Corticosteroids and Laminitis: Are We Overestimating the Risk?

For decades, corticosteroids have carried a warning label in equine practice: “Use carefully — they can trigger laminitis.” 

That concern still shapes clinical decisions today, especially in ponies, obese horses, and animals with endocrine disease. But when the available evidence is reviewed carefully, the story is far less straightforward than many clinicians assume. 

While corticosteroids have long been associated with laminitis, there is actually little scientific evidence proving direct causation in healthy horses^1,2,3. 

Most Reported Cases Already Had Risk Factors 

Several case reports describe horses developing laminitis after corticosteroid administration. However, many of those horses were already high-risk animals^3,4. 

Common underlying factors included: 

• Obesity 

• Previous laminitis 

• EMS or PPID 

• Pony phenotype 

This distinction is important clinically because these are already well-recognized risk factors for laminitis in the general equine population³. 

What Do Larger Studies Show? 

The actual incidence of laminitis following corticosteroid therapy appears surprisingly low. 

Retrospective reviews reported laminitis in: 

• 3/2000 horses treated with triamcinolone⁵ 

• 1/205 horses⁶  

• 20/27,898 horses⁷  

Interestingly, Hammersley et al. (2015) found the untreated control population actually had a higher laminitis risk than the horses receiving triamcinolone⁷. 

Similarly, Jordan et al. (2017) reported that although 3.9% of prednisolone-treated horses developed laminitis, the incidence was not significantly different from untreated controls⁸. 

Overall, the frequency of laminitis in corticosteroid-treated horses was approximately 0.6–1.0%, which is remarkably similar to the reported background prevalence of veterinary-diagnosed laminitis in the general GB equine population at 0.5%⁹. 

That is a key practical point: 

Corticosteroid-treated horses do not appear to develop laminitis more frequently than the general equine population. 

Which Horses Are Actually at Higher Risk? 

The strongest associations were linked to the horse, not necessarily the drug. 

Univariable and logistic regression analyses showed that: 

• Obese or overweight horses were 4 times more likely to develop laminitis 

• Horses with pre-existing laminitis risk factors were 18 times more likely to develop laminitis after corticosteroid therapy 

Importantly, these are the same animals already predisposed to laminitis even without steroid administration. 

Is Triamcinolone More Dangerous? 

Triamcinolone is often blamed as the corticosteroid most likely to trigger laminitis^1,3. 

However, this perception was not supported by the study findings³. 

What About Dose? 

No significant relationship was found between corticosteroid dose and laminitis development. 

However, most administered doses remained within recommended therapeutic ranges. The authors acknowledged that determining whether higher doses alter risk would require more controlled prospective studies³. 

Timing of Laminitis Matters 

Most reported cases developed laminitis either: 

• During corticosteroid therapy 

or 

• Within 14 days after treatment cessation 

Jordan et al. (2017) reported that 75% of prednisolone-associated cases occurred during therapy or within 7 days after stopping treatment⁸. 

This timing matters clinically because laminitis developing weeks later becomes difficult to directly attribute to corticosteroid administration. 

Important Clinical Limitations 

The paper also highlights an important real-world issue: 

Many horses receiving corticosteroids simultaneously undergo management changes that independently increase laminitis risk, including: 

• Reduced exercise 

• Box rest 

• Dietary changes 

• Altered pasture access 

These confounding factors are difficult to separate in field studies. 

Additionally, some mild laminitis cases may never be examined by a veterinarian, meaning true prevalence may be underestimated. 

Practical Takeaways for Equine Vets 

Screen before treating 

Before administering corticosteroids, especially systemically, assess: 

• Body condition score 

• Previous laminitis history 

• EMS or PPID status 

• Pony phenotype 

Be more cautious in metabolically abnormal horses 

Most steroid-associated laminitis cases occur in animals already predisposed to the disease. 

Don’t avoid corticosteroids unnecessarily 

The evidence does not support the idea that corticosteroids commonly trigger laminitis in healthy horses. 

Monitor closely for 2 weeks post-treatment 

Most reported cases develop within this period. 

Final Thought 

Corticosteroids remain valuable and often necessary drugs in equine medicine. Current evidence suggests that laminitis following corticosteroid therapy is uncommon and occurs primarily in horses already carrying significant metabolic or historical risk factors. 

In practice, the bigger question may not be: 

“Can corticosteroids cause laminitis?” 

But rather: 

“Is this horse already predisposed to laminitis before the corticosteroid is even administered?” 

References  

1. Cornelisse CJ, Robinson NE. Glucocorticoid therapy and the risk of equine laminitis. Equine Veterinary Education. 2013 Jan;25(1):39-46. https://doi.org/10.1111/j.2042-3292.2011.00320.x  

2. McGowan C, Cooper D, Ireland J. No evidence that therapeutic systemic corticosteroid administration is associated with laminitis in adult horses without underlying endocrine or severe systemic disease. Veterinary Evidence. 2016 Jan 22;1(1). https://doi.org/10.18849/ve.v1i1.12  

3. Potter K, Stevens K, Menzies‐Gow N. Prevalence of and risk factors for acute laminitis in horses treated with corticosteroids. Veterinary Record. 2019 Jul;185(3):82-.http://dx.doi.org/10.1136/vr.105378  

4. Winfield LD, White SD, Affolter VK, Renier AC, Dawson D, Olivry T, Outerbridge CA, Wang YH, Iyori K, Nishifuji K. Pemphigus vulgaris in a Welsh pony stallion: case report and demonstration of antidesmoglein autoantibodies. Veterinary Dermatology. 2013 Apr;24(2):269-e60. https://doi.org/10.1111/vde.12002  

5. Bathe AP. The corticosteroid laminitis story: 3. The clinician's viewpoint. Equine Veterinary Journal. 2007 Jan;39(1):12-3. https://doi.org/10.2746/042516407X165801  

6. McCluskey MJ, Kavenagh PB. Clinical use of triamcinolone acetonide in the horse (205 cases) and the incidence of glucocorticoid-induced laminitis associated with its use. https://doi.org/10.1111/j.2042-3292.2004.tb00272.x  

7. Hammersley E, Duz M, Marshall JF. Triamcinolone administration does not increase overall risk of developing laminitis. Equine Veterinary Journal. 2015 Sep;47:24-. https://doi.org/10.1111/evj.12486_54  

8. Jordan VJ, Ireland JL, Rendle DI. Does oral prednisolone treatment increase the incidence of acute laminitis?. Equine veterinary journal. 2017 Jan;49(1):19-25. https://doi.org/10.1111/evj.12565  

9. Wylie CE, Collins SN, Verheyen KL, Newton JR. A cohort study of equine laminitis in G reat B ritain 2009–2011: Estimation of disease frequency and description of clinical signs in 577 cases. Equine veterinary journal. 2013 Nov;45(6):681-7. https://doi.org/10.1111/evj.12047