In this episode, Allen Page, DVM, PhD, discussed his research on the metabolic effects of various intra-articular corticosteroids, as well as how ertugliflozin might influence horses’ metabolic responses to these treatments. Page spoke about how differences among corticosteroids can inform veterinarians’ choices when selecting intra-articular agents, key considerations when using SGLT2 inhibitors in horses that require joint injections, the limitations of the current research, and more.
This episode of Disease Du Jour is brought to you by Equithrive.
Metabolic Effects of Different IA Corticosteroids
Page’s research team has evaluated the effects of various intra-articular corticosteroids, including triamcinolone acetonide, betamethasone esters, and methylprednisolone acetate.
In one project1, his team compared the metabolic effects of triamcinolone and Pro-Stride Autologous Protein Solution when injected into a horse’s front fetlock joint. They found that triamcinolone had a significant metabolic effect that lasted upward of seven days, while Pro-Stride did not.
His team also did a project on betamethasone2, which is typically considered a weaker corticosteroid than triamcinolone. While they could not make strong statistical conclusions about betamethasone’s effects on insulin, “we did find that glucose shows a similar time course or effect that we see with triamcinolone,” Page said. “So it suggested to us that maybe if we had more horses, we would’ve seen something with insulin.”
In that study, they also injected three insulin dysregulated horses for the first time. These horses did not respond differently from the metabolically normal horses, but the data was underpowered.
In another study3, his team evaluated the metabolic effects of a low dose of methylprednisolone acetate (20 mg per joint/80 mg total per horse). This steroid did not affect horses’ insulin or glucose levels, but it did transiently impact ACTH and cortisol.
“If we’re talking about just the three [steroids] that are geared toward joint inflammation, triamcinolone is clearly the strongest and most impactful from a metabolic standpoint,” Page said. “We’ve seen that now across multiple studies of ours.”
He reiterated that this research has been conducted in metabolically normal horses and is difficult to extrapolate to insulin dysregulated horses. However, he urged veterinarians to recommend point-of-care insulin testing before administering intra-articular corticosteroids and documenting if owners decline.
“Regardless of that testing, if I was concerned about a horse being insulin dysregulated, I would think long and hard about putting triamcinolone in them,” Page said.
How Ertugliflozin Influences Horses’ Metabolic Response to Steroids
In a crossover study4, Page’s research team treated metabolically normal horses with the SGLT2 inhibitor ertugliflozin for seven days before and after intra-articular injection with triamcinolone. (During the subsequent injection period, the horses received triamcinolone without ertugliflozin.) “We found that pretreatment and subsequent treatment with ertugliflozin significantly decreased the insulin and glucose responses in these horses,” Page said. “They still did have a spike, but the average value for this group and also some of the maximum values were lower than what we saw with just the triamcinolone-only treatment.”
Research Limitations
Page reiterated that more research is needed on the metabolic effects of intra-articular corticosteroids and ertugliflozin in insulin dysregulated horses. “We’ve been really hesitant to move this work into insulin dysregulated horses because we know there is that significantly elevated risk of laminitis, but we also know that’s really the target demographic for a lot of the work we’re doing,” he said.
He also noted that it is unclear whether this work will translate to different doses and joints. “Joint size, joint volume may play a role in the way these drugs are absorbed and have their systemic effects,” he said. “I think there’s a lot of opportunity to explore that in a controlled manner.”
Listen to the podcast episode to learn more about these studies.
About Dr. Allen Page
Allen Page, DVM, PhD, is an Assistant Professor in the Department of Veterinary Science at the University of Kentucky’s Maxwell H. Gluck Equine Research Center. He received both his Bachelor of Science and Doctor of Veterinary Medicine from the University of California, Davis, before moving to Lexington to complete a rotating internship at the Hagyard Equine Medical Institute and a PhD at the University of Kentucky. His research interests include the inflammatory response to exercise and injury in equine athletes across a variety of disciplines, as well as the effects of various intra-articular corticosteroids. He also has an interest in developing diagnostics for various infectious diseases based on mRNA expression analysis and/or serum antibody detection.
References
- Page AE, Johnson M, Parker JL, Jacob O, Poston R, Adams AA, Adam EN. The Effects of Intra-Articular Triamcinolone and Autologous Protein Solution on Metabolic Parameters in Horses. Animals (Basel). 2024 Aug 2;14(15):2250. doi: 10.3390/ani14152250. PMID: 39123776; PMCID: PMC11311071.
- Page AE, Rauber-Ramos AM, Humiston M, McPeek JL, Adam EN. Initial investigation into the metabolic effects of intra-articular betamethasone on normal and insulin dysregulated horses. J Equine Vet Sci. 2025 Apr;147:105404. doi: 10.1016/j.jevs.2025.105404. Epub 2025 Feb 22. PMID: 39993481.
- Page AE, McPeek JL, Carattini S, McGreevy E, Adam E. Intra-articular methylprednisolone acetate does not induce hyperinsulinemia or hyperglycemia in metabolically normal horses. J Am Vet Med Assoc. 2025 Dec 10;264(3):326-331. doi: 10.2460/javma.25.08.0566. PMID: 41370924.
- Page AE, McPeek JL, McGreevy E, Carattini S, Adam EN. Treatment with ertugliflozin mitigates the hyperinsulinemic response to intra-articular triamcinolone acetonide. Equine Vet J. 2026 Feb 1. doi: 10.1002/evj.70150. Epub ahead of print. PMID: 41622114.
Related Reading
- Disease Du Jour: Equine Joint Health and Healing
- Update on the Use of Triamcinolone as a Joint Therapy in Horses
- How Endocrine Disorders Impact Equine Athletes
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