Beyond NSAIDs: Practical Treatment Strategies for Equine Osteoarthritis

Managing osteoarthritis (OA) in horses is rarely about finding a single "best" treatment. Instead, successful outcomes often depend on combining therapies that address inflammation, support cartilage health, improve joint function, and maintain athletic performance¹. 

With numerous options available, understanding where each therapy fits can help practitioners make more informed treatment decisions. 

Controlling Inflammation: The Foundation of OA Management 

Inflammation drives much of the pain and joint deterioration associated with OA. 

Nonsteroidal anti-inflammatory drugs (NSAIDs) remain among the most commonly prescribed therapies. Phenylbutazone continues to be widely used, while COX-2 selective drugs such as meloxicam and firocoxib offer improved gastrointestinal safety profiles¹. 

Although effective for symptom control, NSAIDs do not stop disease progression and should be viewed as part of a broader management strategy. 

Intra-Articular Corticosteroids: Powerful but Not Without Risk 

Intra-articular corticosteroids remain a mainstay for managing synovitis and joint inflammation. 

Commonly used options include: 

• Triamcinolone acetonide

• Methylprednisolone acetate

• Betamethasone acetate

These medications often provide rapid relief from pain and lameness. However, repeated injections may contribute to cartilage degeneration and subchondral bone changes, highlighting the importance of careful case selection and monitoring². 

Where Does Hyaluronic Acid Fit? 

Hyaluronic acid (HA) is frequently used to improve synovial fluid quality and support joint lubrication. 

Its potential benefits include: 

• Improved viscosity of synovial fluid

• Enhanced joint lubrication

• Support of endogenous HA production

• Reduction of synovial inflammation³ 

Clinical success often depends on disease severity, product formulation, and injection protocols. HA tends to perform best in horses with mild-to-moderate synovitis rather than advanced OA². 

Supporting Cartilage Health 

Several therapies aim to slow cartilage degradation and support joint metabolism. 

Common options include: 

• Polysulfated glycosaminoglycans (PSGAGs)

• Pentosan polysulfate

• Chondroitin sulfate

• Glucosamine-based supplements

These compounds may stimulate glycosaminoglycan production, reduce inflammatory mediator activity, and support chondrocyte function¹. 

While they are not curative, they are frequently incorporated into long-term OA management plans. 

Regenerative Medicine: A Growing Role in Equine Practice 

Orthobiologics have become increasingly popular due to their potential to influence the joint environment beyond simple symptom control. 

IRAP and Autologous Protein Solutions 

IRAP increases anti-inflammatory mediators such as IL-1 receptor antagonist and may help reduce ongoing joint inflammation¹. 

Many clinicians report meaningful improvements in comfort and performance, particularly in horses with active synovitis. 

Platelet-Rich Plasma (PRP) 

PRP provides concentrated platelets and growth factors that may: 

• Enhance collagen synthesis

• Promote cartilage metabolism

• Reduce inflammatory activity

Clinical improvement and return to athletic function have been reported in many equine OA cases treated with PRP⁴. 

Mesenchymal Stem Cells 

Mesenchymal stem cells (MSCs) offer both regenerative and immunomodulatory effects. 

Studies have reported improvements in: 

• Lameness scores

• Cartilage appearance

• Joint environment

• Return-to-performance outcomes¹

Although treatment protocols continue to evolve, MSCs are increasingly viewed as a valuable option in selected OA cases. 

Don't Overlook Rehabilitation 

Even the most advanced therapies can underperform without an appropriate rehabilitation plan. 

Useful rehabilitation strategies include: 

• Controlled exercise programs

• Hydrotherapy

• Water treadmill exercise

• Laser therapy

• Physiotherapy

• Joint mobilization techniques

These approaches help restore strength, maintain range of motion, improve proprioception, and support long-term joint function. 

Take-Home Message 

The most successful OA treatment plans are multimodal. While NSAIDs, corticosteroids, and hyaluronic acid continue to play important roles, regenerative therapies and structured rehabilitation are reshaping how veterinarians manage equine joint disease. Rather than focusing on a single intervention, practitioners should aim to build individualized treatment strategies that address both current clinical signs and long-term joint health. 

References

1. Baccarin RY, Seidel SR, Michelacci YM, Tokawa PK, Oliveira TM. Osteoarthritis: a common disease that should be avoided in the athletic horse’s life. Animal Frontiers. 2022 Jun 1;12(3):25-36. https://doi.org/10.1093/af/vfac026

2. Neuenschwander HM, Moreira JJ, Vendruscolo CP, Fülber J, Seidel SR, Michelacci YM, Baccarin RY. Hyaluronic acid has chondroprotective and joint-preserving effects on LPS-induced synovitis in horses. Journal of Veterinary Science. 2019 Nov 1;20(6). https://synapse.koreamed.org/upload/synapsedata/pdfdata/0118jvs/jvs-20-e67.pdf

3. Zhang Y, Chen X, Tong Y, Luo J, Bi Q. Development and prospect of intra-articular injection in the treatment of osteoarthritis: a review. Journal of Pain Research. 2020 Aug 4:1941-55. https://www.tandfonline.com/doi/pdf/10.2147/JPR.S260878

4. Garbin LC, Olver CS. Platelet-rich products and their application to osteoarthritis. Journal of equine veterinary science. 2020 Mar 1;86:102820. https://www.sciencedirect.com/science/article/pii/S0737080619305696