22/08/2025
This is such a great educational post about joint Injections and medications! Its such a mine field out there with so many different products that do very similar things! This is such a great guide on what they are , how they work and when to use them!
𝐔𝐧𝐝𝐞𝐫𝐬𝐭𝐚𝐧𝐝𝐢𝐧𝐠 𝐉𝐨𝐢𝐧𝐭 𝐌𝐞𝐝𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬 𝐢𝐧 𝐡𝐨𝐫𝐬𝐞𝐬
When managing joint discomfort or arthritis in horses, especially those in consistent work or advancing age, it’s not always a “one-size-fits-all” approach. Different joints respond differently to treatment, and different medications offer unique benefits – some better suited to immediate relief, others offering long-term joint support. Clients often ask us why we’ve chosen one medication over another, or whether there are alternatives worth considering. The short answer is: it depends on the joint involved, the severity and type of disease, the horse’s workload, and the long-term goals for their comfort and performance.
Here’s a breakdown of the most commonly used joint medications, why we select them, and what you can expect from each.
𝐂𝐨𝐫𝐭𝐢𝐜𝐨𝐬𝐭𝐞𝐫𝐨𝐢𝐝𝐬 (𝐞.𝐠. 𝐀𝐝𝐜𝐨𝐫𝐭𝐲𝐥® (𝐭𝐫𝐢𝐚𝐦𝐜𝐢𝐧𝐨𝐥𝐨𝐧𝐞), 𝐃𝐞𝐩𝐨-𝐌𝐞𝐝𝐫𝐨𝐧𝐞® (𝐦𝐞𝐭𝐡𝐲𝐥𝐩𝐫𝐞𝐝𝐧𝐢𝐬𝐨𝐥𝐨𝐧𝐞 𝐚𝐜𝐞𝐭𝐚𝐭𝐞)
We use intra-articular corticosteroids for joints that are inflamed, sore, or showing signs of degenerative joint disease (DJD). These are most effective in joints like the hock or stifle where mechanical stress and bony changes are common.
Why we use them:
* Rapid relief: Horses often show improvement within 24–72 hours.
* Potent anti-inflammatory effect: Excellent for calming joint inflammation and breaking the cycle of pain and stiffness.
* Cost-effective: Makes it practical when multiple joints are involved or when periodic repeat injections are expected.
Corticosteroids are especially valuable when we need to get a performance horse comfortable again quickly, or when multiple joints require attention and we need to be mindful of cost. For example, a horse with hock and stifle discomfort may benefit from steroids in both joints, allowing us to manage the whole picture effectively.
Corticosteroids are very effective, but they don’t address the underlying cartilage quality long-term. Also, they are not always suitable for use in high-motion joints such as the fetlock. Repeated injections over time need to be managed carefully to avoid potential side effects on joint tissues. Likewise, depending on withdrawal times and competition dates, it may only be possible to use a short-acting rather than a long-acting steroid in some cases.
𝐏𝐨𝐥𝐲𝐚𝐜𝐫𝐲𝐥𝐚𝐦𝐢𝐝𝐞 𝐡𝐲𝐝𝐫𝐨𝐠𝐞𝐥 (𝐞.𝐠 𝐀𝐫𝐭𝐡𝐫𝐚𝐦𝐢𝐝®)
Arthramid is a synthetic hydrogel that works quite differently. Rather than reducing inflammation directly, it integrates into the synovial membrane, improving joint function and modulating the environment inside the joint capsule.
Why we use it:
* Longer-term benefits (6–12 months) after a single injection
* Reduces need for frequent joint injections
* Ideal for joints where corticosteroids are less effective or not well tolerated
Arthramid is especially helpful in joints with low-grade, chronic discomfort, or when we want to reduce steroid exposure. However, Arthramid is significantly more expensive than corticosteroids. If a horse has several joints affected, the cost can add up quickly. It also takes 2–4 weeks to show results, so it’s not the best choice when fast relief is required.
𝐏𝐞𝐧𝐭𝐨𝐬𝐚𝐧 𝐏𝐨𝐥𝐲𝐬𝐮𝐥𝐟𝐚𝐭𝐞 (𝐞.𝐠. 𝐂𝐚𝐫𝐭𝐫𝐨𝐩𝐡𝐞𝐧®, 𝐀𝐫𝐭𝐡𝐫𝐨𝐩𝐞𝐧®, 𝐏𝐞𝐧𝐭𝐨𝐬𝐚𝐧 𝐆𝐨𝐥𝐝®)
Pentosan polysulfate or PPS is a systemic joint support injection, given intramuscularly rather than into a specific joint. It works like a disease-modifying osteoarthritis drug (DMOAD) and has a broad, body-wide benefit.
Why we use it:
* Supports healthy cartilage and synovial fluid production
* Slows cartilage breakdown
* Addresses all joints, not just one, which is ideal for horses with generalised arthritis or “mileage wear”.
* Complements other treatments like corticosteroids or Arthramid.
We often use PPS as a foundational therapy in horses with age-related joint changes, subtle performance issues, or as a “maintenance” treatment in horses coming off intra-articular medication. It’s also one of the few options we can use preventatively or before joints become significantly inflamed. But, PPS works gradually and doesn’t have the same immediate effect as a corticosteroid. It may not replace targeted joint injections in more severe or advanced cases, but it may reduce the need for them.
𝐇𝐲𝐚𝐥𝐮𝐫𝐨𝐧𝐢𝐜 𝐀𝐜𝐢𝐝 (𝐞.𝐠. 𝐇𝐲-𝟓𝟎®):
Hyaluronic acid (HA) is a naturally occurring substance found in healthy joint fluid. It can be injected directly into a joint (intra-articular) or given systemically to help support lubrication and reduce inflammation, particularly in joints showing early signs of wear or low-grade synovitis.
Why we use it:
* Helps restore normal joint fluid viscosity and cushioning
* Reduces inflammation in the joint lining
* Supports cartilage health in early or mild degenerative changes
* Often combined with corticosteroids for enhanced effect
HA is especially useful in mild joint cases or in younger horses where we want to avoid more aggressive medications. It’s also commonly used in combination with corticosteroids, especially in high-motion joints like the fetlock or coffin, to both control inflammation and protect the joint environment. However, HA alone is typically not strong enough for more advanced or painful joint conditions. It tends to have a milder and shorter-lived effect, so we often use it as part of a broader strategy, either in combination or during maintenance phases between other treatments.
𝐁𝐢𝐬𝐩𝐡𝐨𝐬𝐩𝐡𝐨𝐧𝐚𝐭𝐞𝐬 (𝐞.𝐠. 𝐎𝐬𝐩𝐡𝐨𝐬®):
Used to control clinical signs of navicular disease, and sometimes used ‘off-label’ for horses with other conditions such as arthritis, to reduce bone pain and inflammation.
Why we use it:
* Reduces bone pain associated with conditions like navicular disease, kissing spines, and hock arthritis
* Helps manage areas of active bone remodelling seen on imaging (e.g. X-ray, bone scan)
* Administered systemically, so it can treat multiple affected sites at once
Tildren® (tiludronate disodium) used to be another biphoshonate medication used, but since Osphos® (clodronate disodium) came on the market, many vets have switched to it because:
It can be given intramuscularly rather than via IV infusion, which makes it easier and quicker to administer. It has fewer reported side effects, particularly less risk of transient colic post-treatment.
It’s more cost-effective and client-friendly in terms of administration and aftercare.
Biphosphonates are particularly helpful in horses with foot-related lameness, especially where diagnostic imaging shows increased bone activity. It’s also a good option when horses are not ideal candidates for joint injections, or when discomfort seems more related to the bone than the joint lining. However, not all lameness is bone-related, and Osphos is most effective when used in clearly indicated cases. It doesn’t reduce inflammation in the same way as corticosteroids or biologics, and it may take several weeks for the full effect to be seen.
𝐁𝐢𝐨𝐥𝐨𝐠𝐢𝐜𝐚𝐥 𝐭𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭𝐬:
Biologic treatments such as IRAP, PRP, alpha-2-macroglobulin (A*M), Lipogems and stem cells are regenerative therapies derived from the horse’s own blood, fat or bone marrow. These are injected directly into the affected joint or soft tissue and aim to support natural healing processes rather than simply reducing inflammation.
Why we use them:
* Help reduce inflammation using the horse’s own anti-inflammatory proteins
* Support tissue regeneration and repair, particularly in cartilage, tendon, or ligament injuries
* Useful when corticosteroids are no longer effective or not recommended
* May provide longer-term benefit in younger horses or early-stage disease
We often recommend biologic therapies in younger performance horses, or in joints where we’re aiming to slow progression rather than just manage symptoms. They’re also a good option in horses where repeated corticosteroid use is not ideal – for example, in high-motion joints like the fetlocks, or in horses with metabolic concerns.
That said, biologics can be more expensive, and the response time is slower; you may not see the full effect for 2–4 weeks. They’re also more technical to produce, often requiring a blood draw and processing ahead of time. But for the right horse and the right joint, they can offer a powerful, steroid-free option for long-term joint care. With some procedures such as Alpha-2, we can store any ‘extra’ that is harvested, meaning we can potentially get multiple future injections out of one procedure.
𝐒𝐨, 𝐡𝐨𝐰 𝐝𝐨 𝐰𝐞 𝐝𝐞𝐜𝐢𝐝𝐞 𝐰𝐡𝐚𝐭’𝐬 𝐛𝐞𝐬𝐭 𝐭𝐨 𝐮𝐬𝐞?
Thanks to ongoing continuing professional development, and having a certified ISELP (International Society of Equine Locomotor Pathology) member on our team, we are regularly updated on the latest advances in joint therapy, imaging, diagnostics, and rehabilitation strategies. Some of these medicines are actually human medicines, some do not have many studies behind them, and on top of this, there is new research emerging all the time on how we can help horses with osteoarthritis! It’s also important to have an actual diagnosis; this is where improved diagnostic imaging options may be advised to aid us in being able to offer a more specific (or a wider range of) treatment option/s.
Our decision is always based on a combination of:
* The joint(s) involved: High-motion joints (like fetlocks) may respond differently to treatment than low-motion joints (like hocks).
* Severity and type of pathology: Some joints are inflamed, some are degenerative, some are sore due to compensatory strain.
* Your horse’s workload and career stage: A competition horse in hard work may need rapid relief, while a retired horse may benefit from long-term support.
* Budget and practical management: We always aim to balance the best medical option with what’s sustainable for you long-term.
This is the foundation of what is known in the veterinary world as contextualised care – a way of delivering veterinary treatment that recognises there are multiple appropriate ways to approach diagnosis and management depending on the individual horse, their medical history, their comfort, and their owner’s circumstances. It relies on a genuine partnership between the veterinary team and the caregiver, working together to achieve the best possible quality of life for the horse.
While the term ‘contextualised care’ may be relatively new, the principles behind it are not. It draws on the values of evidence-based decision making, patient-centred care, spectrum of care and shared decision-making. It means recognising that what works for one horse and owner pair may not be the right fit for another, and that’s okay. Our role is to combine clinical expertise with the best available scientific evidence, while also factoring in what’s realistic, sustainable, and meaningful to each individual horse and owner. In doing so, we provide truly holistic, high-quality veterinary care.
𝐐𝐮𝐞𝐬𝐭𝐢𝐨𝐧𝐬?
We’re always happy to discuss your horse’s individual case and help tailor a plan that works for both of you. More info can be found on our knowledge Hub post: https://www.espinarequine.co.uk/knowledgehub/
*𝑇ℎ𝑖𝑠 𝑖𝑛𝑓𝑜𝑟𝑚𝑎𝑡𝑖𝑜𝑛 𝑖𝑠 𝑝𝑟𝑜𝑣𝑖𝑑𝑒𝑑 𝑎𝑠 𝑎 𝑔𝑒𝑛𝑒𝑟𝑎𝑙 𝑔𝑢𝑖𝑑𝑒 𝑎𝑛𝑑 𝑠ℎ𝑜𝑢𝑙𝑑 𝑏𝑒 𝑟𝑒𝑎𝑑 𝑖𝑛 𝑐𝑜𝑛𝑗𝑢𝑛𝑐𝑡𝑖𝑜𝑛 𝑤𝑖𝑡ℎ 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙 𝑣𝑒𝑡𝑒𝑟𝑖𝑛𝑎𝑟𝑦 𝑎𝑑𝑣𝑖𝑐𝑒 𝑓𝑜𝑟 𝑦𝑜𝑢𝑟 ℎ𝑜𝑟𝑠𝑒.*
