{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T01:36:29Z","timestamp":1781228189340,"version":"3.54.1"},"reference-count":50,"publisher":"American Veterinary Medical Association (AVMA)","issue":"3","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["javma"],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The goal of this project was to examine the metabolic effects of IA methylprednisolone acetate (MPA) following injection into multiple low-motion joints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Six 3-year-old geldings without pituitary pars intermedia dysfunction or insulin dysregulation were randomly injected with 20 mg of IA MPA\/joint (80 mg total; bilateral distal hock joints) or an equal volume of saline. Serial blood samples were collected for resting ACTH, cortisol, insulin, and glucose, as well as insulin and glucose following repeated low-dose oral sugar tests. Treatments were crossed over after a 6-week washout, and the process was repeated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>IA treatment with a total dose of 80 mg of MPA caused significant decreases in resting ACTH and cortisol concentrations between 4 and 12 hours after MPA injection. No significant effects of IA MPA treatment were noted in relation to resting insulin or glucose concentrations, nor were there any effects of IA MPA on insulin or glucose concentrations following low-dose oral sugar tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>80 mg of IA MPA in metabolically normal horses failed to induce significant changes in insulin and\/or glucose, in contrast to data reported with other IA corticosteroids.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>With significant concern regarding corticosteroid-induced laminitis and the reported correlation of laminitis with IA corticosteroid administration, the present report provides additional information for equine veterinarians. Reported practitioner sentiment that IA MPA carries a lower risk for corticosteroid-induced laminitis may relate to the lack of postinjection hyperinsulinemia noted in this study. However, additional work in insulin-dysregulated and\/or laminitis-prone horses is required before IA MPA should be considered safe to use in these horses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2460\/javma.25.08.0566","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:55:38Z","timestamp":1765385738000},"page":"326-331","source":"Crossref","is-referenced-by-count":1,"title":["Intra-articular methylprednisolone acetate does not induce hyperinsulinemia or hyperglycemia in metabolically normal horses"],"prefix":"10.2460","volume":"264","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6023-9230","authenticated-orcid":true,"given":"Allen E.","family":"Page","sequence":"first","affiliation":[{"name":"Maxwell H. Gluck Equine Research Center, Department of Veterinary Science, Martin-Gatton College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4885-3220","authenticated-orcid":true,"given":"Jenna L.","family":"McPeek","sequence":"additional","affiliation":[{"name":"Maxwell H. Gluck Equine Research Center, Department of Veterinary Science, Martin-Gatton College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Carattini","sequence":"additional","affiliation":[{"name":"Maxwell H. Gluck Equine Research Center, Department of Veterinary Science, Martin-Gatton College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ella","family":"McGreevy","sequence":"additional","affiliation":[{"name":"Lincoln Memorial University, Harrogate, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0777-0708","authenticated-orcid":true,"given":"Emma","family":"Adam","sequence":"additional","affiliation":[{"name":"Maxwell H. Gluck Equine Research Center, Department of Veterinary Science, Martin-Gatton College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1272","reference":[{"issue":"6","key":"ref1","series-title":"Equine Vet J","first-page":"563","article-title":"The use of intra-articular corticosteroids in the horse: what is known on a scientific basis?","volume":"42","author":"McIlwraith CW","year":"2010","unstructured":"McIlwraith CW. The use of intra-articular corticosteroids in the horse: what is known on a scientific basis? Equine Vet J. 2010;42(6):563-571. doi:10.1111\/j.2042-3306.2010.00095.x. Published correction appears in Equine Vet J. 2011;43(1):122"},{"issue":"7","key":"ref2","series-title":"Equine Vet Educ","first-page":"371","article-title":"Intra-articular corticosteroids: systematic review of effects on osteoarthritis and joint health","volume":"37","author":"Tokawa PKA","year":"2025","unstructured":"Tokawa PKA, Baccarin RYA, Zanotto GM. Intra-articular corticosteroids: systematic review of effects on osteoarthritis and joint health. Equine Vet Educ. 2025;37(7):371-381. doi:10.1111\/eve.14097"},{"issue":"4","key":"ref3","series-title":"Equine Vet J","first-page":"750","article-title":"Current joint therapy usage in equine practice: changes in the last 10 years","volume":"54","author":"Zanotto GM","year":"2021","unstructured":"Zanotto GM, Frisbie DD. Current joint therapy usage in equine practice: changes in the last 10 years. Equine Vet J. 2021;54(4):750-756. doi:10.1111\/evj.13489"},{"issue":"suppl 48","key":"ref4","series-title":"Equine Vet J","first-page":"24","article-title":"Triamcinolone administration does not increase overall risk of developing laminitis","volume":"47","author":"Hammersley E","year":"2015","unstructured":"Hammersley E, Duz M, Marshall JF. Triamcinolone administration does not increase overall risk of developing laminitis. Equine Vet J. 2015;47(suppl 48):24. Clinical research abstract of the British Equine Veterinary Association Congress. doi:10.1111\/evj.12486_54"},{"issue":"3","key":"ref5","series-title":"Vet Rec","first-page":"82","article-title":"Prevalence of and risk factors for acute laminitis in horses treated with corticosteroids","volume":"185","author":"Potter K","year":"2019","unstructured":"Potter K, Stevens K, Menzies-Gow N. Prevalence of and risk factors for acute laminitis in horses treated with corticosteroids. Vet Rec. 2019;185(3):82-82. doi:10.1136\/vr.105378"},{"issue":"5","key":"ref6","series-title":"Equine Vet J","first-page":"895","article-title":"Intrasynovial triamcinolone treatment is not associated with incidence of acute laminitis","volume":"53","author":"Haseler CJ","year":"2021","unstructured":"Haseler CJ, Jarvis GE, McGovern KF. Intrasynovial triamcinolone treatment is not associated with incidence of acute laminitis. Equine Vet J. 2021;53(5):895-901. doi:10.1111\/evj.13361"},{"issue":"4","key":"ref7","series-title":"J Am Vet Med Assoc","first-page":"470","article-title":"Case-control study of risk factors for pasture-and endocrinopathy-associated laminitis in North American horses","volume":"253","author":"Coleman MC","year":"2018","unstructured":"Coleman MC, Belknap JK, Eades SC,  Case-control study of risk factors for pasture-and endocrinopathy-associated laminitis in North American horses. J Am Vet Med Assoc. 2018;253(4):470-478. doi:10.2460\/javma.253.4.470"},{"issue":"10","key":"ref8","series-title":"Am J Vet Res","first-page":"1733","article-title":"Changes in articular cartilage after intra-articular injections of methylprednisolone acetate in horses","volume":"50","author":"Chunekamrai S","year":"1989","unstructured":"Chunekamrai S, Krook LP, Lust G, Maylin GA. Changes in articular cartilage after intra-articular injections of methylprednisolone acetate in horses. Am J Vet Res. 1989;50(10):1733-1741. doi:10.2460\/ajvr.1989.50.10.1733"},{"issue":"2","key":"ref9","series-title":"Osteoarthritis Cartilage","first-page":"106","article-title":"The effects of intra-articular methylprednisolone and exercise on the mechanical properties of articular cartilage in the horse","volume":"6","author":"Murray RC","year":"1998","unstructured":"Murray RC, DeBowes RM, Gaughan EM, Zhu CF, Athanasiou KA. The effects of intra-articular methylprednisolone and exercise on the mechanical properties of articular cartilage in the horse. Osteoarthritis Cartilage. 1998;6(2):106-114. doi:10.1053\/joca.1997.0100"},{"issue":"12","key":"ref10","series-title":"Am J Vet Res","first-page":"1619","article-title":"Effects of 6\u03b1-methylprednisolone acetate on an equine osteochondral fragment exercise model","volume":"59","author":"Frisbie DD","year":"1998","unstructured":"Frisbie DD, Kawcak CE, Baxter GM,  Effects of 6\u03b1-methylprednisolone acetate on an equine osteochondral fragment exercise model. Am J Vet Res. 1998;59(12):1619-1628. doi:10.2460\/ajvr.1998.59.12.1619"},{"issue":"5","key":"ref11","series-title":"Equine Vet J","first-page":"905","article-title":"Residual effects of intra-articular betamethasone and triamcinolone acetonide in an equine acute synovitis model","volume":"55","author":"Partridge E","year":"2023","unstructured":"Partridge E, Adam E, Wood C,  Residual effects of intra-articular betamethasone and triamcinolone acetonide in an equine acute synovitis model. Equine Vet J. 2023;55(5):905-915. doi:10.1111\/evj.13899"},{"issue":"2","key":"ref12","series-title":"Equine Vet J","first-page":"326","article-title":"Intra-articular triamcinolone acetonide injection results in increases in systemic insulin and glucose concentrations in horses without insulin dysregulation","volume":"56","author":"Boger BL","year":"2024","unstructured":"Boger BL, Manfredi JM, Loucks AR,  Intra-articular triamcinolone acetonide injection results in increases in systemic insulin and glucose concentrations in horses without insulin dysregulation. Equine Vet J. 2024;56(2):326-331. doi:10.1111\/evj.14003"},{"key":"ref13","series-title":"Front Vet Sci","first-page":"1388470","article-title":"Systemic absorption of triamcinolone acetonide is increased from intrasynovial versus extrasynovial sites and induces hyperglycemia, hyperinsulinemia, and suppression of the hypothalamic-pituitary-adrenal axis","volume":"11","author":"Hallowell KL","year":"2024","unstructured":"Hallowell KL, Dembek K, Horne CR, Knych HK, Messenger KM, Schnabel LV. Systemic absorption of triamcinolone acetonide is increased from intrasynovial versus extrasynovial sites and induces hyperglycemia, hyperinsulinemia, and suppression of the hypothalamic-pituitary-adrenal axis. Front Vet Sci. 2024;11:1388470. doi:10.3389\/fvets.2024.1388470"},{"key":"ref14","series-title":"J Equine Vet Sci","first-page":"105404","article-title":"Initial investigation into the metabolic effects of intra-articular betamethasone on normal and insulin dysregulated horses","volume":"147","author":"Page AE","year":"2025","unstructured":"Page AE, Rauber-Ramos AM, Humiston M, McPeek JL, Adam EN. Initial investigation into the metabolic effects of intra-articular betamethasone on normal and insulin dysregulated horses. J Equine Vet Sci. 2025;147:105404. doi:10.1016\/j.jevs.2025.105404"},{"issue":"15","key":"ref15","series-title":"Animals (Basel)","first-page":"2250","article-title":"The effects of intra-articular triamcinolone and autologous protein solution on metabolic parameters in horses","volume":"14","author":"Page AE","year":"2024","unstructured":"Page AE, Johnson M, Parker JL,  The effects of intra-articular triamcinolone and autologous protein solution on metabolic parameters in horses. Animals (Basel). 2024;14(15):2250. doi:10.3390\/ani14152250"},{"issue":"4","key":"ref16","series-title":"Am J Vet Res","first-page":"654","article-title":"Pharmacokinetics of methylprednisolone acetate after intra-articular administration and its effect on endogenous hydrocortisone and cortisone secretion in horses","volume":"67","author":"Soma LR","year":"2006","unstructured":"Soma LR, Uboh CE, Luo Y, Guan F, Moate PJ, Boston RC. Pharmacokinetics of methylprednisolone acetate after intra-articular administration and its effect on endogenous hydrocortisone and cortisone secretion in horses. Am J Vet Res. 2006;67(4):654-662. doi:10.2460\/ajvr.67.4.654"},{"issue":"9","key":"ref17","series-title":"Am J Vet Res","first-page":"1453","article-title":"Pharmacokinetics of methylprednisolone acetate after intra-articular administration and subsequent suppression of endogenous hydrocortisone secretion in exercising horses","volume":"73","author":"Men\u00e9ndez MI","year":"2012","unstructured":"Men\u00e9ndez MI, Phelps MA, Hothem EA, Bertone AL. Pharmacokinetics of methylprednisolone acetate after intra-articular administration and subsequent suppression of endogenous hydrocortisone secretion in exercising horses. Am J Vet Res. 2012;73(9):1453-1461. doi:10.2460\/ajvr.73.9.1453"},{"key":"ref18","article-title":"Recommendations for the diagnosis and treatment of pituitary pars intermedia dysfunction (PPID)","author":"Hart K","year":"2023","unstructured":"Hart K, Bertin FR, Durham A,  Recommendations for the diagnosis and treatment of pituitary pars intermedia dysfunction (PPID). 2023. Accessed May 6, 2025. https:\/\/equineendocrinologygroup.org\/s\/2023-EEG-PPID-Digital-version-with-insert-12222023.pdf"},{"key":"ref19","article-title":"Recommendations for the Diagnosis and Management of Equine Metabolic Syndrome (EMS) and Insulin Dysregulation","author":"Bertin F-R","year":"2024","unstructured":"Bertin F-R, Bailey S, Burns T,  Recommendations for the Diagnosis and Management of Equine Metabolic Syndrome (EMS) and Insulin Dysregulation. 2024. Accessed May 6, 2025. https:\/\/equineendocrinologygroup.org\/s\/Final-Oct-2024-EEG-EMS-ID-Recommendations.pdf"},{"issue":"4","key":"ref20","series-title":"Equine Vet J","first-page":"371","article-title":"Relationship between condition score, physical measurements and body fat percentage in mares","volume":"15","author":"Henneke DR","year":"1983","unstructured":"Henneke DR, Potter GD, Kreider JL, Yeates BF. Relationship between condition score, physical measurements and body fat percentage in mares. Equine Vet J. 1983;15(4):371-372. doi:10.1111\/j.2042-3306.1983.tb01826.x"},{"issue":"2","key":"ref21","series-title":"Vet J","first-page":"204","article-title":"Apparent adiposity assessed by standardised scoring systems and morphometric measurements in horses and ponies","volume":"179","author":"Carter RA","year":"2009","unstructured":"Carter RA, Geor RJ, Burton Staniar W, Cubitt TA, Harris PA. Apparent adiposity assessed by standardised scoring systems and morphometric measurements in horses and ponies. Vet J. 2009;179(2):204-210. doi:10.1016\/j.tvjl.2008.02.029"},{"key":"ref22","series-title":"Front Vet Sci","first-page":"1436714","article-title":"Accuracy and validation of a point-of-care blood glucose monitoring system for use in horses","volume":"11","author":"Velineni S","year":"2024","unstructured":"Velineni S, Schiltz P, Chang KH, Peng YM, Cowles B. Accuracy and validation of a point-of-care blood glucose monitoring system for use in horses. Front Vet Sci. 2024:11:1436714. doi:10.3389\/fvets.2024.1436714"},{"issue":"4","key":"ref23","series-title":"J Vet Pharmacol Ther","first-page":"260","article-title":"Meta-analysis and mechanism-based modeling of synovial and plasma pharmacokinetics and adrenal suppression following intra-articular injection of methylprednisolone acetate in horses","volume":"48","author":"Yu R","year":"2025","unstructured":"Yu R, Jusko WJ. Meta-analysis and mechanism-based modeling of synovial and plasma pharmacokinetics and adrenal suppression following intra-articular injection of methylprednisolone acetate in horses. J Vet Pharmacol Ther. 2025;48(4):260-273. doi:10.1111\/jvp.13504"},{"issue":"2","key":"ref24","series-title":"J Vet Pharmacol Ther","first-page":"125","article-title":"Disposition of methylprednisolone acetate in plasma, urine, and synovial fluid following intra-articular administration to exercised Thoroughbred horses","volume":"37","author":"Knych HK","year":"2014","unstructured":"Knych HK, Harrison LM, Casbeer HC, McKemie DS. Disposition of methylprednisolone acetate in plasma, urine, and synovial fluid following intra-articular administration to exercised Thoroughbred horses. J Vet Pharmacol Ther. 2014;37(2):125-132. doi:10.1111\/jvp.12070"},{"issue":"2","key":"ref25","series-title":"J Vet Intern Med","first-page":"902","article-title":"Blood glucose and insulin concentrations after alpha-2-agonists administration in horses with and without insulin dysregulation","volume":"34","author":"Kritchevsky JE","year":"2020","unstructured":"Kritchevsky JE, Muir GS, Leschke DHZ, Hodgson JK, Hess EK, Bertin FR. Blood glucose and insulin concentrations after alpha-2-agonists administration in horses with and without insulin dysregulation. J Vet Intern Med. 2020;34(2):902-908. doi:10.1111\/jvim.15747"},{"issue":"6","key":"ref1","series-title":"Equine Vet J","first-page":"563","article-title":"The use of intra-articular corticosteroids in the horse: what is known on a scientific basis?","volume":"42","author":"McIlwraith CW","year":"2010","unstructured":"McIlwraith CW. The use of intra-articular corticosteroids in the horse: what is known on a scientific basis? Equine Vet J. 2010;42(6):563-571. doi:10.1111\/j.2042-3306.2010.00095.x. Published correction appears in Equine Vet J. 2011;43(1):122"},{"issue":"7","key":"ref2","series-title":"Equine Vet Educ","first-page":"371","article-title":"Intra-articular corticosteroids: systematic review of effects on osteoarthritis and joint health","volume":"37","author":"Tokawa PKA","year":"2025","unstructured":"Tokawa PKA, Baccarin RYA, Zanotto GM. Intra-articular corticosteroids: systematic review of effects on osteoarthritis and joint health. Equine Vet Educ. 2025;37(7):371-381. doi:10.1111\/eve.14097"},{"issue":"4","key":"ref3","series-title":"Equine Vet J","first-page":"750","article-title":"Current joint therapy usage in equine practice: changes in the last 10 years","volume":"54","author":"Zanotto GM","year":"2021","unstructured":"Zanotto GM, Frisbie DD. Current joint therapy usage in equine practice: changes in the last 10 years. Equine Vet J. 2021;54(4):750-756. doi:10.1111\/evj.13489"},{"issue":"suppl 48","key":"ref4","series-title":"Equine Vet J","first-page":"24","article-title":"Triamcinolone administration does not increase overall risk of developing laminitis","volume":"47","author":"Hammersley E","year":"2015","unstructured":"Hammersley E, Duz M, Marshall JF. Triamcinolone administration does not increase overall risk of developing laminitis. Equine Vet J. 2015;47(suppl 48):24. Clinical research abstract of the British Equine Veterinary Association Congress. doi:10.1111\/evj.12486_54"},{"issue":"3","key":"ref5","series-title":"Vet Rec","first-page":"82","article-title":"Prevalence of and risk factors for acute laminitis in horses treated with corticosteroids","volume":"185","author":"Potter K","year":"2019","unstructured":"Potter K, Stevens K, Menzies-Gow N. Prevalence of and risk factors for acute laminitis in horses treated with corticosteroids. Vet Rec. 2019;185(3):82-82. doi:10.1136\/vr.105378"},{"issue":"5","key":"ref6","series-title":"Equine Vet J","first-page":"895","article-title":"Intrasynovial triamcinolone treatment is not associated with incidence of acute laminitis","volume":"53","author":"Haseler CJ","year":"2021","unstructured":"Haseler CJ, Jarvis GE, McGovern KF. Intrasynovial triamcinolone treatment is not associated with incidence of acute laminitis. Equine Vet J. 2021;53(5):895-901. doi:10.1111\/evj.13361"},{"issue":"4","key":"ref7","series-title":"J Am Vet Med Assoc","first-page":"470","article-title":"Case-control study of risk factors for pasture-and endocrinopathy-associated laminitis in North American horses","volume":"253","author":"Coleman MC","year":"2018","unstructured":"Coleman MC, Belknap JK, Eades SC,  Case-control study of risk factors for pasture-and endocrinopathy-associated laminitis in North American horses. J Am Vet Med Assoc. 2018;253(4):470-478. doi:10.2460\/javma.253.4.470"},{"issue":"10","key":"ref8","series-title":"Am J Vet Res","first-page":"1733","article-title":"Changes in articular cartilage after intra-articular injections of methylprednisolone acetate in horses","volume":"50","author":"Chunekamrai S","year":"1989","unstructured":"Chunekamrai S, Krook LP, Lust G, Maylin GA. Changes in articular cartilage after intra-articular injections of methylprednisolone acetate in horses. Am J Vet Res. 1989;50(10):1733-1741. doi:10.2460\/ajvr.1989.50.10.1733"},{"issue":"2","key":"ref9","series-title":"Osteoarthritis Cartilage","first-page":"106","article-title":"The effects of intra-articular methylprednisolone and exercise on the mechanical properties of articular cartilage in the horse","volume":"6","author":"Murray RC","year":"1998","unstructured":"Murray RC, DeBowes RM, Gaughan EM, Zhu CF, Athanasiou KA. The effects of intra-articular methylprednisolone and exercise on the mechanical properties of articular cartilage in the horse. Osteoarthritis Cartilage. 1998;6(2):106-114. doi:10.1053\/joca.1997.0100"},{"issue":"12","key":"ref10","series-title":"Am J Vet Res","first-page":"1619","article-title":"Effects of 6\u03b1-methylprednisolone acetate on an equine osteochondral fragment exercise model","volume":"59","author":"Frisbie DD","year":"1998","unstructured":"Frisbie DD, Kawcak CE, Baxter GM,  Effects of 6\u03b1-methylprednisolone acetate on an equine osteochondral fragment exercise model. Am J Vet Res. 1998;59(12):1619-1628. doi:10.2460\/ajvr.1998.59.12.1619"},{"issue":"5","key":"ref11","series-title":"Equine Vet J","first-page":"905","article-title":"Residual effects of intra-articular betamethasone and triamcinolone acetonide in an equine acute synovitis model","volume":"55","author":"Partridge E","year":"2023","unstructured":"Partridge E, Adam E, Wood C,  Residual effects of intra-articular betamethasone and triamcinolone acetonide in an equine acute synovitis model. Equine Vet J. 2023;55(5):905-915. doi:10.1111\/evj.13899"},{"issue":"2","key":"ref12","series-title":"Equine Vet J","first-page":"326","article-title":"Intra-articular triamcinolone acetonide injection results in increases in systemic insulin and glucose concentrations in horses without insulin dysregulation","volume":"56","author":"Boger BL","year":"2024","unstructured":"Boger BL, Manfredi JM, Loucks AR,  Intra-articular triamcinolone acetonide injection results in increases in systemic insulin and glucose concentrations in horses without insulin dysregulation. Equine Vet J. 2024;56(2):326-331. doi:10.1111\/evj.14003"},{"key":"ref13","series-title":"Front Vet Sci","first-page":"1388470","article-title":"Systemic absorption of triamcinolone acetonide is increased from intrasynovial versus extrasynovial sites and induces hyperglycemia, hyperinsulinemia, and suppression of the hypothalamic-pituitary-adrenal axis","volume":"11","author":"Hallowell KL","year":"2024","unstructured":"Hallowell KL, Dembek K, Horne CR, Knych HK, Messenger KM, Schnabel LV. Systemic absorption of triamcinolone acetonide is increased from intrasynovial versus extrasynovial sites and induces hyperglycemia, hyperinsulinemia, and suppression of the hypothalamic-pituitary-adrenal axis. Front Vet Sci. 2024;11:1388470. doi:10.3389\/fvets.2024.1388470"},{"key":"ref14","series-title":"J Equine Vet Sci","first-page":"105404","article-title":"Initial investigation into the metabolic effects of intra-articular betamethasone on normal and insulin dysregulated horses","volume":"147","author":"Page AE","year":"2025","unstructured":"Page AE, Rauber-Ramos AM, Humiston M, McPeek JL, Adam EN. Initial investigation into the metabolic effects of intra-articular betamethasone on normal and insulin dysregulated horses. J Equine Vet Sci. 2025;147:105404. doi:10.1016\/j.jevs.2025.105404"},{"issue":"15","key":"ref15","series-title":"Animals (Basel)","first-page":"2250","article-title":"The effects of intra-articular triamcinolone and autologous protein solution on metabolic parameters in horses","volume":"14","author":"Page AE","year":"2024","unstructured":"Page AE, Johnson M, Parker JL,  The effects of intra-articular triamcinolone and autologous protein solution on metabolic parameters in horses. Animals (Basel). 2024;14(15):2250. doi:10.3390\/ani14152250"},{"issue":"4","key":"ref16","series-title":"Am J Vet Res","first-page":"654","article-title":"Pharmacokinetics of methylprednisolone acetate after intra-articular administration and its effect on endogenous hydrocortisone and cortisone secretion in horses","volume":"67","author":"Soma LR","year":"2006","unstructured":"Soma LR, Uboh CE, Luo Y, Guan F, Moate PJ, Boston RC. Pharmacokinetics of methylprednisolone acetate after intra-articular administration and its effect on endogenous hydrocortisone and cortisone secretion in horses. Am J Vet Res. 2006;67(4):654-662. doi:10.2460\/ajvr.67.4.654"},{"issue":"9","key":"ref17","series-title":"Am J Vet Res","first-page":"1453","article-title":"Pharmacokinetics of methylprednisolone acetate after intra-articular administration and subsequent suppression of endogenous hydrocortisone secretion in exercising horses","volume":"73","author":"Men\u00e9ndez MI","year":"2012","unstructured":"Men\u00e9ndez MI, Phelps MA, Hothem EA, Bertone AL. Pharmacokinetics of methylprednisolone acetate after intra-articular administration and subsequent suppression of endogenous hydrocortisone secretion in exercising horses. Am J Vet Res. 2012;73(9):1453-1461. doi:10.2460\/ajvr.73.9.1453"},{"key":"ref18","article-title":"Recommendations for the diagnosis and treatment of pituitary pars intermedia dysfunction (PPID)","author":"Hart K","year":"2023","unstructured":"Hart K, Bertin FR, Durham A,  Recommendations for the diagnosis and treatment of pituitary pars intermedia dysfunction (PPID). 2023. Accessed May 6, 2025. https:\/\/equineendocrinologygroup.org\/s\/2023-EEG-PPID-Digital-version-with-insert-12222023.pdf"},{"key":"ref19","article-title":"Recommendations for the Diagnosis and Management of Equine Metabolic Syndrome (EMS) and Insulin Dysregulation","author":"Bertin F-R","year":"2024","unstructured":"Bertin F-R, Bailey S, Burns T,  Recommendations for the Diagnosis and Management of Equine Metabolic Syndrome (EMS) and Insulin Dysregulation. 2024. Accessed May 6, 2025. https:\/\/equineendocrinologygroup.org\/s\/Final-Oct-2024-EEG-EMS-ID-Recommendations.pdf"},{"issue":"4","key":"ref20","series-title":"Equine Vet J","first-page":"371","article-title":"Relationship between condition score, physical measurements and body fat percentage in mares","volume":"15","author":"Henneke DR","year":"1983","unstructured":"Henneke DR, Potter GD, Kreider JL, Yeates BF. Relationship between condition score, physical measurements and body fat percentage in mares. Equine Vet J. 1983;15(4):371-372. doi:10.1111\/j.2042-3306.1983.tb01826.x"},{"issue":"2","key":"ref21","series-title":"Vet J","first-page":"204","article-title":"Apparent adiposity assessed by standardised scoring systems and morphometric measurements in horses and ponies","volume":"179","author":"Carter RA","year":"2009","unstructured":"Carter RA, Geor RJ, Burton Staniar W, Cubitt TA, Harris PA. 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