Abstract
PICO question
 In horses that are lame due to osteoarthritis of the distal tarsal joints (bone spavin), is intra-articular medication with corticosteroids compared to systemic bisphosphonate treatment more effective in long-term lameness reduction?
 
 Clinical bottom line
 Category of research question 
 Treatment
 The number and type of study designs reviewed
 Three papers were critically reviewed. Two were randomised controlled trials, and one was a retrospective study.
 Strength of evidence 
 Weak
 Outcomes reported
 There is insufficient evidence to support the use of systemic bisphosphonates over intra-articular corticosteroids to treat distal hock osteoarthritis in horses.
 Conclusion
 Horses with distal hock osteoarthritis should not be treated with systemic bisphosphonates until further blinded randomised controlled trials are completed. Additionally, supportive evidence for the use of intra-articular corticosteroids as a treatment for degenerative hock osteoarthritis is limited to a retrospective study where modest, short-term improvements are reported: 58% of horses improved after an average of 56 days (Labens et al., 2007). Evidence does not support significant improvement in long-term outcomes: 50% of horses improved after 4 months (Watts et al., 2016) and only 38% of horses improved after a mean follow-up period of 787 days (Labens et al., 2007).
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 
Highlights
WB crosses; 23 undisclosed breeds Use: 29 general purpose, 10 showjumping, four dressage, two eventing, two hunting, four unknown use
There was radiographic evidence of TMT and/or DIT joint OA The horses received an IA injection of methylprednisolone acetate (MPA) or triamcinolone acetonide with or without hyaluronic acid (HA) into the TMT and/or DIT joint Horses with bilateral hindlimb lameness (25/51 at first examination) were included in the study if they met the following criteria: IA analgesia reduced lameness by 50% or more in one hindlimb There was increased uptake of a radiopharmaceutical by the DIT and/or TMT joint in the other hindlimb on scintigraphic examination Horses were split into two groups: Group 1 = moderate or severe radiographic evidence of OA of DIT and TMT joints Group 2 = mild or no radiographic evidence of OA of DIT and TMT joints
No significant differences observed between effects of MPA and triamcinolone (p-value or raw numbers not provided)
Summary
Question In horses that are lame due to osteoarthritis of the distal tarsal joints (bone spavin), is intra-articular medication with corticosteroids compared to systemic bisphosphonate treatment more effective in longterm lameness reduction?. Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Three papers were critically reviewed. Two were randomised controlled trials, and one was a retrospective study. Strength of evidence Weak Outcomes reported There is insufficient evidence to support the use of systemic bisphosphonates over intra-articular corticosteroids to treat distal hock osteoarthritis in horses
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