Low-Dose Corticosteroids for Treating Acute Laminitis

Veterinarians often shy away from administering corticosteroids, however, due to possible systemic effects associated with high doses--including triggering laminitic episodes. But corticosteroids' benefits could outweigh the risks.

Photo: Christy M. West

Laminitis treatment recommendations and therapies come and go: Some once considered gold standards have been abandoned altogether, and others resurface over time (e.g., icing acutely laminitic feet). Corticosteroids, which veterinarians have historically advised against using to treat laminitic horses, might be one of those therapies warranting reconsideration. With this in mind, Robert Boswell, DVM, a private practitioner in Wellington, Fla., discussed why he believes these potent anti-inflammatories are an effective treatment method at the 6th International Equine Conference on Laminitis and Diseases of the Foot, held Oct. 28-31 in West Palm Beach, Fla.

When approaching a laminitis case, Boswell's goals include identifying and treating the cause of disease (as opposed to addressing just the clinical signs); supporting the bony column of the distal limb and the sensitive soft tissues within the hoof capsule; and treating inflammation aggressively and rapidly with tools such as ice, rest, dimethylsulfoxide (DMSO), and non-steroidal anti-inflammatory drugs (NSAIDs). Veterinarians often shy away from administering corticosteroids (such as dexamethasone and prednisone), however, due to possible systemic effects associated with high doses--including triggering laminitic episodes.

According the Boswell, corticosteroids' benefits (when used appropriately, in low doses) should outweigh the risks. For instance, these drugs inhibit inflammatory mediator expression and decrease prostaglandin production (a fatty acid-derived compound that triggers an inflammatory response). He emphasized that no causal relationship exists between corticosteroid use and laminitis development; cases associated with corticosteroid use occurred with unreasonably high drug doses for long periods of time.

"I propose that if we are indeed intending to aggressively decrease inflammation we are not maximizing our chances for success by excluding low doses of corticosteroids," he said. "I believe that the use of low-dose corticosteroids would dramatically improve the outcomes for many of our laminitis patients."

Boswell reminded veterinarians to consider each laminitic horse's clinical picture before prescribing corticosteroids. An insulin-resistant horse or one at risk for systemic inflammatory response syndrome, for instance, might not be an appropriate candidate because high doses of corticosteroids can raise blood insulin levels. He said more research is needed to determine appropriate doses, administration rates, and if low doses also raise insulin levels.

In conclusion Boswell suggested that "the use of low-dose corticosteroids such as dexamethasone, in the acutely laminitic horse, either systemically or via regional limb perfusion, would decrease inflammation in the laminae and hoof capsule."

By incorporating corticosteroids into acute laminitis treatment regimens, veterinarians might start seeing a better overall response to initial therapies.

About the Author

Alexandra Beckstett, The Horse Managing Editor

Alexandra Beckstett, Managing Editor of The Horse and a native of Houston, Texas, is a lifelong horse owner who has shown successfully on the national hunter/jumper circuit and dabbled in hunter breeding. After graduating from Duke University, she joined Blood-Horse Publications as Assistant Editor of its book division, Eclipse Press, before joining The Horse.

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