Kentucky Equine Research

McIlwraith on Management of Joint Disease in the Sport Horse

April 27, 2010

Starting off the second day of the 17th KER Nutrition Conference, C. Wayne McIlwraith, D.V.M., director of the Orthopaedic Research Center at Colorado State University, continued on the topic of joint health with his presentation titled "Prevention and Management of Joint Disease in the Sport Horse."

According to one study cited by McIlwraith, 60% of lameness problems are associated with osteoarthritis. The goal of osteoarthritis treatment is to return the joint to normal as quickly as possible, primarily by reducing the pain and minimizing the progression of joint deterioration.

Treatments for osteoarthritis are varied.

-Physiotherapy such as swimming and underwater treadmills are popular rehabilitation tools, but more controlled studies are needed to ascertain their effectiveness.

-Extracorporeal shock wave therapy decreases lameness and synovial fluid parameters of inflammation, though more clinical studies should be undertaken.

-Nonsteroidal anti-inflammatory steroids (NSAIDs) are a routine part of management. Recent focus has been on topical NSAIDs (such as 1% diclofenac sodium cream or Surpass®) rather than systemic ones. Recent research at Colorado State University revealed a superiority of topical NSAIDs over systemic NSAIDs.

Intraarticular corticosteroids are still used frequently with much success, though certain corticosteroids are safer than others and attention must be paid to total dosage.

Intraarticular hyaluronic acid (HA) appears to be useful for mild to moderate synovitis, but adjunctive use of a corticosteroid is necessary for most clinical cases. Evidence for long-term disease-modifying activity is accumulating, said McIlwraith. Combination intraarticular therapy involves using HA and corticosteroids simultaneously. The recommended combination is HA and triamcinolone acetonide (Vetalog®).

Oral joint supplements are popular among horsemen, even though there are little data to support effectiveness. None of the oral supplements or oral nutraceuticals are licensed, and proof of efficacy is generally lacking.

Newer therapies were also discussed, including gene therapy and IRAP®.

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