The use of intra‐articular corticosteroids in the horse: What is known on a scientific basis?

Abstract

SummaryIntra-articular use of corticosteroids has become a recent focus (or re-focus) of attention in the Thoroughbred racing industry. This manuscript reviews the clinical use and scientific basis of intra-articular corticosteroid administration including catastrophic injury, articular cartilage degradation and the development of osteoarthritis (OA), as well as the timing of injection relative to racing.

Effects of insulin-like growth factor-1 and dexamethasone on cytokine-challenged cartilage: relevance to post-traumatic osteoarthritis

“…Such high-dose intra-articular injections 47,48 have caused systemic side effects. Thus, therapeutic efficacy would be greatly aided by methods to deliver low concentrations of Dex directly inside cartilage so as to appropriately minimize exposure of Dex to other joint tissues such as tendon, ligament and meniscus 28 .…”

Osteoarthritis in horses - Part 2: a review of the intra-articular use of corticosteroids as a method of treatment

“…Although there are several therapeutic modalities for the treatment of OA, the intra-articular administration of COs is widely used in humans (Habib et al 2010) and animals (McIIwraith 2010) for the treatment of OA and synovitis. However, the use of steroids in joints with pre-existing synovitis increases the expression of genes related to inflammation and the activity of catabolic enzymes (MacLeod et al 1998;Todhunter et al 1998).…”

“…Corticosteroids inhibit the production of prostaglandin (PG) E2; vasodilation; the margination, transmigration and accumulation of inflammatory cells, and the release of enzymes, cytokines and other mediators of inflammation. Because COs act on the metabolism of arachidonic acid, the reduction of pain (van Weeren and de Grauw 2010), as well as of synovial effusion (McIIwraith, 2010) occur quickly and effectively, with a consequent decrease in lameness (van Weeren and de Grauw, 2010). However, there is controversy regarding the intra-articular use of COs because of their adverse results in the metabolism of chondrocytes by inhibiting the synthesis of proteoglycans and changing the structure of collagen networks.…”

“…The administration of COs in combination with SH, which is a widely used protocol in the practice of equine medicine (Caron 2005), is due to the chondroprotective action of this drug (Caron 2005;Mcllwraith 2010; van Weeren and de Grauw 2010), which may reduce the possible undesirable effects of steroids (McIIwraith 2010;van Weeren and de Grauw 2010). However, controlled trials have not shown an adequate reduction of pain symptoms or the action on the cartilage matrix when used alone or in combination with SH (Doyle et al 2005;Yates et al 2006).…”

“…As a consequence, may cause premature cartilage degeneration. Controlled studies have demonstrated that the beneficial results of these drugs may outweigh the disadvantages and possible risks (Goodrich and Nixon 2006;McIIwraith 2010). However, as previously mentioned, in joints, steroids should be used judiciously regarding the dose and frequency of application (Goodrich and Nixon 2006), due to their side effects.…”