Osteoarthritis in the Equine Athlete

Osteoarthritis (OA) is the most common cause of lameness in horses with some studies attributing up to 60% of all unsoundness in the equine athlete to this process. While for some this degenerative disease is career ending, plenty more are maintained with early signs while continuing to lead active lives.

 The causes of osteoarthritis are varied, but in all it results in a loss of integrity in the cartilage surface of articulating joints. This results in pain, inflammation and subsequent loss of function. In severe cases the bony surfaces of the joint are affected, leading to bony remodeling and ultimately fusion of the joint.

 While some horses are predisposed to osteoarthritis through genetic factors, the primary causes are trauma related, although the severity of this trauma can be relatively minor in relation to the impact on the joint.

 Common predisposing factors include:

  • Injury to the joint structures – microfractures of the bone, ligament damage
  • Infection of the joint – septic arthritis, synovitis, capsulitis
  • Age related degeneration
  • Micro abrasions due to daily wear and tear, especially in the horse exposed to work on hard ground or strenuous exercise, or simply the big moving horse
  • Osteochondrosis (OCD)

 Your treatment options once your horse has been diagnosed with OA are many and need to be discussed with your vet to find a plan that suits you, your horse, your expected outcomes and your wallet.

1. Pain management with Non-Steroidal Anti-Inflammatory Drugs (NSAID’s) e.g. Phenylbutazone (Bute)

Although NSAID’s are a long-term solution given to many, these need to be approached with caution. They certainly have their place in the acute setting, providing immediate relief from symptoms and reducing the inflammation rapidly, therefore preventing further damage. However long-term the side effects of these drugs can be devastating and ultimately more grim than the disease process they are treating, with life-threatening complications such as gastric ulcers, kidney impairment and diarrhoea. NSAID’s are also banned substances and cannot be used on the competing horse.

2. Intra-articular injections

There are many options for intra-articular injections including hyularonic acid, polysulfated glycosaminoglycans (GAG’s) and corticosteroids. Once again these can provide immediate relief by reducing inflammation and introducing fluid volume into the joint space. There are side effects to consider – there is always a danger with injections and the trauma caused by the introduction of a needle itself can produce further negative impacts on the cartilage surface you are trying to protect. The after care is also extremely important, usually including several days box rest which is labour intensive and means time off work for the horse.

 3. Intramuscular polysulfated glycosaminoglycans (GAG’s)

There is less impact to the joint with these injections and side effects are usually restricted to localised swelling and pain at the injection site, however the effects are also subsequently reduced with the medication needing to be metabolised systemically.

4. Weight Management

It goes without saying that a lighter horse will produced a lighter impact on the joints with every step. Excess weight is a key component in many causes of soundness problems, not just osteoarthritis, and therefore should be part of the management of any equine athlete. Talk to your vet or your equine nutritionist (nearly every large feed company provides this service free of charge on request) about a suitable diet for your horse, taking into account their energy and performance requirements and your expectations as a rider. Don’t let your vanity get in the way of the health of your horse – there are many competitors out there compromising their partners longevity, particularly in showing, dressage and children’s ponies.

 5. Physical Therapy

The use of non or reduced weight bearing activities during rehabilitation can help keep the horse fit and joints mobile while recovering. Consider swimming and the use of water treadmills, although do talk to your vet first as these can cause increased stress on connective tissues. You don’t want to replace one lameness with another! And be careful on return to normal work to increase the impact related activities slowly.

6. Supplementation

A balanced Omega fatty acid should be added to the horses diet. Make sure that the oil you choose balances the Omega-3’s and Omega-6’s to ensure the correct inflammatory response.

Most common joint supplements use a combination of glycosamine, chondroitin and MSM to reduce inflammation. The objective research on these substances is minimal, although anecdotally they do have some impact on the inflammatory enzymes. The most effective ingredient of these in MSM which unfortunately is due to become a controlled substance in January 2018 meaning it will no longer be allowed to be given to the competition horse.


Epiitalis® Forte gel is the new super power in joint health. Containing the new active ingredient, Epiitalis® which is extracted from a natural plant based source before being put through a proprietary process to ensure efficacy and bio-availability. It is patented for its ability to reduce inflammation (comparison study to an NSAID) and to proliferate chondrocytes. (In-vitro study on the impact on cartilage explant) Chondrocytes are immature cartilage cells and are essential to the repair and rebuilding of the cartilage surface. ‘Repair relies on the multiplication potential of chondrocytes’ (Nathan Wei, MD, FACP, FACR)

The anti-inflammatory effect of Epiitalis® is produced by the suppression of the inflammatory enzymes PGE2 and NO as well as by inhibiting GAG leaching. (Visit the science page through the navigation above to see an in-vivo trial showing effects within 48hrs in horses administered Epiitalis® orally - 2009) 

The effect of Epiitalis® Forte gel on horses with Osteoarthritis has been studied specifically by Dr. Fred Benker DVM of the Equine Medical Center in Ocala, Florida. In the clinical trial he ran in 2015 on a sample population of 10 horses who were all showing advanced clinical signs of osteoarthritis and were subsequently retired to the field unsound. Of these 10 horses, 9 were significantly improved in their range of movement. Three of these 10 horses whose careers were considered over returned to the competition arena. (Link to trial)


One owner of a horse affected by osteoarthritis provided this testimonial:

I am truly amazed what a great product Epiitalis® is. Attach are some photos of Jack and it is unbelievable that just over two weeks ago he was so lame he could hardly get around his paddock. He sustained an injury as a foal on his nearside stifle from a kick from his mum. After thousands of dollars of treatment, his future was not looking good. 4CYTE™ has given him a much better outlook. In reality the product works out at such a low price per day that I can only say this also very good value. I would not have imagined Jack would be so active again in such a short period of time. (Jack pictured below playing in his field after using Epiitalis)


Epiitalis® Forte gel is an oral supplement that can be given by oral syringe or added directly on to the feed. The supplement consists simply of the active ingredient Epiitalis® in a soya oil gel suspension with some apple flavouring. It is very palatable, with no known side effects and has undergone trials showing it to be safe for long-term use. It is a very small, once daily dose having minimal impact on your routine and pocket. It is sold in 238gm tubes which is approximately 2 month supply, although we do recommend a loading dose of 8gms for the first two weeks, meaning the initial tube will last around 6 weeks. Click here to purchase.


Of course prevention is better than cure, and with the possibility of tiny micro-abrasions on the cartilage surface occurring from birth, Epiitalis® Forte gel should be thought of as an inexpensive insurance policy. Even more so if your young horse suffers trauma to the joint through infection or injury. For titrated daily doseage recommendations, please contact 4CYTE UK on info@4cytevet.co.uk.