Whether you are a top competitor or a happy hacker, most of us can agree that we want our horse to perform at his best and in the greatest comfort for the longest time possible. With all the advances in medicine in recent years, longevity for our equine partners suddenly seems more achievable than ever before.
Whilst this is fantastic news, there does seem to be a lack of understanding amongst owners about what exactly maintenance of a horse for longevity really means. It is not uncommon to hear of horses having joint injections every few months to keep them competition ready, and many riders seem blissfully unaware of the risks that go along with these injections. The saddest part is that the desired effect – a horse that can perform for longer – is often negated through this aggressive regime of interference with the joint structures. Many horses retire earlier than before as a consequence of corticosteroid damage to the joint, and several others have lost their lives due to septic arthritis. In each of these cases, the blame is laid squarely at the vet’s door, with many believing that using a different vet will avoid any risks associated with joint injections. Alas, this is not the case, and every vet doing joint injections will have their fair share of infections and loss of function stories. Joint injections are risky, and while using them is unavoidable in certain cases, we certainly shouldn’t be using them as a ‘regular maintenance regime’ unless advised to the contrary by our vet.
There are many other maintenance options available before we hit the last resort of a joint injection, and most of these alternatives don’t come with the same kind of risks as the risk of joint injection. Here we look at why joint injections are used and what we know about the risks involved:
Why joint injections?
The most common reason to medicate a joint is during the management of osteoarthritis, and the most frequently used medications for this include corticosteroids, hyaluronic acid, and polysulfated glycosaminoglycans (PSGAG). Although osteoarthritis has no cure, these drugs are all used to manage the condition by controlling the inflammation and improving joint mobility. The decision as to which product or combination of products is best will depend on the joint, the horse’s function and the timing before the competition.
Joint injections, although performed frequently without complications, are not risk-free. It is important to be aware of these risks when making decisions regarding treatments for your horse. The risks include:
Infection
Any time a needle is inserted into a joint, there is the potential to introduce bacteria, which can lead to infection. With proper handling and technique, and thorough preparation of the limb, the risk of infection can be minimised, which is why all joints are thoroughly prepared prior to injection. Unfortunately, even with proper preparation, there is some risk of infection following a joint injection. Symptoms of infection include heat and swelling around the joint and, in most cases, lameness (which is often quite severe).
Joint infection results in cartilage damage and arthritis and, as such, needs to be stopped as soon as possible. Joint infections can be very difficult to treat but respond best when treated early. So if your horse shows any of the above signs following injection, contact your vet immediately.
Adverse reaction to the chemicals
As with every drug we administer, there is a chance that the horse’s immune system will respond inappropriately to it. The types of adverse reactions vary, but when they happen in joints, they commonly result in similar signs to infection, with heat, swelling and lameness. This adverse reaction is referred to as a “flare” and, unlike infection, does not involve bacteria (it is sterile). It is essential to distinguish between joint infection and a flare (by sampling the synovial fluid) because treatment differs between the two. In most cases, horses that have a synovial flare are treated with rest and pain killers, although severe cases might require lavage of the joint.
Joint degeneration
Long term use of certain corticosteroids can result in cartilage breakdown. The amount and rate of degeneration depend on the joint, the amount of damage, and the individual horse. This has to be weighed up against the potential benefits of reducing the inflammation within the joint.
Laminitis
While corticosteroids are very useful in treating joint disease, it has been suggested that these drugs can contribute to the onset of laminitis or founder in certain instances. More recent research has failed to confirm this association, but it is advised that the lowest effective dose of corticosteroids is used in most cases. In animals with a history of previous laminitis or that are particularly obese, more care is generally taken (with lower, short-acting doses), and animals with current laminitis generally won’t be treated with corticosteroids.
Alternatives
Whilst, as acknowledged above, joint injections are necessary in certain cases, there are so many safer alternatives for the vast majority of horses that it makes sense to work through these first. As a general overview:
- The first port of call would be oral joint maintenance.
- The second would be giving joint maintenance rectally, which has a much higher bioavailability than oral administration in most cases.
- Thirdly you can give joint maintenance either intramuscularly or intravenously.
- Finally, you can consider joint injections.
As you see from this stepwise approach, there is an awful lot to try before putting a needle into a joint capsule. If joint injections were risk-free and your horse was guaranteed to survive the experience, then regular administration would not be an issue, but when one considers the risk to not only their career but also their life, it seems irresponsible to bypass other, far safer alternatives.
Take-home message
It goes without saying that your vet is best placed to advise you on how to maximise your horse’s longevity and potential. It is just worth educating yourself on the risks of joint injections from the outset to make sure that if given alternative options, you at least consider them!