22/08/2025
๐ This is timely, as I have had quite a few conversations about the pros and cons of joint injections this week.
โ๏ธ Do you know all of your options?
โจ This is a really good summary of injection choices, should you choose to reach for the needle.
๐๐ง๐๐๐ซ๐ฌ๐ญ๐๐ง๐๐ข๐ง๐ ๐๐จ๐ข๐ง๐ญ ๐๐๐๐ข๐๐๐ญ๐ข๐จ๐ง๐ฌ ๐ข๐ง ๐ก๐จ๐ซ๐ฌ๐๐ฌ
When managing joint discomfort or arthritis in horses, especially those in consistent work or advancing age, itโs not always a โone-size-fits-allโ approach. Different joints respond differently to treatment, and different medications offer unique benefits โ some better suited to immediate relief, others offering long-term joint support. Clients often ask us why weโve chosen one medication over another, or whether there are alternatives worth considering. The short answer is: it depends on the joint involved, the severity and type of disease, the horseโs workload, and the long-term goals for their comfort and performance.
Hereโs a breakdown of the most commonly used joint medications, why we select them, and what you can expect from each.
๐๐จ๐ซ๐ญ๐ข๐๐จ๐ฌ๐ญ๐๐ซ๐จ๐ข๐๐ฌ (๐.๐ . ๐๐๐๐จ๐ซ๐ญ๐ฒ๐ฅยฎ (๐ญ๐ซ๐ข๐๐ฆ๐๐ข๐ง๐จ๐ฅ๐จ๐ง๐), ๐๐๐ฉ๐จ-๐๐๐๐ซ๐จ๐ง๐ยฎ (๐ฆ๐๐ญ๐ก๐ฒ๐ฅ๐ฉ๐ซ๐๐๐ง๐ข๐ฌ๐จ๐ฅ๐จ๐ง๐ ๐๐๐๐ญ๐๐ญ๐)
We use intra-articular corticosteroids for joints that are inflamed, sore, or showing signs of degenerative joint disease (DJD). These are most effective in joints like the hock or stifle where mechanical stress and bony changes are common.
Why we use them:
* Rapid relief: Horses often show improvement within 24โ72 hours.
* Potent anti-inflammatory effect: Excellent for calming joint inflammation and breaking the cycle of pain and stiffness.
* Cost-effective: Makes it practical when multiple joints are involved or when periodic repeat injections are expected.
Corticosteroids are especially valuable when we need to get a performance horse comfortable again quickly, or when multiple joints require attention and we need to be mindful of cost. For example, a horse with hock and stifle discomfort may benefit from steroids in both joints, allowing us to manage the whole picture effectively.
Corticosteroids are very effective, but they donโt address the underlying cartilage quality long-term. Also, they are not always suitable for use in high-motion joints such as the fetlock. Repeated injections over time need to be managed carefully to avoid potential side effects on joint tissues. Likewise, depending on withdrawal times and competition dates, it may only be possible to use a short-acting rather than a long-acting steroid in some cases.
๐๐จ๐ฅ๐ฒ๐๐๐ซ๐ฒ๐ฅ๐๐ฆ๐ข๐๐ ๐ก๐ฒ๐๐ซ๐จ๐ ๐๐ฅ (๐.๐ ๐๐ซ๐ญ๐ก๐ซ๐๐ฆ๐ข๐ยฎ)
Arthramid is a synthetic hydrogel that works quite differently. Rather than reducing inflammation directly, it integrates into the synovial membrane, improving joint function and modulating the environment inside the joint capsule.
Why we use it:
* Longer-term benefits (6โ12 months) after a single injection
* Reduces need for frequent joint injections
* Ideal for joints where corticosteroids are less effective or not well tolerated
Arthramid is especially helpful in joints with low-grade, chronic discomfort, or when we want to reduce steroid exposure. However, Arthramid is significantly more expensive than corticosteroids. If a horse has several joints affected, the cost can add up quickly. It also takes 2โ4 weeks to show results, so itโs not the best choice when fast relief is required.
๐๐๐ง๐ญ๐จ๐ฌ๐๐ง ๐๐จ๐ฅ๐ฒ๐ฌ๐ฎ๐ฅ๐๐๐ญ๐ (๐.๐ . ๐๐๐ซ๐ญ๐ซ๐จ๐ฉ๐ก๐๐งยฎ, ๐๐ซ๐ญ๐ก๐ซ๐จ๐ฉ๐๐งยฎ, ๐๐๐ง๐ญ๐จ๐ฌ๐๐ง ๐๐จ๐ฅ๐ยฎ)
Pentosan polysulfate or PPS is a systemic joint support injection, given intramuscularly rather than into a specific joint. It works like a disease-modifying osteoarthritis drug (DMOAD) and has a broad, body-wide benefit.
Why we use it:
* Supports healthy cartilage and synovial fluid production
* Slows cartilage breakdown
* Addresses all joints, not just one, which is ideal for horses with generalised arthritis or โmileage wearโ.
* Complements other treatments like corticosteroids or Arthramid.
We often use PPS as a foundational therapy in horses with age-related joint changes, subtle performance issues, or as a โmaintenanceโ treatment in horses coming off intra-articular medication. Itโs also one of the few options we can use preventatively or before joints become significantly inflamed. But, PPS works gradually and doesnโt have the same immediate effect as a corticosteroid. It may not replace targeted joint injections in more severe or advanced cases, but it may reduce the need for them.
๐๐ฒ๐๐ฅ๐ฎ๐ซ๐จ๐ง๐ข๐ ๐๐๐ข๐ (๐.๐ . ๐๐ฒ-๐๐ยฎ):
Hyaluronic acid (HA) is a naturally occurring substance found in healthy joint fluid. It can be injected directly into a joint (intra-articular) or given systemically to help support lubrication and reduce inflammation, particularly in joints showing early signs of wear or low-grade synovitis.
Why we use it:
* Helps restore normal joint fluid viscosity and cushioning
* Reduces inflammation in the joint lining
* Supports cartilage health in early or mild degenerative changes
* Often combined with corticosteroids for enhanced effect
HA is especially useful in mild joint cases or in younger horses where we want to avoid more aggressive medications. Itโs also commonly used in combination with corticosteroids, especially in high-motion joints like the fetlock or coffin, to both control inflammation and protect the joint environment. However, HA alone is typically not strong enough for more advanced or painful joint conditions. It tends to have a milder and shorter-lived effect, so we often use it as part of a broader strategy, either in combination or during maintenance phases between other treatments.
๐๐ข๐ฌ๐ฉ๐ก๐จ๐ฌ๐ฉ๐ก๐จ๐ง๐๐ญ๐๐ฌ (๐.๐ . ๐๐ฌ๐ฉ๐ก๐จ๐ฌยฎ):
Used to control clinical signs of navicular disease, and sometimes used โoff-labelโ for horses with other conditions such as arthritis, to reduce bone pain and inflammation.
Why we use it:
* Reduces bone pain associated with conditions like navicular disease, kissing spines, and hock arthritis
* Helps manage areas of active bone remodelling seen on imaging (e.g. X-ray, bone scan)
* Administered systemically, so it can treat multiple affected sites at once
Tildrenยฎ (tiludronate disodium) used to be another biphoshonate medication used, but since Osphosยฎ (clodronate disodium) came on the market, many vets have switched to it because:
It can be given intramuscularly rather than via IV infusion, which makes it easier and quicker to administer. It has fewer reported side effects, particularly less risk of transient colic post-treatment.
Itโs more cost-effective and client-friendly in terms of administration and aftercare.
Biphosphonates are particularly helpful in horses with foot-related lameness, especially where diagnostic imaging shows increased bone activity. Itโs also a good option when horses are not ideal candidates for joint injections, or when discomfort seems more related to the bone than the joint lining. However, not all lameness is bone-related, and Osphos is most effective when used in clearly indicated cases. It doesnโt reduce inflammation in the same way as corticosteroids or biologics, and it may take several weeks for the full effect to be seen.
๐๐ข๐จ๐ฅ๐จ๐ ๐ข๐๐๐ฅ ๐ญ๐ซ๐๐๐ญ๐ฆ๐๐ง๐ญ๐ฌ:
Biologic treatments such as IRAP, PRP, alpha-2-macroglobulin (A*M), Lipogems and stem cells are regenerative therapies derived from the horseโs own blood, fat or bone marrow. These are injected directly into the affected joint or soft tissue and aim to support natural healing processes rather than simply reducing inflammation.
Why we use them:
* Help reduce inflammation using the horseโs own anti-inflammatory proteins
* Support tissue regeneration and repair, particularly in cartilage, tendon, or ligament injuries
* Useful when corticosteroids are no longer effective or not recommended
* May provide longer-term benefit in younger horses or early-stage disease
We often recommend biologic therapies in younger performance horses, or in joints where weโre aiming to slow progression rather than just manage symptoms. Theyโre also a good option in horses where repeated corticosteroid use is not ideal โ for example, in high-motion joints like the fetlocks, or in horses with metabolic concerns.
That said, biologics can be more expensive, and the response time is slower; you may not see the full effect for 2โ4 weeks. Theyโre also more technical to produce, often requiring a blood draw and processing ahead of time. But for the right horse and the right joint, they can offer a powerful, steroid-free option for long-term joint care. With some procedures such as Alpha-2, we can store any โextraโ that is harvested, meaning we can potentially get multiple future injections out of one procedure.
๐๐จ, ๐ก๐จ๐ฐ ๐๐จ ๐ฐ๐ ๐๐๐๐ข๐๐ ๐ฐ๐ก๐๐ญโ๐ฌ ๐๐๐ฌ๐ญ ๐ญ๐จ ๐ฎ๐ฌ๐?
Thanks to ongoing continuing professional development, and having a certified ISELP (International Society of Equine Locomotor Pathology) member on our team, we are regularly updated on the latest advances in joint therapy, imaging, diagnostics, and rehabilitation strategies. Some of these medicines are actually human medicines, some do not have many studies behind them, and on top of this, there is new research emerging all the time on how we can help horses with osteoarthritis! Itโs also important to have an actual diagnosis; this is where improved diagnostic imaging options may be advised to aid us in being able to offer a more specific (or a wider range of) treatment option/s.
Our decision is always based on a combination of:
* The joint(s) involved: High-motion joints (like fetlocks) may respond differently to treatment than low-motion joints (like hocks).
* Severity and type of pathology: Some joints are inflamed, some are degenerative, some are sore due to compensatory strain.
* Your horseโs workload and career stage: A competition horse in hard work may need rapid relief, while a retired horse may benefit from long-term support.
* Budget and practical management: We always aim to balance the best medical option with whatโs sustainable for you long-term.
This is the foundation of what is known in the veterinary world as contextualised care โ a way of delivering veterinary treatment that recognises there are multiple appropriate ways to approach diagnosis and management depending on the individual horse, their medical history, their comfort, and their ownerโs circumstances. It relies on a genuine partnership between the veterinary team and the caregiver, working together to achieve the best possible quality of life for the horse.
While the term โcontextualised careโ may be relatively new, the principles behind it are not. It draws on the values of evidence-based decision making, patient-centred care, spectrum of care and shared decision-making. It means recognising that what works for one horse and owner pair may not be the right fit for another, and thatโs okay. Our role is to combine clinical expertise with the best available scientific evidence, while also factoring in whatโs realistic, sustainable, and meaningful to each individual horse and owner. In doing so, we provide truly holistic, high-quality veterinary care.
๐๐ฎ๐๐ฌ๐ญ๐ข๐จ๐ง๐ฌ?
Weโre always happy to discuss your horseโs individual case and help tailor a plan that works for both of you. More info can be found on our knowledge Hub post: https://www.espinarequine.co.uk/knowledgehub/
*๐โ๐๐ ๐๐๐๐๐๐๐๐ก๐๐๐ ๐๐ ๐๐๐๐ฃ๐๐๐๐ ๐๐ ๐ ๐๐๐๐๐๐๐ ๐๐ข๐๐๐ ๐๐๐ ๐ โ๐๐ข๐๐ ๐๐ ๐๐๐๐ ๐๐ ๐๐๐๐๐ข๐๐๐ก๐๐๐ ๐ค๐๐กโ ๐๐๐๐๐ฃ๐๐๐ข๐๐ ๐ฃ๐๐ก๐๐๐๐๐๐๐ฆ ๐๐๐ฃ๐๐๐ ๐๐๐ ๐ฆ๐๐ข๐ โ๐๐๐ ๐.*
