Equine osteoarthritis (OA) is a complex disease process that can be challenging for veterinarians to manage. A new study sponsored by American Regent Animal Health aimed to identify patterns in how equine veterinarians stage, diagnose, and treat osteoarthritis, as well as how they communicate with their clients about OA, to identify areas where additional resources or support could benefit the profession.
During the Dec. 7 Sunrise Session “Closing the Treatment Gap: Optimizing Early Intervention in Equine DJD,” presented by American Regent Animal Health at the 2025 American Association of Equine Practitioners Convention, Sherry Johnson, DVM, MS, PhD, DACVSMR, senior partner at Equine Sports Medicine in Pilot Point, Texas/Scottsdale, Arizona, and Kyla Ortved, DVM, PhD, DACVS, DACVSMR, associate professor of large animal surgery at University of Pennsylvania’s New Bolton Center, presented findings from the survey, including the following highlights:
- 93% of equine veterinarians stage OA as mild, moderate, or severe.
- 89% of veterinarians say stage-specific guidance would be helpful.
- 91% say flexibility in guidance is important.
Respondent Demographics
This was a fully blinded study conducted by an independently contracted research firm, with respondents having no knowledge of the survey’s affiliation with American Regent Animal Health. In total, 198 equine veterinarians completed the survey, representing 5.2% of equine veterinarians in the United States. This was a nationally representative survey, with respondents from every state except Arkansas and West Virginia. The highest number of respondents came from California and Texas. The survey took an average of 37 minutes to complete.
All respondents were currently licensed and practicing in the U.S., with at least 25% of their practice dedicated to equine health and wellness and at least part of their practice associated with joint care. Respondents ranged from early- to late-career practitioners with a broad range of experience.
Seventy-one percent of respondents’ practices focused on general care, and 21% focused on sports medicine. Thirty-one percent worked in equine-only clinics, 29% in mixed-animal clinics, and 28% in ambulatory-only practices.
Assessing the Need: Stage-Based OA Guidance
The presenters reported that 93% of survey respondents stage OA as mild, moderate, or severe. Importantly, 89% of respondents said having a stage-specific framework for managing OA would be extremely, very, or somewhat helpful.
When asked why stage-specific guidance would be helpful, respondents noted:
- It would provide structure and clarity to treatment offerings.
- It would enhance the evidence base and the objective decision-making process of their overall treatment approach.
- It would help support younger and/or less specialized veterinarians.
- It would strengthen owner understanding and expectations.
- It would help standardize care across multiple-doctor practices.
- It would help keep pace with evolving therapies.
“The interesting thing to note is that everyone said we want a framework, but we still want it very flexible, and we still want the ability to modify a plan for each patient,” said Johnson.
Ninety-two percent of veterinarians agreed it’s extremely important for any stage-based treatment guidelines to allow for clinical flexibility to accommodate individual patient differences. Additionally, almost every respondent said they always or often observe variability in treatment response or clinical presentation among horses at the same clinical stage of disease.
“We still don’t understand fully how this complex disease process will respond,” said Johnson. “OA stage alone is not a reliable predictor of how horses are going to present or respond to therapies.”
How Are Veterinarians Managing OA Today?
To determine what stage-based guidance might look like in practice, the survey explored how veterinarians currently manage OA.
Evaluation
The survey asked respondents about the clinical, functional, contextual, and imaging factors they rely on to distinguish between stages of OA progression. Common clinical factors cited across all three stages included flexion tests, lameness, and changes in a specific joint (palpation, range of motion, etc.). For mild OA, 68% of respondents also rely on response to intra-articular medication.
Lameness and decreased performance were the top functional factors cited across each OA phase. “More specifically, how is that horse able to move with the rider?” said Ortved. “Are we seeing reduced willingness to flex, collect, extend, jump?” One key distinction for moderate OA is that clinical signs recur more frequently. For severe OA, horses often exhibit significant joint stiffness, postural changes, and loss of soundness.
The most important contextual factor respondents noted for mild OA was owner- or trainer-reported changes. “This has changed quite a lot in the last couple of decades, where owners are much more in tune with the behavior and the performance of their horse,” said Ortved. In the moderate stage, a history of OA, horse age or career stage, and history of trauma or prior surgery were important factors. Prior surgery was also an important contextual factor in severe OA.
Across the three OA stages, respondents reported using easily accessible diagnostic imaging tools, such as radiographs and ultrasound, to detect and monitor changes over time. Some also used MRI, CT, nuclear scintigraphy, and PET.
Treatment
The most common first-line treatments respondents rely on for mild OA cases include rest, turnout or workload modification, systemic anti-inflammatories, and FDA-approved systemic treatments. “These are noninvasive modalities. These are modalities that are available readily within practice, and the price point is feasible for most owners,” said Johnson.
To assess how treatment preferences change with disease severity, respondents were asked to rank their preferred treatments for mild, moderate, and severe OA. For mild cases, management strategies such as shoeing, rest, and workload modification, followed by pharmaceuticals and biologic therapies, were the top responses.
Eighty-two percent of respondents use FDA-approved systemic OA injectables for mild cases, with Adequan i.m.® (polysulfated glycosaminoglycan) being the most frequently used. Please see indications and important safety information below. In moderate and severe cases, veterinarians tend to shift away from these therapies and rely more heavily on systemic anti-inflammatories or intra-articular medications.
“What we took away from this is that veterinarians taking this survey do prioritize conservative management strategies such as shoeing, rest, and workload modification for mild OA,” said Johnson. “As the severity of OA increases, this treatment preference tends to shift toward pharmaceuticals. For moderate and severe cases, the biologic therapies and the physical modalities serve as secondary options.”
Other treatment and management strategies highlighted in the survey included corrective shoeing, structured physical therapy, shockwave therapy, and weight management. Euthanasia was also cited as a management decision in severe OA cases.
Nearly every veterinarian surveyed reported adjusting treatment protocols based on the individual horse’s response to treatment.
Supplement Use
Approximately half of respondents said they always or often recommend oral or feed-based joint supplements such as glucosamine and MSM for horses with suspected or diagnosed OA. Notably, more than 80% of respondents reported that horse owners believe supplements alone are sufficient to manage joint disease. Additionally, 42% of veterinarians reported joint supplement usage to occasionally or frequently delay or interfere with their ability to implement appropriate OA treatment.
The OA Communication Gap
Seventy-four percent of respondents said they find it challenging to educate horse owners about stage-appropriate OA intervention. Factors included a “quick fix” mentality among owners, economic concerns, and influence from trainers and social media.
When asked which types of horse owners are most difficult to communicate evidence-based OA treatment decisions with, respondents most frequently cited owners who primarily follow trainer influence.
“This identifies an opportunity for us, because as veterinarians we don’t only communicate with owners; we have to communicate with the entire treatment team,” said Ortved. “If we do have some more specific stage-based treatment recommendations, it allows us as a profession to be a little bit more specific.”
Respondents were also asked which communication tools would be most helpful and effective. They expressed a desire for simple, visual, and evidence-based tools that are easy for owners to understand, such as handouts, brochures, or digital resources. Respondents also wanted access to an unbiased, centralized database to look up evidence on different medications.
Takeaways
The purpose of this study was to understand how veterinarians currently stage and treat OA, identify common challenges, and determine how American Regent Animal Health can support practitioners in managing this complex disease.
“We learned that the profession wants stage-based guidance that’s still flexible and still adaptable,” said Johnson. This guidance can help improve care outcomes, educate clients, and align multidoctor teams.
The areas of consensus identified in the study can help form the foundation of an evidence-based model. In mild OA cases, veterinarians want to intervene early and focus on proactive management. In the moderate OA category, practitioners rely more heavily on pharmaceuticals alongside systemic FDA-approved treatments. In the severe OA category, the primary challenge becomes prioritizing patient comfort and quality of life.
“There’s clearly a need, and there are a lot of challenges that we still have in our quest toward improving the lives of patients with OA,” said Johnson. “We’re working on those next steps to ultimately advance the research and improve the veterinarian’s experience in managing OA.”
This study was conducted from August to September 2025 and has not yet been published.
Adequan® i.m. polysulfated glycosaminoglycan (PSGAG) solution 100 mg/mL
INDICATIONS
Adequan® i.m. is recommended for the intramuscular treatment of non-infectious degenerative and/or traumatic joint dysfunction and associated lameness of the carpal and hock joints in horses.
IMPORTANT SAFETY INFORMATION
There are no known contraindications to the use of intramuscular Polysulfated Glycosaminoglycan (PSGAG). Studies have not been conducted to establish safety in breeding horses. WARNING: Do not use in horses intended for human consumption. Not for use in humans. Keep this and all medications out of the reach of children. CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian. For additional safety information, please see full prescribing information at adequan.com.
Related Reading
- Tackling Equine Degenerative Joint Disease: Real-World Case Studies
- Disease Du Jour: Equine Joint Health and Healing
- Equine Joint Disease Updates: PAAG and APS
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