New Research | NR Perspective

Demystifying Equine Joint Care

By Liberty Getman DVM, DACVS

Lameness remains one of the most frequent and challenging conditions equine practitioners face. It affects most horses at some point in their lives, often linked to osteoarthritis (OA), which impacts about 60% of horses.¹ Managing OA requires balancing owner expectations, long-term joint health, and the risks and benefits of available therapies.

For decades, intra-articular corticosteroids and hyaluronic acid (HA) were the mainstays of OA treatment. Corticosteroids provide rapid relief but can contribute to cartilage degeneration and alter metabolic parameters, posing risks for insulin-resistant or PPID horses.²,³,⁴ HA is used as a lubricant, often paired with corticosteroids, but offers little long-term benefit and is less effective in advanced OA.

Autologous blood or bone marrow-based orthobiologics, such as Pro-Stride® APS, Restigen® PRP, and CenTrate® BMA, are derived from the patient’s own cells and represent the cutting-edge of equine joint therapies. By concentrating anti-inflammatory cytokines and growth factors, they help break the cycle of inflammation and support healing. This sets them apart from corticosteroids, HA, and synthetic fillers.

Allogenic and xeongenic products (e.g., amnion- or bovine-derived injectables) are convenient but carry concerns over immune reactions and limited regulation. Polyacrylamide gels, meanwhile, provide structural support but can trigger foreign body responses, and their long-term joint effects remain uncertain.⁵

NEW RESEARCH MAKES THE CASE: WHAT SETS PRO-STRIDE AND RESTIGEN APART
Recent research has provided greater clarity on how autologous orthobiologics perform compared to other options.

A 2025 University of Pennsylvania study compared four orthobiologic devices: Pro-Stride APS, Restigen PRP, Arthrex ACP, and Alpha2EQ. Pro-Stride and Restigen produced the highest levels of a2-macroglobulin (A2M), TGF-ß1, and IL-1Ra, which are key factors for modulating inflammation and promoting healing in equine joints.⁶

At the University of Georgia, researchers evaluated Pro-Stride and IRAP in horses with PPID (Cushing’s disease) and found no significant differences in cytokine output compared to healthy horses.⁷ This is great news and provides reassurance that metabolic status does not diminish the therapeutic benefit of Pro-Stride, making it a safe and effective choice for insulin-resistant or PPID horses that may be at risk with other treatments like corticosteroids.

Another study conducted at the University of Kentucky compared Pro-Stride to triamcinolone, a commonly used corticosteroid. Horses treated with triamcinolone experienced several days of steroid-induced insulin resistance and adrenal suppression, changes not seen with Pro-Stride or saline.³ These findings underscore the risks corticosteroids pose for insulin-dysregulated horses, including heightened chances of laminitis.

A follow-up study on betamethasone confirmed similar metabolic disruptions: adrenal suppression and glucose alterations were observed even in normal horses.⁴ Together, these studies emphasize the importance of ongoing research into corticosteroid safety while highlighting the value of regenerative options like Pro-Stride.

UNDERSTANDING TREATMENT OPTIONS
Intra-articular therapies for OA vary widely, and understanding their mechanisms and risks is key to making informed choices. Autologous orthobiologics like Pro-Stride and Restigen stand out for their ability to support natural healing, help reduce inflammation, and avoid the metabolic risks tied to corticosteroids. Backed by equine-specific research, these therapies provide veterinarians with safe, effective alternatives for managing lameness and supporting long-term joint health.

REFERENCES

1. McIlwraith W, Frisbie D, René P, et al. Joint disease in the horse (2nd edition). 2016;1. doi: 10.1016/C2012-0-00759-4.
2. Smanik LE, Goodrich, L. In: Baxter GM, ed. Adams and Stashak’s Lameness in Horses. 7th ed. Hoboken, NJ: Wiley-Blackwell;2020:886.
3. Page AE, Johnson M, Parker JL, et al. The effects of intra-articular triamcinolone and autologous protein solution on metabolic parameters in horses. Anim. 2024;14(15):2250. doi: 10.3390/ani14152250.
4.  Page AE, Rauber-Ramos AM, Humiston M, et al. Initial investigation into the metabolic effects of intra-articular betamethasone on normal and insulin dysregulated horses. J Equine Vet Sci. 2025;147:105404. doi: 10.1016/j.jevs.2025.105404.
5. Lowe J, de Clifford L, Julian A, et al. Histologic and cytologic changes in normal equine joints after injection with 2.5% injectable polyacrylamide hydrogel reveal low-level macrophage-driven foreign body response. J Am Vet Med Assoc. 2024;262(5):649-647. doi: 10.2460/javma.23.10.0553.
6.  Barot D, Usimaki A, Linardi R, et al. Equine autologous blood-based products contain variable quantities of transforming growth factor-ß1, interleukin-1 receptor agonist, and a2-macroglobulin. Am J Vet Res. 2025;86(4):[page range]. doi: 10.2460/ajvr.24.11.0363.
7. Moorman VJ, Hart KA, Gordon J, et al. Cytokine profiles of autologous conditioned serum (ACS) and autologous protein solution (APS) from horses with pituitary pars intermedia dysfunction (PPID) and unaffected controls. VCOT Open. 2024;7(S 01):1-12. doi: 10.1055/s-0044-1786215.

For more information, visit the Pro-Stride website.