🩺 Vet’s 2025 Guide to Chronic Inflammation in Horses

By Dr Duncan Houston BVSc

1. Understanding Chronic Inflammation

Chronic inflammation is persistent tissue response—commonly seen in joints, tendons, soft tissues, and organs. Left unchecked, it leads to fibrosis, pain, impaired performance, and systemic effects like metabolic derangement.

2. Common Causes

• Musculoskeletal injuries – persistent tendon, ligament, joint damage, incomplete healing.
• Recurrent infections – low-grade foot abscesses, guttural pouch disease, chronic endometritis.
• Metabolic/endocrine causes such as EMS or PPID can increase inflammatory markers.
• Environmental factors – stable dust, poor footing, or repetitive overwork.

3. Clinical Signs & Detection

• Swelling, heat, and pain on palpation—often mild but progressive.
• Reduced performance, stiffness, shifting lameness.
• Systemic signs: mild fever, weight loss, poor coat or condition.
• Chronic lameness with fluctuating signs, dependent on rest and work cycles.

4. Diagnostic Approach

• Physical exam: flexion tests, palpation, heat/swelling assessment.
• Imaging: ultrasound for tendons/ligaments, radiographs/ultrasound/joint scans for joint disease.
• Joint fluid analysis: scoring EPS (WBC, protein) to confirm chronic synovitis.
• Lab tests: CBC, fibrinogen, serum amyloid A (SAA) to assess systemic inflammation.
• Metabolic screening: insulin, ACTH, and metabolic panels where endocrine disease is suspected.

5. Treatment Strategies

5.1 Pharmaceutical Management

• NSAIDs (phenylbutazone, flunixin) — lowest effective dose, mindful of gastric/hindgut side effects.
• Corticosteroids (systemic or intra-articular, e.g., methylprednisolone or triamcinolone) — highly effective for joint/tendon sheath issues; monitor for laminitis risk.
• Bisphosphonates (tiludronate, clodronate) help manage bone-associated inflammation, especially in navicular or collateral remodeling.
• Biologic therapies: IRAP, PRP, stem cell injections—support tissue healing and modulate inflammation.

5.2 Supportive Care & Rehabilitation

• Controlled exercise with turnout and physiotherapy to promote healthy healing.
• Cold water therapy post-exercise; hydrotherapy for swelling control.
• Therapeutic shoeing or support boots to reduce joint/tendon stress.

5.3 Dietary & Nutritional Support

• Omega-3 fatty acids (flaxseed, fish oil) help reduce cytokine activity.
• Antioxidant vitamins (E, C) and trace minerals (selenium, zinc) support tissue recovery.
• Low starch/fat diet when endothelial or obese—allied with EMS management.

6. Long-Term Monitoring

• Periodic clinical recheck—joint fluid analysis, imaging comparison.
• Monitor NSAID use—occasional gastroscopy and renal profile when using chronic NSAIDs.
• Regular metabolic checks (insulin, ACTH) if endocrine involvement suspected.

7. Prevention Strategies

• Maintain sound training plans—avoid overuse injuries.
• Ensure good surface quality in arenas/paddocks.
• Balanced exercise and adequate recovery, including physiotherapy and turnout.
• Early treatment of minor injuries to prevent chronic inflammation.

8. Rehabilitation & Return to Work

• Structured rehab timeline: 4–6 weeks rest, then gradual return over several months.
• Use markers like swelling, lameness grade, and imaging to guide progress.
• Avoid premature high-impact sessions; focus on flexibility and strength first.

9. Ask A Vet Support 🩺

With Ask A Vet you benefit from:

• Real-time video/photo evaluation of swelling, gait, or posture.
• Support choosing and monitoring medication strategies and side effects.
• Custom rehab schedules with milestone tracking.
• Dietary coaching and supplement review to reduce chronic inflammatory load.
• Follow-up checks on lab results and endocrine screening.

Download the Ask A Vet app and get personalized long-term inflammation management support into 2025 and beyond! ❤️

10. Quick Reference Table

11. Final Thoughts

Chronic inflammation in horses, though complex, can be expertly managed with strategic diagnosis, balanced pharmaceuticals, rehabilitation, and lifestyle adaptations. With Ask A Vet at your side, you’ll receive ongoing veterinary insight to help your horse stay comfortable, functional, and thriving well into 2025 and beyond. ❤️