Equine vets show growing caution on IA corticosteroids

A new EquiManagement report points to a notable shift in equine practice: veterinarians appear to be growing more cautious about intra-articular corticosteroids, even as orthobiologic therapies become more accepted in joint management. The change matters because corticosteroids have long been a mainstay for equine osteoarthritis and performance-limiting joint pain, but they’re now being weighed against a larger menu of biologic and synthetic options. (frontiersin.org)

That shift didn’t happen overnight. In a 2020 cross-sectional survey published in Frontiers in Veterinary Science, 353 completed responses showed that non-steroidal intra-articular therapeutics were already widely used, with 87.5% of respondents reporting use of those products. Even so, corticosteroids remained the most widely used intra-articular therapeutic, ranking ahead of hyaluronic acid and blood-based products such as autologous conditioned serum. (frontiersin.org)

What seems to be changing now is sentiment around how, when, and how often corticosteroids should be used. A recent Equine Veterinary Education update says intra-articular corticosteroids still provide symptom-modifying benefit, but growing concern centers on potential deleterious cartilage effects depending on drug choice, dose, timing, and repeated administration. That same review suggests the field is reconsidering best practices rather than rejecting the category outright. (beva.onlinelibrary.wiley.com)

The background science helps explain why orthobiologics are gaining traction. Auburn University research on orthobiologic use in equine joint disease found increased practitioner preference for blood-based, point-of-care products in acute joint-related pathology compared with past years, even though corticosteroids still led overall. In that work, the author concluded orthobiologics may offer a more joint-preserving strategy in some settings, while also noting that corticosteroids remain deeply embedded in current practice. (etd.auburn.edu)

Regulatory and professional guidance also shape the conversation. AAEP’s current position statement, revised by its board in 2025, says corticosteroids have clear therapeutic indications in horses, but warns that excessive or too-frequent use may negatively affect immune response and that locally injected corticosteroids may weaken cartilage and ligament support tissues in damaged joints if used excessively or indiscriminately. The organization also reminds practitioners to follow the rules of the competition jurisdiction in which they practice. (aaep.org)

Industry and expert commentary broadly reflects a middle-ground view: corticosteroids still have a role, but they’re no longer the unquestioned default in every joint case. Reviews in the equine literature continue to describe them as a mainstay, while newer analyses increasingly frame orthobiologics and other intra-articular therapies as part of a more individualized treatment strategy, especially when the goal is balancing short-term anti-inflammatory benefit with longer-term joint preservation. (doi.org)

Why it matters: For veterinary professionals, the practical takeaway is that treatment planning is getting more nuanced. Pet parents may hear more about tradeoffs between fast symptom control and possible structural concerns with repeated steroid exposure, as well as the cost, evidence base, processing demands, and expected outcomes of orthobiologics. This trend could also influence referral patterns, inventory decisions, rehab planning, and how equine practices discuss return-to-work timelines in sport horses. (frontiersin.org)

What to watch: The next phase will likely center on comparative evidence, not just popularity, including better head-to-head data on corticosteroids versus orthobiologics, clearer protocols for dose and frequency, and continued scrutiny from competition regulators and professional bodies as equine joint therapy evolves. (beva.onlinelibrary.wiley.com)