New Research and Regulatory Issue Associated with Corticosteroids

The use of corticosteroids for the treatment of equine joint disease, as well as the controversy surrounding the risk–benefit ratio of their use have been reported for almost five decades. Few, if any, of the early clinical reports suggesting deleterious effects associated with intra-articular (IA) corticosteroid administration have withstood close modern-day scientific scrutiny. Specifically, most of these reports lacked an appropriate control population that would ensure the reported deleterious effects occurring in corticosteroid treated joints would not have occurred as a natural progression of the disease process that often initiated corticosteroid use in these clinical cases. Extensive reviews dealing with the benefits and controversy surrounding IA corticosteroid administration have been published, and these works will not be recreated here. Rather, a brief review of the basic pharmacology, a subjective synopsis of IA corticosteroid research, an update on research since these published reviews, a summary of the beneficial and potentially deleterious effects based on scientific evidence, and how the use of IA and systemic corticosteroids relates to issues surrounding the athletic horse (including regulatory issues) will be presented.