need. Voltage-gated sodium (NaV) channels regulate the pro-inflammatory response of macrophages in the synovium, the central driver of joint homeostasis. Neosaxitoxin (NeoSTX) is a phycotoxin that blocks NaV channels, conferring a unique potential to regulate joint inflammation. This study evaluated the safety of intra-articular administration of NeoSTX in hors...
Chaimbeul SF, Rodrigues NNP, Thurston DD, Scoggin KE, Janes J, Jacobs CA, MacLeod JN, Stone AV, Menarim BC.Synovitis resolution is critical for joint homeostasis and prevents the progression of osteoarthritis (OA). Treatments like NSAIDs and intra-articular corticosteroids relieve symptoms by blocking pro-inflammatory mediators, but also impair the production of pro-resolving mediators, contributing to the likelihood of chronic synovitis. PPARγ signaling is an essential mechanism of synovitis resolution, which is decreased in OA tissues. To evaluate the potential of PPARγ agonists to promote pro-resolving pathways, equine macrophages cultured in autologous, normal, or inflamed synovial fluid ( = ...
Page AE, McPeek JL, Carattini S, McGreevy E, Adam E.The goal of this project was to examine the metabolic effects of IA methylprednisolone acetate (MPA) following injection into multiple low-motion joints. Unassigned: Six 3-year-old geldings without pituitary pars intermedia dysfunction or insulin dysregulation were randomly injected with 20 mg of IA MPA/joint (80 mg total; bilateral distal hock joints) or an equal volume of saline. Serial blood samples were collected for resting ACTH, cortisol, insulin, and glucose, as well as insulin and glucose following repeated low-dose oral sugar tests. Treatments were crossed over after a 6-week washout,...
Moroni R, Fanelli D, Maltinti S, Orefice M, Rota A, Camillo F, Melanie P, Cantile C, Miragliotta V, Pirone A, Lazzarini G, Passamonti F, Marmorini P....Equine persistent breeding-induced endometritis can lead to chronic uterine inflammation and fibrosis, reducing fertility. Intrauterine ozone (O₃) has recently been proposed as a potential treatment for mares unresponsive to conventional therapies. This case series describes O₃ treatment in eleven mares barren for at least one year despite multiple inseminations attempts. During the first oestrous cycle, low-volume uterine lavage and endometrial biopsy were performed, followed by 3 consecutive days of intrauterine O₂-O₃ gas insufflation. In the subsequent cycle, both procedures were re...
Page AE, McPeek JL, McGreevy E, Carattini S, Adam EN.Intra-articular (IA) corticosteroids can cause hyperinsulinemia, which can subsequently increase the risk of laminitis, particularly in horses with insulin dysregulation (ID). Sodium glucose cotransporter 2 inhibitors (SGLT2i), a drug class that is being utilised more commonly in horses with insulin dysregulation, could potentially be used to control post-IA corticosteroid hyperinsulinemia. Objective: To determine whether treatment with the SGLT2i drug ertugliflozin decreases hyperinsulinemia following intra-articular corticosteroid administration in metabolically normal horses. Methods: Prosp...
Vishwanath K, McClure SR, Bonassar LJ.Intra-articular injections of hyaluronic acid (HA) are the cornerstone of osteoarthritis (OA) treatments. However, the mechanism of action and efficacy of HA viscosupplementation are debated. As such, there has been recent interest in developing synthetic viscosupplements. Recently, a synthetic 4 wt% polyacrylamide (pAAm) hydrogel was shown to effectively lubricate and bind to the surface of cartilage in vitro. However, its ability to localize to cartilage and alter the tribological properties of the tissue in a live articulating large animal joint is not known. The goal of this study was to...
