Like your doctor, most veterinarians are hesitant to inject joints too frequently and, while what constitutes “too frequently” varies among practitioners, most prefer not to inject any one joint more than twice a year. Your questions are good ones: Are joint injections good for my horse and are there alternatives?
How Joint Injections Help
To answer the first question, it’s important to understand that veterinarians typically use joint injections to treat osteoarthritis. Osteoarthritis is a vicious cycle: It starts with damage to the cartilage or underlying bone (called subchondral bone), which leads to joint inflammation, which causes further articular cartilage degradation, and so on.
The purpose of a joint injection is to decrease inflammation which, not only reduces the osteoarthritis-associated pain and lameness, but also temporarily stops this vicious joint inflammation cycle. Additionally, researchers have shown that triamcinolone—the most commonly used corticosteroid in joint injections—protects the articular cartilage. So from these viewpoints, joint injections are “good.”
But can there be too much of a good thing? In this case, yes. When joint injections no longer have a lasting effect (i.e., they used to relieve pain and lameness for six months but are now wearing off after three), the osteoarthritis disease process has likely worsened to the point where joint injections are no longer adequate as the sole management strategy.
Additional Treatment Options
So, to answer your second question, yes, there are many other treatments that can be helpful with managing osteoarthritis. These might include systemic (oral or injectable) and/or topical low-grade non-steroidal anti-inflammatory medications, oral and injectable systemic joint support products, and/or shock wave therapy.
Additionally, certain management and husbandry techniques can have a substantial effect. In humans with knee osteoarthritis, every additional pound of body weight produces an additional 4 pounds of force on the affected joint. And a small study in dogs with hip osteoarthritis showed that they were sounder following weight loss of 11-18%. Therefore, you shouldn’t overlook the benefits of maintaining a horse in a healthy weight.
Other management techniques that could help horses with osteoarthritis include daily access to turnout and getting regular, daily exercise. If horses must be temporarily housed in a box stall (for example, at a competition), frequent hand-walking and allowing ample time for a slow warm-up might help.
In summary, in all but the most severe cases, judicial use of joint injections coupled with other treatments and management techniques allows for successful long-term management of our equine athletes with osteoarthritis.