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Medications Articles

Medications Articles

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Published by S. Bala Dahiya
American Association of Equine Practitioners
American Association of Equine Practitioners

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Published by: S. Bala Dahiya on Jul 20, 2014
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Medications Articles
Lameness & Joint Medications
by Benjamin Espy, DVM
General Information  As horse owners you have een omarded with numerous articles and advertisements that dealwith the !revention and treatment of "oint disease in horses# Althou$h "oint thera!y has een !rimarily tar$eted at thorou$hred and %uarter horses there are even miniature horses that deal with the same sorts of !rolems# Breedin$ stallions and drivin$ horses are es!ecially !rone to  "oint soreness# Traumatic "oint disease in horses includes synovitis 'inflammation of the fluid(!roducin$ memrane) ca!sulitis 'inflammation of the firous "oint ca!sule) articular cartila$e and one fra$mentation li$amentous tearin$ and eventually arthritis# In most cases the disease !rocess !rimarily involves soft tissue overuse and in"ury and cannot e dia$nostically confirmed e*ce!t for arthrosco!y+,ou have to trust your veterinarian to decide when "oint in"ections may e eneficialfor your horse# There is no -$old standard. for the dia$noses of !reliminary "oint disease in the horse as radio$ra!hic chan$es are usually indicative of irre!arale harm# A$$ressive treatment in "oint disease is indicated to decrease immediately soft tissue swellin$ and inflammation as well asto !ost!one the onset of !ermanent osteoarthritic chan$es# There is inherent difficulty in identifyin$ "oint !atholo$y y any other means than su"ective e*amination and lameness or -shortness of stride. re!orts from trainers# The $oal of any intraarticular 'medications !ut directly into the "oint) thera!y is to sto! !rolems efore they occur rather than wait for anormal radio$ra!hs and then start a$$ressive thera!y# Inflammatory and de$radative en/ymes that destroy normal "oint environments can e altered y use of hyaluronic acid 'HA) and corticosteroids in"ected into the "oint# The comination of the two has een scientifically !roven to have a more thorou$h and lastin$ effect than HA alone or corticosteroids alone# Medications introduced into "oints y human !hysicians that s!eciali/e in s!orts medicine are ecomin$ more common!lace# 0revious $enerali/ations and !er!etuation of myths aout dama$e to "oint environments caused y corticosteroids are !rimarily unfounded# The elief that corticosteroids cause dama$e or !er!etuate cartila$e destruction can only e e*!erimentally re!eated y multi!le "oint in"ections over days to wee1s# Ty!ically when there is mild soreness '"oint ca!sulitis or synovitis) in a "oint and "oint thera!y is instituted 2(3 times !er year the environment inside the "oint ecomes more hos!itale to cartila$e not destructive# 4ama$e may occur from corticosteroid in"ection alone when there is cartila$e fra$mentation and one alterations in a "oint usually associated with lameness# This is why your veterinarian may re%uire a radio$ra!h efore institutin$ "oint thera!y# Interestin$ly even in "oints that have documented one fra$ments cartila$e dama$e does not occur until "oints are re!eatedly in"ected with corticosteroids routinely over many days and wee1s#The metaolism of the e%uine "oint is different than in other s!ecies# They are not afflicted with -5harcot(Li1e. arthro!athy that occurs in humans with the develo!ment of arthritis from corticosteroid in"ections# It has een !roven that corticosteroids and HA to$ether allows the natural synovial linin$ of a "oint to ma1e a more viscous and luricatin$ environment# Intraarticular Hyaluronic Acid 'HA) 0roaly the most commonly used HA !roducts are Hylartin(6 Hy6isc Le$end or Hyalovet# All of these !roducts are laeled for intraarticular use insurin$ !urity and consistency with each
individual manufacturer# MA0(7 is hyaluronic acid used in s!erm e*tender and is not laeled for ut has een used in "oint thera!y# HA is normally synthesi/ed y the synovial memrane# HA is res!onsile for the oundary lurication of articular cartila$e# 8*!erimental evidence comined with anecdotal re!orts from e%uine !ractitioners that do s!orts medicine s!ecialties re!ort that usin$ the hi$hest molecular wei$ht 'thic1ness) of HA !rovides the most enefit# 0olysulfated Glycosamino$lycans '0SGAG9s) The most common e*am!le of this ty!e of !roduct is Ade%uan# This !roduct is used only y intramuscular in"ection and will cause "oint inflammation if used intraarticularly# These !roducts are !rimarily used as the uildin$ loc1s for successful cartila$e re!aration# This !roduct is also usually used when cartila$e dama$e is already !resent rather than in acute "oint inflammation#  Arte!aron is the human e%uivalent to Ade%uan and the chemical structure of the two !roducts is identical# 5hondroitin sulfate is the most commonly used GAG in these !roducts and is harvestedfrom ovine lun$ and trachea# :ral Joint Su!!lementation 5hondroitin sulfate and various other GAG9s can e found in oral su!!lements# 0ure chondroitin can e found in ;le*(;ree and with a comination of nutrients from the sea mussel in Syno(;le*# Most recently $lucosamine chondroitin and various other GAG9s have een comined in the !roduct 5ose%uin# Benefits of these oral thera!ies alone are difficult to !rove e*!erimentally so usually we treat a$$ressively with intraarticular medication and then su!!lement the horse with oral !roducts# <ecently there has een much deate aout whether horses can even asor oral forms of "oint su!!lementation# ;or years we have used data e*tra!olated from human research studies and since horses are herivores and have different GI asor!tion characteristics efficacyof oral su!!lementation is in %uestion until further studies can e done# Glucosamine y itself has een associated with decreased !ain inflammation and ran$e of motion when com!ared with a !laceo in human trials# It has een shown in one study to e as effective as iu!rofin 'Motrin) in !eo!le with arthritic chan$es# La studies have shown increased  "oint !roduction of !rotective GAG9s in tissues treated with $lucosamine# It is li1ely that this !roduct !rovides the most enefit in the concoction of oral "oint su!!lementation since there is confusion over how well GAG9s y themselves are asored throu$h intestinal linin$s# Intraarticular 5orticosteroids This class of dru$ $ained much fame or infamy as it is commonly used in racehorses with arthritis and has een lamed for many in"uries !ost(in"ection# <esearch has !roven that used correctly these are necessary medications in the !atho$enesis of "oint disease# As we mentionedearlier en/ymes that are !roduced y diseased or inflamed "oints are very destructive to normal cartila$e# Joints that are inflamed must e treated with anti(inflammatory medication as well as HA in some instances to allow them to secrete normal "oint fluid# Intraarticular corticosteroids allow the "oint to start !roducin$ luricatin$ HA as inflamed "oint tissues =ILL >:T ma1e thic1 luricatin$ HA# It was once said that a -human on corticosteroids can wal1 to the auto!sy room. ut now most ortho!edic sur$eons use these !roducts in the most famous athletes in the world# Horses are y far much harder on their "oints than any human athlete# It only ma1es sense# Sustantiation for a direct lin1 etween corticosteroid administration and arthritis has !ersistently een unale to !rove y do/ens of investi$ators+Most of the !rolems associated are attriuted to !oor techni%ue 'infection) and !oor selection of corticosteroid !roducts# >onsteroidal Medication '>SAI49s)

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