Should I use corticosteroids?

It's coming to that time of year again that Bodie needs her joints injected with corticosteroids. It's always a time of reflection for me. The steroid injection have risks associated and there is no cure for arthritis as I'm sure a lot of human counterparts are all too aware of. So I am often left with the conundrum, do I inject her again?

Bodie is another year older, she is 29 now, how worthwhile is it to inject her? What are the risks? What will she gain out of it? What will I gain out of it? What will we gain out of it? How long will the relief last? Can I afford it?

The bad

At best the corticosteroids are just a temporary relief in the long lasting battle against osteoarthritis, but it isn't guaranteed, the older a horse, the less likely the success of the treatment. There is risk of infection as the needle is entering into the joint, which can at worst result in death, another complication that can occur (albeit rare) and to take into account when making the decision is the risk of developing laminitis.

The corticosteroid isn't going to buffer the already damaged cartilage. Pain is a natural defence mechanism to reduce the use, if you consider you have gone to the gym (or Monday night's BounceFit!) you may wake up sore and in pain, the pain is there to stop you from using the muscle so you can regenerate and reduce further damage. By using corticosteroids, you aren't lubricating the joint, you are merely masking the pain and inflammation. A month later your horse may feel amazing, you may up the workload to more than you usually would, but ultimately you are still grinding bone on bone, with the upped workload, you may actually be contributing to the deterioration without realising due to the masking properties. Other minor concerns to be aware of are the cost, which can vary greatly depending on where is being injected. Another concern is box rest is required for the first few days to really embed the corticosteroid so that is has chance to work, this is then followed by steadily bringing horses back into work after being injected, depending on the vet/horse this could be days or it could be weeks.

So where am I at?

I am a classic overthinker, so when I make decisions I will brew over it for days, ask other people, brew it over with them... and then brew it over some more by myself.

At 29 years old, if she wanted to live her life as a field ornament, I would fully respect and support that, she owes me nothing and for all of her years of service she deserves to have the best twilight years. I would choose not to inject her joints, avoid the risk and let her bodies defence system be a natural reminder that she needs to take it steady to avoid further cartilage (or worse bone) damage, I would want her to preserve herself and think before she galloped down the field, I could always turn to bute to help ease tough days.

However, here we are at the end of August, with a horse who went Eventing at the start of the month, fighting me in the dressage arena and tugging me into jumps. a horse that cantered past the two team chasers because she couldn't sit steadily behind them and a horse that after 3 days off of work turns into a trotting menace on the yard.

We might have a couple more years together, or we might only have a couple more months together. No one really knows. Bodie loves a sport that is heavy on concussion, she thrives on being out in an arena, hearing the start bell and throwing in long ones as and when she sees fit. This sport is likely to be her downfall and although I take the best care that I can with regard to warming up, ground conditions, physiotherapy etc.

I can't stop the degenerative condition of osteoarthritis no matter how many injections or supplements I give her. But what I can do, is provide her with the buzz of entering into an arena whether it's for the next few years or for her very last time.

So I will be treating Bodie with corticosteroid on Thursday (27th August 2020) under the direction of my vet.