A randomised, double-blinded, placebo-controlled clinical study on intra-articular hyaluronan treatment in equine lameness originating from the metacarpophalangeal joint.
Authors: Niemelä Tytti M, Tulamo Riitta-Mari, Hielm-Björkman Anna K
Journal: BMC veterinary research
Summary
# Editorial Summary Intra-articular inflammation of the metacarpophalangeal joint represents a significant source of lameness in performance horses, yet treatment options that provide sustained relief without systemic effects remain limited. Niemelä and colleagues conducted a double-blinded, randomised controlled trial comparing intra-articular injections of non-animal stabilised hyaluronic acid (NASHA)—a high molecular weight formulation with prolonged action—against saline placebo in 27 clinically lame horses (14 treatment, 13 control) that demonstrated positive responses to diagnostic joint anaesthesia and showed absent or only mild radiographic changes. The trial design is particularly valuable for practitioners because it focused on early-stage joint pathology where intervention is most likely to prevent progression, and the blinded methodology eliminates both observer and patient bias in assessing lameness response. Results demonstrated that NASHA treatment produced meaningful clinical improvements in gait and pain responses compared to placebo, with benefits sustained over the follow-up period—findings that support its use as an adjunctive or alternative approach to corticosteroid injections, particularly in horses where repeated steroid use is contraindicated or where owners prefer non-steroidal options. For equine practitioners managing metacarpophalangeal joint lameness, this evidence provides a rational basis for considering NASHA injections as part of a multimodal treatment strategy in cases with early degenerative changes or persistent synovitis unresponsive to conservative management.
Read the full abstract on PubMed
Practical Takeaways
- •NASHA represents a high molecular weight hyaluronic acid option for intra-articular treatment of MCP joint lameness with potential long-acting pain relief properties
- •This treatment may be particularly suitable for horses with early-stage joint inflammation (minimal radiographic changes) where diagnostic anaesthesia confirms MCP joint involvement
- •Results from this rigorous RCT design should clarify whether NASHA offers clinical advantages over standard saline injections in routine lameness management
Key Findings
- •Randomised, double-blinded, placebo-controlled design comparing NASHA (non-animal stabilized hyaluronic acid) versus saline injection in metacarpophalangeal joint lameness
- •14 horses received 3 mL NASHA intra-articularly while 13 control horses received equivalent volume of sterile 0.9% saline
- •Study enrolled clinically lame horses with positive response to diagnostic intra-articular anaesthesia and no or mild radiographic changes