Beyond Steroids: What the Latest Research Means for Your Competition Horse's Joints

There is a conversation happening in barns and veterinary clinics from Wellington to Wiesbaden, in warm-up rings and radiograph suites, and increasingly between riders and their vets at the start of every competition season. It is a conversation about joints — about what we put into them, what we are learning not to, and what the next chapter of sport horse medicine looks like. For decades, the corticosteroid injection was the unquestioned standard: fast-acting, effective, and deeply embedded in the routine of competitive equine management. That standard is shifting. And if you have a horse in serious work, what is happening in the research right now may change what you discuss at your next lameness appointment.

Why Osteoarthritis Is the Central Health Concern of the Sport Horse

Osteoarthritis is not a disease of old horses. It is the disease of athletic horses — the progressive degeneration of articular cartilage and synovial tissue that begins long before a horse shows detectable lameness and advances quietly through years of competition. It is the leading cause of lameness in horses, affecting more than sixty percent of them at some point in their working lives. For the hunter, jumper, and warmblood competing regularly on varied footing, the cumulative load on fetlocks, coffin joints, hocks, and carpal joints is considerable. The conversation was never whether these horses would experience joint inflammation — only when, and what we would do about it.

For most of modern sport horse medicine, the answer was corticosteroids. Injected directly into the affected joint, drugs like triamcinolone acetonide and methylprednisolone acetate reduce inflammation rapidly, restore comfort, and allow horses to continue training. In many cases, they remain an appropriate tool. But an evolving body of research — accumulating with particular momentum over the last three years — is raising important questions about when steroids are the right choice, which horses they may harm, and whether newer therapies offer something fundamentally better for the long-term health of the joint.

What the Latest Research Says About Corticosteroids and Metabolic Risk

The fear that corticosteroid injections cause laminitis has been part of equine medicine for decades — and for most of that time, the evidence has been complicated. Studies from the Royal Veterinary College in London, published in the Veterinary Record, found that overall laminitis risk following corticosteroid treatment was low, and that the horses most likely to develop laminitis after treatment were those already carrying pre-existing risk factors: obesity, pituitary pars intermedia dysfunction (PPID), or a prior history of the disease. The RVC researchers found significant associations between laminitis development and body condition score, breed, and the presence of pre-existing metabolic disease — not corticosteroid use in isolation.

That nuance is clinically critical — and it is precisely where the field is now focused. Dr. Erin Contino, Associate Professor of Equine Sports Medicine and Rehabilitation at Colorado State University and a current member of the AAEP Board of Directors, presented at the 2025 American Association of Equine Practitioners Convention with a message that reframes the debate for sport horse owners: the issue is not corticosteroids broadly, but their use in metabolically compromised horses who may not appear compromised at all. In one study of horses receiving intra-articular triamcinolone, researchers documented a significant increase in systemic insulin levels persisting for up to 120 hours post-injection — a finding with serious implications for horses with underlying insulin dysregulation, which is both common and frequently undiagnosed.

"There is no safe dose of corticosteroids in metabolic horses. We also can't rely on the horse's appearance to determine his metabolic status, so testing is crucial."
— Dr. Erin Contino, MS, DVM, Dipl. ACVSMR, Associate Professor of Equine Sports Medicine and Rehabilitation, Colorado State University; AAEP Convention, 2025

At the University of Kentucky, researchers — working as part of the newly USDA-funded program announced in May 2026 — are investigating whether intra-articular corticosteroid injections affect horses' response to vaccination. The $300,000 study, led by Dr. Allen Page of UK's Department of Veterinary Science, represents one of five new projects receiving a combined $1.8 million from the USDA's National Institute of Food and Agriculture. It is one of the clearest signals yet of how central joint therapy decisions have become to the broader equine health research agenda.

Meanwhile, NC State College of Veterinary Medicine researchers led by Dr. Lauren Schnabel — Professor of Equine Orthopedic Surgery who completed her DVM, residency, and PhD at Cornell University under Dr. Lisa Fortier — were scheduled to present results from their sport horse corticosteroid study in June 2026. Schnabel's lab has focused extensively on stem cell immunology and regenerative therapies, and her work on the relationship between joint inflammation, tissue healing, and biologic treatment response is shaping how the profession now approaches the metabolic question at the clinical level.

Orthobiologics: What They Are and Why They Are Increasingly First-Line

The term orthobiologics refers to therapies derived from biological substances naturally found in the body — principally from the horse's own blood, bone marrow, or adipose tissue — used to promote healing in damaged musculoskeletal tissue. They are not new: platelet-rich plasma has been used in equine medicine for years, and autologous conditioned serum has been a fixture in high-level sport horse management for over a decade. What is new is the momentum behind them, the sophistication of the research supporting them, and an emerging consensus that for many horses and many joint conditions, they should be considered first rather than last.

Dr. Lisa Fortier, James Law Professor of Surgery at Cornell University's College of Veterinary Medicine and Editor-in-Chief of the Journal of Cartilage and Joint Preservation, is among the most cited researchers in this field. Over more than three decades at Cornell, Fortier has been instrumental in developing and validating the use of PRP, bone marrow concentrate, and stem cell therapies in equine patients — work that has also directly influenced human orthopedic medicine. At the 2024 AAEP Frank J. Milne State-of-the-Art Lecture, one of the most prestigious platforms in veterinary medicine, she made her position clear.

"None of the biologics are miracle drugs, but I still recommend orthobiologics as first-, not last-line, therapies."
— Dr. Lisa Fortier, DVM, PhD, Dipl. ACVS, James Law Professor of Surgery, Cornell University College of Veterinary Medicine; AAEP Milne Lecture, 2024

Her influence is measurable. According to data cited at Fortier's 2022 induction into the Equine Research Hall of Fame, 87% of U.S. equine veterinarians now use biologics for regenerative medicine in equine patients. The shift in clinical practice is real and is continuing.

Polyacrylamide Hydrogel and the Two-Year Soundness Data

Of all the alternatives to corticosteroids generating discussion in equine sports medicine right now, polyacrylamide hydrogel has perhaps the most striking long-term dataset. In a double-blinded study of flat-racing Thoroughbreds comparing 2.5% PAAG against triamcinolone acetonide and hyaluronic acid for middle carpal joint lameness, ten out of twelve PAAG-treated horses were sound at six weeks — compared to three of eleven in the triamcinolone group and four of ten in the hyaluronic acid group. Joint effusion resolved in half the PAAG horses and in none of the steroid or HA horses. At twelve weeks, the PAAG horses were still sound.

At the 2024 AAEP Convention's Kester News Hour, Dr. Kyla Ortved — Associate Professor of Large Animal Surgery at the University of Pennsylvania's New Bolton Center, where her research focuses on cartilage repair, gene therapy, and regenerative medicine for both horses and humans — reviewed histologic and clinical data on PAAG injected into equine fetlock and carpal joints. The study, published in the Journal of the American Veterinary Medical Association, found that all horses remained clinically normal throughout the study period with no adverse events recorded.

"It is likely that early recognition of joint inflammation followed by targeted treatment can help limit the inflammatory cascades that potentiate the development of osteoarthritis."
— Dr. Kyla Ortved, DVM, PhD, Dipl. ACVS, ACVSMR, Associate Professor of Large Animal Surgery, University of Pennsylvania New Bolton Center

What Is Coming: Nanotechnology, Wearables, and the Personalized Joint

The most significant new entry to the equine OA treatment market arrived at the AAEP Convention in December 2025, when American Regent Animal Health introduced Synoglide — a first-of-its-kind intra-articular injection using nanotechnology developed by Belgian biomedical company Allegro. Synoglide works by mimicking the elasticity and mechanical behavior of natural synovial fluid through cross-linked microparticle bonds engineered to strengthen under mechanical stress — providing the most support precisely when the joint is working hardest. In a clinical study of 29 horses, 89.6% experienced reduced lameness four weeks after treatment, with 72.4% experiencing complete resolution. Its parent compound, Hydrocelin, is entering human clinical trials in 2026 — a fact that underscores how tightly equine and human joint research are now linked.

Alongside these therapeutic advances, the profession is moving toward earlier detection. The AAEP funded a year-long wearable biometric sensor research project through 2025 involving six sensor manufacturers and 100 Thoroughbreds, with the goal of validating sensor-based musculoskeletal injury detection. Inertial measurement unit systems already used in clinical settings are being validated for field conditions, with the ambition of continuous welfare monitoring that identifies subclinical gait asymmetry before it becomes visible lameness. Dr. Fortier has also drawn attention to the endocrine dimension underlying all of this: "We're becoming much more aware of subtle endocrine abnormalities, and these horses, who have a higher risk of tendon injury, will not heal as you might expect." Her recommendation is routine endocrine testing for all horses as part of standard wellness care — not only those who appear overweight or clinically abnormal.

Questions to Bring to Your Veterinarian This Season

None of this research suggests that corticosteroids should never be used, or that orthobiologics are appropriate in every case. What it suggests — and what the researchers who study this most closely now say explicitly — is that the choice of therapy should be individualized: matched to the specific joint, the specific horse's metabolic profile, the degree of pathology present, and the goals for the season ahead. As Dr. Contino put it plainly: "Each has their own place. Case selection is very important."

For the competitive hunter or jumper owner, this means arriving at your next lameness evaluation with more specific questions than you may have had before. Has your horse been tested for insulin dysregulation or PPID recently — not just assessed visually? If your veterinarian is recommending a joint injection, which product are they recommending, and why for this specific joint? Is the goal symptom management, or is there an opportunity to intervene earlier and more durably? Are orthobiologics on the table, and if so, which type is best suited to what this particular horse and joint actually need?

The research will keep evolving. The University of Kentucky's new USDA-funded program will produce results. Dr. Schnabel's June 2026 findings will enter the clinical conversation. Synoglide will be evaluated in real practice conditions. What will not change is the basic fact that the joints in a performance horse represent both the center of their athletic life and the most vulnerable point in their long-term soundness — and that the decisions made about them, season after season, compound in their consequences.

The conversation worth having is not whether your horse gets injections. It is whether the injection your horse gets is the right one.

"The horse that carries you through an entire season without a lame step is not lucky. It is managed — early, specifically, and with full knowledge of what the science now offers."

— Notting Hill Equine

Sources referenced in this article include research from Cornell University College of Veterinary Medicine, Colorado State University, the University of Pennsylvania New Bolton Center, NC State College of Veterinary Medicine, the University of Kentucky, the Royal Veterinary College London, Auburn University, and Leipzig University. University of Kentucky USDA funding announced May 28, 2026. This article is for informational purposes only and does not constitute veterinary medical advice.