Managing Arthritis in Performance Horses
Updated: Feb 13, 2020
Recently I have been battling bouts of off-and-on lameness with my Dressage horse Cole. Cole is a 12-year-old Holsteiner gelding who did working hunter in his previous life. He and I qualified for regionals last year in 1st level and were also showing in 2nd level. Most recently we were schooling and preparing for 3rd level before we had an unfortunate frisky turn-out day in the field which lead to an episode of lameness. With this being the second occurrence of unexplained lameness, we decided to investigate further into the cause.
For Cole, there was no heat or swelling in the area. (Though this is uncommon as most osteoarthritis in joints will manifest in some form of topical swelling such as windpuffs or heat.) My vet first performed flexions and nerve blocks to narrow the lameness down to a particular area. Next, we did x-rays but we also had previous x-rays to compare with. (I highly recommend having base x-rays for all horse owners as it will greatly assist when it comes to making a diagnosis on your horse’s current lameness.) Since we did have previous x-rays, we knew he had minor arthritic changes in his coffin joint. The new x-rays didn’t show any changes compared to the previous x-rays. We also performed an ultrasound to check for any soft tissue tears. The ultrasound did show some modeling, but no obvious soft tissue tears. We were confident the ultrasound was showing previous “wear and tear.” However, it’s important to note that it’s nearly impossible to ultrasound the tendons that go into the hoof that's why an MRI can sometimes be the best option for a clear diagnosis.
Our findings thus far definitely gave us some things to consider and treat, but I was still concerned there was more going on. I have dealt with osteoarthritis (OA) in horses previously and, for me, it always revealed itself as coming out stiff or as a slight lameness most the time. For that reason, we decided to bring him over to UGA for an MRI. (I will do a later post on this experience).
This was the best decision we made because the MRI truly showed EVERYTHING going on. Though I am happy to report Cole did not have any soft tissue injuries, unfortunately, he does have moderate osteoarthritis, cartilage wear, and synovitis(inflammation) in his coffin joint. The synovitis is most likely what caused the onset lameness thanks to his “winter romp.” Though cartilage damage is not reversible, it is treatable with long term management, medications, and care.
Treatment options for arthritis
No drug treatment can replace or repair lost cartilage. In Cole’s situation, where there is an excess of inflammation in the joint (synovitis), the first goal is to reduce the inflammation. Synovitis can be even more damaging to the joint, so rest with only light exercise is important until the inflammation is under control.
Physical therapy is also very beneficial for horses with arthritis. Depending on the nature of the arthritis, physical therapy may include ice boots/wraps, cold hydrotherapy, heat
for chronic inflammation, support wraps, liniments, hand walking, poultices, laser therapy, and ultrasound therapy.
NSAIDS(bute or Banamine) are a short-term solution to reduce inflammation quickly. They shouldn’t be used as long-term treatment because they can cause potential toxicity as well as other side effects such as stomach ulcers. Surpassis a new topical cream that works well and has less potential for serious side effects.
There are overwhelming amounts of over-the-counter joint supplements available to horse owners, but there is limited information proving their effectiveness in treating already existing osteoarthritis or degenerative joint disease. Joint supplements can help provide building blocks for horses' bodies to help protect their joints from future damage, but they most likely shouldn’t be used as the sole treatment for a horse that already has arthritis.
IM and IV Injectable treatments
Adaquan is the only FDA approved (polysulfated glycosaminoglycan) for degenerative joint disease (DJD) in horses. Adequan reduces inflammation in joints and stimulates the production of hyaluronic acid within the joint. Repeat intra-muscular injections are given every 4 days for one month, then as needed to maintain.
Legend is the only FDA approved (Hyaluronate Sodium) intravenous treatment for joint dysfunction due to non-infectious synovitis associated with equine osteoarthritis. Legend is a hyaluronate sodium injectable solution. Treatment with Legend may be repeated at weekly intervals for a total of three treatments and then as needed to maintain.
Summit Joint Performance is a newer non-FDA approved (chondroitin sulfate) used to promote healthy, thick synovial fluid, decreasing inflammation in joints and improving the cushioning properties of joint cartilage. Summit is given as repeat intra-muscular injections once a week for four weeks and then monthly or bi-monthly as needed.
Corticosteroids are the most potent and possibly most effective treatment in relieving joint inflammation. They can be used in conjunction with hyaluronic acid and administered into the joint simultaneously. Inflammation is reduced and the joint is lubricated. There are two main side effects of using corticosteroids. First is infection, because steroids can suppress the immune system, horses can be prone to bacterial infection after the injection. Second is laminitis, although there is a less than .5% chance that a horse treated with steroids can develop laminitis, this risk is more likely to occur in elderly horses or horses with a history of laminitis. Limiting the number of joints being treated can help minimize this risk as well.
IRAP Interleukin-1 Receptor Antagonist Protein is a new and effective intra-articular treatment for joint disease. IRAP is an anti-inflammatory protein that counteracts the destructive effects of inflammatory proteins such as Interleukin-1 (IL-1) which are produced within inflamed or arthritic joints. The process of harvesting IRAP is quite simple and can be performed as outpatient and/or potentially on the farm. Blood is collected from the jugular vein and incubated for 24 hours in special syringes that contain glass beads that induce the white blood cells present in the blood to produce and secrete therapeutic proteins, namely, IRAP. Each collection produces enough serum for between 3-5 injections. The therapy involves three joint injections at 7-14-day intervals, but the serum can be stored for up to 12 months from the date of collection.
Pro-Stride APS is a newer joint injection therapy whose output produces a concentrated solution of cells, platelets, growth factors, and anti-inflammatory proteins (including IL-1ra and TNF-Alpha proteins). Pro-Stride combines IRAP and PRP. PRP(platelet-rich plasma) is another blood-derived product that concentrates growth factors helping to fight inflammation and promote healing. Pro-Stride offers the advantage of 20-minute processing time as opposed to 24 hours with IRAP. It can be used in the field and, in most cases, will have a positive effect on the joint for approximately one year. Because IRAP and Pro-stride both use the patient’s own blood, there is a less likely occurrence of infection or other complications.
Intra-articular joint injections do require a minimum of 3 days stall rest, and an additional 10 days of limited exercise is advised.
Our treatment plan for Cole
Because Cole currently has acute synovitis, I have opted to treat him initially with a corticosteroid and hyaluronic acid (HA) combined joint injection. After that I will try to move forward on a schedule using Pro-Stride injections since it is possibly a safer intra-articular injection option. I will be giving Cole Adequan IM injection series along with Legend IV series injections every six months to a year as needed. As far as a joint supplement, we will be giving him one that focuses more on being anti-inflammatory and pain-relieving. SmartPak offers a supplement called SmartStride Senior Pellets which has ingredients such as turmeric root powder, MSM, and yucca extract which may help reduce pain and inflammation associated with arthritis. Boswellia extract helps address discomfort associated with exercise, and hydrolyzed collagen helps promote healthy cartilage and soft tissue.
On days Cole works extra hard, I will be icing his legs after riding with my Professionals Choice ice boots. One thing I had already started doing is tack walking him at least 20 minutes during my warm-up. This is such an important, often skipped step when it comes to warming up your horse. A proper warm-up is one of the best things you can do to protect your horse from injury. Slowly phasing into work allows your horse's tendons to stretch gently and joints to prepare for more vigorous exercise. Initially, having a timer for this step is crucial.