Intra-articular treatment with triamcinolone compared with triamcinolone with hyaluronate: A randomised open-label multicentre clinical trial in 80 lame horses.
BACKGROUND
Intra-articular (IA) injection of corticosteroids with or without hyaluronate (HA) has been used for decades in equine practice for treatment of noninfectious synovitis and osteoarthritis. However, to date, no large-scale randomised equine field trials have been reported that address the supposed superior clinical efficacy of the combination of corticosteroid + HA compared with IA injection of corticosteroid alone.


OBJECTIVE
To compare the clinical efficacy of IA triamcinolone acetonide (TA, 12 mg) compared with IA TA (12 mg) + high molecular weight HA (20 mg) in horses with clinical joint disease.


METHODS
Prospective, randomised, parallel, open label, multicentre clinical trial.


METHODS
Eighty client-owned horses from 13 clinics were included. Lameness and effusion scores were assessed at baseline and 3 weeks after IA treatment. A standardised telephone questionnaire was completed between the owner and consulting veterinarian at 3 months. The primary outcome parameter was clinical success rate, defined as ≥2 grades lameness reduction (on a 0-5 scale) at 3 weeks. Chi-square statistics and binary logistic regression were used to analyse data on an intention-to-treat basis for the 3 week outcome.


RESULTS
The success rate of IA TA 3 weeks after treatment was 87.8%, while that of TA+HA was 64.1% (P = 0.01). Age >13 years was associated with a reduced success rate for the combination treatment (P = 0.004) at 3 weeks. At 3 months, half the horses in each group had returned to their previous level of performance.


CONCLUSIONS
The combination of TA with HA was associated with a lower short-term clinical success rate and a similar medium-term outcome compared with IA TA, with only half of the horses performing at their previous level of exercise after 3 months regardless of treatment group allocation.
Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, The Netherlands.
J C
JC
de Grauw
Veterinary Center Honselersdijk, The Netherlands.
M C
MC
Visser-Meijer
Equine Clinic de Raaphorst, Wassenaar, The Netherlands.
F
F
Lashley
Veterinary Clinic Ridderkerk, The Netherlands.
P
P
Meeus
Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, The Netherlands.
P R
PR
van Weeren
D000818:Animals; D006734:Horse Diseases / Q000188:drug therapy*; D006736:Horses; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D007270:Injections, Intra-Articular; D007592:Joint Diseases / Q000188:drug therapy / Q000662:veterinary*; D007794:Lameness, Animal / Q000188:drug therapy*; D012307:Risk Factors; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000627:therapeutic use*
D006820:Hyaluronic Acid; D014222:Triamcinolone Acetonide
arthritis; corticosteroid; horse; hyaluronan; joint; randomised