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Joint Therapies
Laura Werner, DVM, MS, DACVS
From the moment a horse stands and walks, his joints are at a steady rate of degradation.
Repeated trauma or stress to the joint during everyday riding, athletic training or performance,
results in joint inflammation at some level in your horse which leads to the start of arthritis.
Osteoarthritis is the inflammation and subsequent bony changes that occur as a result of damage
to the cartilage padding the ends of bones in joints. As osteoarthritis progresses, veterinarians
have several different therapy options available to help combat your horses aching joints. The
goals of treatment are to minimize pain and inflammation, to slow down the degenerative
process, and to control the clinical signs of joint disease while extending the useful life of the
horse. Success is better achieved with early normalization of the acutely inflamed joint before
cartilage damage occurs and early initiation of therapy before the condition becomes chronic.
Treatment often includes a combination of therapies to provide the best response.
NSAIDS, or Non-Steroidal Anti-Inflammatory Drugs, are one of our first lines of defense with
treatment of joint disease in the horse. These include phenylbutazone, flunixin (Banamine®),
ketoprofen, firocoxib, and diclofenac. Newer NSAID’s such as firocoxib (Equioxx ®) and
topical diclofenac (Surpass®) are good options as they are safer for longer term use with less
ulcerogenic effects then phenylbutazone or flunixin. Longer -14 day- treatment periods of the
drug firocoxib are allowed within drug rule guidelines for competition.
Oral joint supplements are important as they do more to prevent inflammation and joint
breakdown than they do to treat it once it has started. Two excellent first-level joint
nutraceuticals are glucosamine and chondroitin sulfate as these products exhibit antiinflammatory properties for joints. There is a wide variety in costs, amounts of nutrients in each
product, and quality control in manufacturing so it is important to purchase your supplements
from a reputable source, such as veterinary owned companies. Additional supplement ingredients
such as Hyaluronic Acid (HA), MSM (methysufonylmethane) and Avocado Soybean
Unsaponifiables (ASU) have also been shown to reduce joint inflammation and improve the
appearance of cartilage in patients with arthritis.
Sodium hyaluronate is a major component of joint fluid and cartilage. Products containing
hyaluronate or hyaluronic acid and are available for intravenous (such as Legend®) or intraarticular use. Research has shown decreased lameness and decreased inflammatory factors in the
joint. It has few adverse reactions and intravenous use of the product has a wide distribution
throughout body. The intra-articular products are often used in combination with corticosteroids.
Hyaluronate is legal for competitions and the intravenous product is allowed during FEI
competitions.
Polysulfated glycosaminoglycans (Adequan®) also help decrease inflammation, improve
cartilage remodeling, improve mobility of the joint, and help decrease pain. The product can
also be used intramuscularly or intra-articularly. The intra-articular products are also often used
in combination with corticosteroids. The product is very safe and is also allowed for use during
competitions.
Tildren ®, a bisphosphanate compound, similar to drugs used for osteoporosis in humans is
another therapy for joint disease. It helps regulate the remodeling process of bone and clinical
trials show positive results for arthritis of hocks, spine, and navicular syndrome.
Still a popular option for direct joint therapy is intra-articular injections with corticosteroids.
Corticosteroids are powerful anti-inflammatory agents for the joint and achieve long lasting antiinflammatory effects by inhibiting the tissues within the joint from releasing several chemical
mediators that cause the initial process of inflammation – heat, pain, swelling and excess fluid.
Triamcinolone and betamethasone may help protect cartilage at lower doses, while
betamethasone may be a safer choice in an older patient with metabolic disease. Intra-articular
injections of hyaluronate or glycosaminoglycan products alone will maintain some horses as
well.
Newer therapies like regenerative medicine, also show positive results in the treatment of joint
disease. IRAP (or Interleukin Receptor Antagonist Protein) is a product that helps block the
negative effects of interleukin 1 in the joint. Interleukin 1 increases inflammation in the joint
and increases the degradation of protein within the joint. The product is derived from the
patient’s blood and then used directly in the joint for a series of 3-5 injections. The product is
easy to use, has few adverse reactions, and is safe to use around the time of competitions.
Platelet rich plasma (PRP) is also obtained from the patient’s own blood and is rich in growth
factors to help tissue healing and is another option in the treatment of joint disease. PRP is easy
to use, relatively low cost and is available for almost immediate use. Stem cells derived from a
patient’s own fat or bone marrow or banked stem cells from a donor horse are also used
frequently. The fat or bone marrow is collected and stem cells are cultured over 2-3 weeks to be
injected into an affected joint or joints. Stem cells from a donor source are available for
immediate use, but reactions occur at a higher rate since they are not derived from the individual
patient. Technology is improving for stem cells to be selectively cultured to help repair cartilage
within the joint. Gene therapy may also hold the key in the future for treatment of joint disease.
IRAP therapy
Arthritis of distal hock joints
Collection of bone marrow for stem cell culture