Updated: Dec 16, 2019
In our last blog post we discussed joint supplements and how to go about avoiding the pit falls that can occur when browsing the supplements catalogue. Today we're having a more in depth look at the condition of osteoarthritis (OA) and your treatment options beyond supplements.
Now I've had a look around for a good horse based video to explain the condition but unless you want to sit through a 45 minute lecture the best one I could come up with is this human one. It's all relevant except which joints are most commonly affected and you can stop when you get to the bit about treatment options, equine joint replacements aren't coming our way any time soon.
Without doubt, OA is one of the most common causes of lameness in horses. Typically age related (it can happen in young horses) and often associated with work load and wear and tear its a good bet that if your horse is late teens are above, they will have some degree of arthritic change in at least one joint. Hocks, fetlocks, pasterns, stifles and the neck are some of the most common sites but any joint can be affected.
Typically we'll get the call when your horse has developed a lameness or you notice some joint swelling. The actual process of the examination will vary depending on what the problem is but typically OA is diagnosed via a combination of lameness examination and imaging such as xrays although more advance techniques such as MRI or bone scans may be needed.
Once diagnosed you have a number of options available to you and we'll work through them from the most conservative to the more invasive. Which one is right for your horse will depend on the severity of the problem and where your preferences lie. There is no right or wrong treatment option but treatment should be focused on .....
Improving joint function
Exercise: Complete rest is not recommended for OA. Regular gentle exercise can help keep things moving. This can be a simple as regular daily turnout or hand/tack walking.
Farriery: Now this comes with a caveat. If your horse has not been blessed with the greatest limb alignment, trying to 'correct' it with farriery may do more harm than good. But maintaining good foot balance can help mediate some OA symptoms and your farrier can help make things biomechanically easier for your horse by bringing the breakover back, rolling the toe or adding support.
Physical therapy: This takes dedication from owners to persist with but can be useful in helping horses that have been chronically lame and may have suffered some loss of muscle as a result. It is recommended to enlist the services of a specialist if you plan on developing a physical therapy program.
Joint supplements - see previous blog post.
Non-steroidal anti-inflammatories are the mainstay of many OA cases. Drugs such as phenylbutazone, flunixin meglumine and firocoxib can be used either daily or on an as needed basis. Although all these medications are typically well tolerated, some horses tend to respond better to one over the others and some come with a greater risk of side effects so make sure you have all the information you need before making a decision. If you end up keeping your horse on this type of medication long term, annual blood work is recommended.
Hyaluronic acid (Legend): Typically used as an initial course of 3 weekly intravenous injections followed by monthly administration. Results can be variable but many swear by it.
Polysulfated glycosaminoglycans (Adequan): An intramuscular option which many feel more comfortable performing themselves. 7 injections given at 4 day intervals. Similar to the hyaluronic acid, results may be variable but can be very effective. Both of these drugs are safe to use but you are unlikely to see results straight away. You will need to give them some time before deciding if they have been effective or not.
Focusing the treatment at the source. Typically these injections contain a combination of hyaluronic acid, a steroid and some antibiotics. They can offer great relief to horses with OA although there are pros and cons so make sure you have all the information on hand before making the decision to go ahead with joint injections. The effects are seen quickly but your horse will need a few days off after the treatment.
Products such as IRAP, PRP, Prostride, and stem cells have been in use for some years now for treating soft tissue injuries such as tendon and ligament strains and are now being used in cases of OA. They can offer the benefits of joint injections without the added risks associated with steroids. That said, their use in cases of OA is still relatively new and due to the processes involved would need to be conducted within a clinic setting.
Arthroscopy: Usually reserved for conditions other than OA, it involves entering the joint with a small camera and removing unhealthy tissue via keyhole surgery.
Arthrodesis: Fusing the joint. This can be done surgically or chemically, the surgical route requires a prolonged recovery phase and the chemical route isn't guaranteed to give results. It is generally reserved for severe cases.
If you are looking to prevent OA, there are some things you can do to be proactive although, nothing is guaranteed of course.
Regular farrier visits to ensure appropriate foot balance
Avoid working on hard surfaces
Icing limbs/joints after intense activity
We can't reverse OA but we certainly have a number of options available to you. Often times a combination of strategies are used to manage OA in horses and it can take some time to find the protocol that gives you the results you're looking for. Be patient and don't assume your horse will never be able to perform at their best again.