Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
Westover Veterinary Centre, Hainford, UK.
Equine Vet J. 2021 Sep;53(5):895-901. doi: 10.1111/evj.13361. Epub 2020 Nov 30.
Intrasynovial corticosteroid injections are commonly used in the treatment of equine orthopaedic disease, but corticosteroid administration is widely considered a risk factor for the development of laminitis. Despite a list of putative mechanisms and a number of case reports of steroid-induced laminitis, no case-control or cohort studies investigating the association between use of intrasynovial corticosteroids and acute laminitis have been published.
To quantify the risk of laminitis posed by intrasynovial triamcinolone acetonide (TA) administration in a mixed population of horses.
Retrospective observational cohort study.
Clinical records of horses registered with one large UK equine practice were reviewed retrospectively to identify all horses receiving intrasynovial TA treatment between 1 January 2007 and 31 December 2017. A total of 1510 horses were selected and records investigated for incidence of laminitis over a 4-month period following treatment. For each TA-treated horse, an untreated horse, individually matched by age, sex, date of treatment and client type, was selected from the clinical records. Untreated horses were then investigated for laminitis over the same 4-month period. Data were analysed in a 2 × 2 contingency table using Fisher's exact test.
A total of 489 horses were lost to follow-up and 55 horses were excluded, leaving 966 treated and matched, untreated horses. The incidence of laminitis over the 4-month study period in both groups was identical: 3/966 horses (0.31%) (95% C.I. [0.08%, 0.91%]), equivalent to 0.93 cases per 100 horses per year (P > .9).
Retrospective study; large proportion (489/1510) of horses lost to follow-up; large proportion of study population were racehorses; selection method resulted in disproportionate selection of horses born before 2013; similar incidence between groups may reflect existing risk-based selection by clinicians.
intrasynovial triamcinolone acetonide administration does not increase the risk of laminitis in this study population.
关节内皮质类固醇注射常用于治疗马的骨科疾病，但皮质类固醇的使用被广泛认为是导致蹄叶炎的一个危险因素。尽管有一系列推测的机制和一些类固醇引起的蹄叶炎的病例报告，但没有病例对照或队列研究调查关节内皮质类固醇的使用与急性蹄叶炎之间的关系。
量化混合马群中关节内曲安奈德（TA）给药引起蹄叶炎的风险。
回顾性观察性队列研究。
回顾性查阅一家英国大型马科诊所的病历，以确定 2007 年 1 月 1 日至 2017 年 12 月 31 日期间接受关节内 TA 治疗的所有马匹。共选择了 1510 匹马，在治疗后 4 个月内记录蹄叶炎的发病率。对于每只接受 TA 治疗的马，从病历中选择一只未接受治疗的马，根据年龄、性别、治疗日期和客户类型进行个体匹配。然后在相同的 4 个月内对未接受治疗的马进行蹄叶炎调查。使用 Fisher 确切检验对 2×2 列联表中的数据进行分析。
共有 489 匹马失访，55 匹马被排除，966 只接受治疗和匹配的未接受治疗的马被留下。两组在 4 个月的研究期间蹄叶炎的发病率相同：3/966 匹马（0.31%）（95%CI[0.08%，0.91%]），相当于每 100 匹马每年 0.93 例（P>.9）。
回顾性研究；大量（489/1510）马匹失访；研究人群中很大一部分是赛马；研究人群选择方法导致 2013 年前出生的马匹选择比例过高；两组之间相似的发病率可能反映了临床医生现有的基于风险的选择。
在本研究人群中，关节内曲安奈德给药不会增加蹄叶炎的风险。
