Ask the Vet: Joint Injections & Soft Tissue Injury

Question: Are horses with Equine Metabolic Syndrome (EMS) prone to laminitic episodes following joint injection? Answered by, Amy Poulin-Braim, VMD, DACVS-LA, Neshanic Station, NJ.

Answered by, Amy Poulin-Braim, VMD, DACVS-LA, Neshanic Station, NJ

Answer: Thank you for your question regarding joint injections in the Equine Metabolic Horse (EMS). To date, there have been no definitive published research studies establishing or linking a cause and effect between joint injections in the insulin resistant (IR) or EMS horse and laminitis in the veterinary literature.

That being said, horses with a previous history of laminitis and those horses who are obese and/or have been diagnosed with IR or EMS , older, debilitated horses with multiple other systemic problems may be at an increased risk for complications secondary to joint injections with corticosteroids. Corticosteroids are potent anti-inflammatory and analgesic (pain relieving) drugs and may affect certain metabolic pathways depending on type of steroid and dose used. This in turn may, in a very small percentage of horses exacerbate in a laminitic flare or bout.

While joint injections are very helpful to those horses where the lameness has been localized to a certain area and there is concurrent intra-articular arthritis or synovitis (inflammation of the joint capsule), it is not an innocuous procedure and could be detrimental to a normal healthy joint with no indication of inflammation. There as always a risk, albeit low, of joint flare or infection post injection even when all appropriate steps to aseptic preparation and post injection care are instituted. Therefore, joint injections should be carefully considered and risk analysis performed by your veterinarian. Generally speaking, the universal rule of thumb is that the lowest level/dose of corticosteroid should be injected that will elicit a response regardless of horse age, breed, use or history.

If your horse is considered to be in the possible higher risk categories described above, alternatives to corticosteroids that also provide an anti-inflammatory effect could also be considered if joint injections are considered to be necessary. That could included: platelet rich plasma, IRAP, mesenchymal stem cells, Legend or Adequan. A similar low risk of flare and/or infection is still present with these drugs as well. It is always best to have your veterinarian evaluate your horse for lameness and identify the source of lameness with appropriate diagnostic tests prior to just simply injecting a joint based on a hunch. Your veterinarian will take into consideration the age, breed, use and prior history coming up with a plan for an appropriate injection protocol. They can also go through and explain to you the pros and cons of each option.


Question: How real is the chance injections cause infection?

Answer:  Thank you for your question regarding joint injections. To date, there have been no definitive published research studies establishing a connection or cause and effect between joint injections and laminitis in the veterinary literature.

That being said, there may be certain horses that veterinarians may be more wary of injecting corticosteroids. Those would include horses with a previous history of laminitis and those horses that are obese and/or have been diagnosed with insulin resistance or Equine Metabolic Syndrome. Corticosteroids are potent anti-inflammatory and analgesic (pain relieving) drugs and may affect certain metabolic pathways depending on type of steroid and dose used.

While joint injections are very helpful to those horses where the lameness has been localized to a certain area and there is concurrent intra-articular arthritis or synovitis (inflammation of the joint capsule), it is not an innocuous procedure and could be detrimental to a normal healthy joint with no indication of inflammation. There is always a risk, albeit low, of joint flare or infection post injection even when all appropriate steps to aseptic preparation and post injection care are instituted. Therefore, joint injections should be carefully considered and risk analysis performed by your veterinarian. Generally speaking, the universal rule of thumb is that the lowest level/dose of corticosteroid should be injected that will elicit a response regardless of horse age, breed, use or history.

If your horse is considered to be in the possible higher risk categories described above, alternatives to corticosteroids for joint injections could also be considered if joint injections are considered to be necessary. That could included: platelet rich plasma, IRAP, mesenchymal stem cells, Legend or Adequan. It is always best to have your veterinarian evaluate your horse for lameness and identify the source of lameness with appropriate diagnostic tests prior to just simply injecting a joint based on a hunch. Your veterinarian will take into consideration the age, breed, use and prior history coming up with a plan for an appropriate injection protocol. They can explain to you the pros and cons of each option.