Dr. Lisa Fortier, long-time equine surgeon and clinician-scientist at Cornell University and now Editor-in-Chief of JAVMA and AJVR, has devoted much of her career to understanding and treating OA. In conversation with us, she highlighted how the understanding of the disease has shifted over time, and what veterinarians can do to improve outcomes in practice today.
“For so long, the conversation around OA was all about cartilage,” Dr. Fortier explains. “But what really drives pain is the synovial membrane. Targeting joint homeostasis means targeting the synovium, and understanding OA as an immune-regulated disease, not just wear-and-tear.”
This recognition has reshaped how clinicians approach OA: from diagnostics and imaging to biologic therapies and long-term management.
Accurate diagnosis, Fortier says, is the foundation of successful treatment. Even mild lameness deserves a thorough work-up rather than a “shotgun” injection. Flexion tests can be helpful, but they should guide further diagnostics, not replace them. And above all, the physical exam remains the veterinarian’s best tool.
“Too often we jump to injections,” she cautions. “But if you treat the wrong joint, you not only waste money, you also risk convincing the client that a therapy ‘doesn’t work’ when it was never the right target to begin with.”
When it comes to intra-articular therapy, Fortier’s philosophy is clear: set the joint up for success. She explains, “I often start with leukocyte-reduced PRP or IRAP to restore joint biology, then after two weeks I follow up with a polyacrylamide hydrogel such as Arthramid®. That combination — in the right patient and with the right management — can make a real difference.”
She rarely uses corticosteroids anymore, pointing out their limited durability, negative systemic effects, and the risk of misleading “steroid euphoria.” And she offers a strong caution: “If you have to go back to the joint more than twice in your initial treatment scheme, either the disease is too advanced — which you should see radiographically — or you’ve got the diagnosis wrong.”
For Fortier, medical therapy is only one piece of the puzzle. She sees overnutrition and metabolic disease as the biggest challenges in equine health today, urging veterinarians to include baseline insulin checks in routine exams. Load management is equally critical, with clients encouraged to track riding time and intensity just as an athlete would monitor training loads. Footing and farriery also play pivotal roles, and the value of foot balance films should not be overlooked.
Rehabilitation is another essential element, although it is quite under-researched: “As far as I’m aware, using poles, on the ground or raised, are the only exercises that have been proven for increased core strength ”, she notes. “Other exercises may help, but poles are what have been studied.”
She acknowledges that nutrition, workload, and turnout are often the hardest things to change, yet they are also the most cost-effective. “They often matter more than any injection I can offer,” she says.
What excites Fortier most about the future of OA treatment is twofold: the potential of targeted immunotherapies that address the immune cells driving the disease, and tech advances that could increase diagnostics, like motion analysis and PET scanning, to help us understand why some patients respond well to treatment while others do not.
Ultimately, Fortier returns to a few guiding principles that every veterinarian can apply in daily practice. Get the diagnosis right before reaching for the syringe. Think about setting the joint up for success rather than chasing short-term relief. If you find yourself going back into the same joint more than twice in the initial treatment phase, stop and reassess. And never forget that management — from nutrition and workload to shoeing and rehab — is as important as any medical therapy.
“Equine osteoarthritis is about the whole horse,” she concludes. “If we manage the environment, nutrition, and workload, our medical therapies stand a far better chance of helping the joint succeed.”
