Intra-articular Corticosteroids for Knee Pain—What Have We Learned from the Equine Athlete and Current Best Practice

Abstract

The use of intra-articular corticosteroids for traumatic arthritis and osteoarthritis (OA) is common in the horse. The beneficial and deleterious effects of the principal corticosteroids used betamethasone esters (Celestone [Soluspan], methylprednisolone acetate [Depo Medrol], and triamcinolone acetonide [TA] [Vetalog or Kenalog]) have been defined for the horse. While TA has both disease-modifying as well as symptom-modifying effects, methyl prednisolone acetate has deleterious effects on the articular cartilage. Studies in traumatically injured joints show the same rationale (suppression of deleterious mediators associated with inflammation) and positive results from the use of TA in both equine and human patients. Studies in the experimental equine OA model allow for more in-depth knowledge of disease-modifying effects. Recent insights allow us to understand posttraumatic OA as an early consequence of joint injury that may require a more aggressive and proactive treatment approach than commonly applied to date.

Intra‐articular corticosteroids for the treatment of osteoarthritis: A systematic review and meta‐analysis on the comparison of different molecules and doses

“…A number of controlled in vivo studies have been performed as well, including the large animal model in the horse, to both clarify the therapeutic response as well as the possible deleterious effects of intra‐articular CS products like triamcinolone acetonide, methylprednisolone acetate and betamethasone esters [ 42 , 43 ]. Two studies were performed using an equine chip fragment model of OA and the most significant results were both symptom‐modifying and disease‐modifying effects with injections of 12 mg of triamcinolone acetonide 2 and 4 weeks after induction of OA [ 25 ].…”

“…CS act directly on nuclear steroid receptors, interrupting the inflammatory and immune OA cascade at several levels, thereby reducing pro‐inflammatory and pain mediators [ 26 , 52 ]. The benefits observed in animal models and in the clinical setting have led to the widespread use of CS injections in clinical practice, and this approach has been shown to provide pain relief and joint function improvement in OA joints [ 4 , 5 , 31 , 42 , 43 , 47 ]. Scientific societies and healthcare organizations endorsed the use of CS injections as part of a comprehensive treatment plan for OA.…”