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Management of Joint Disease in the Sport Horse
Abstract
The joint is an organ, and there are a number of ways in which traumatic damage occurs, ultimately resulting in degradation of articular cartilage. It was recognized in 1966 that articular cartilage change that accompanied osteochondral fragmentation could also be associated with concurrent traumatic damage to the attachment of the joint capsule and ligaments (Raker et al., 1966). However, there was little association made between primary disease in the synovial membrane and fibrous joint capsule and the development of osteoarthritic change in the articular cartilage until an experimental study demonstrated that cartilage degradation could occur in the horse in the absence of instability or trau-matic disruption of tissue and that loss of glycosaminoglycan (GAG) staining was associated with early morphologic breakdown at the surface of the cartilage (McIlwraith and Van Sickle, 1984). Surveys have confirmed that approximately 60% of lameness problems are related to osteoarthritis (National Animal Health Monitoring Systems, 2000; Caron and Genovese, 2003). Rapid resolution of synovitis and capsuli-tis is a critical part of the medical treatment of joint disease because of the principal role of synovitis in causing cartilage matrix breakdown. The goal of treatment of traumatic entities of the joint is twofold: (1) returning the joint to normal as quickly as possible, and (2) preventing the occurrence or reduction of the severity of osteoarthritis. In other words, treatment is intended to (1) reduce pain (lameness), and (2) minimize progression of joint deterioration. Minimizing progression is mainly addressed by medical treatment, but it is also important to remember that timely removal of osteochondral chip fragments, timely and appropriate reduction or fixation of large intra-articular fractures, accurate diagnosis of liga-mentous and meniscal injuries with arthroscopy, and the appropriate treatment of osteochondritis dissecans (OCD) entities are also critical treatments to prevent osteoarthritis. This paper will address both medical and surgical treatments. Principles of Therapy The aim of treatments for acute synovitis, with or without accompanying capsulitis, is to return the joint to normal as quickly as possible. In addition to bringing relief to the patient and allowing it to return to typical work, suppression of synovitis and capsulitis is important to prevent the products of inflammation from compromising the articular cartilage and leading to osteoarthritis. Pain relief, as well as minimizing the potential microinstability associated with excessive synovial effusion, is critical. As information increases regarding targets for therapeutic intervention, the range of treatment options has increased. The term chondroprotection has since been replaced by disease-modifying osteoarthritic drugs (DMOADs). Medications providing pain relief but undefined therapeutic action at the level of car-tilage matrix are termed symptom-modifying osteoarthritic drugs (SMOADs).
... From an antidoping perspective, glucocorticoids are of the most interest; therefore, any subsequent mention of corticosteroids refers to glucocorticoids. While corticosteroids are administered in a variety of ways, including intramuscularly and topically, they are considered more rapidly effective for joint inflammation when administered intra-articularly (8,9). The recommended intra-articular dose for BET or TMA is 6 -15 mg/joint space and for MPA is 40 -100 mg/joint space (10). ...
... With the increased interest in the detection of corticosteroids in equine synovial fluid and the absence of a rapid, sensitive multiplex screening method, the assay developed in this study is both necessary and timely. The corticosteroids examined-BET, MP, MPA and TMA-were chosen because they are commonly used to manage joint diseases in the equine athlete (9). ...
Most antidoping method development in the equine industry has been for plasma and urine, though there has been recent interest in the analysis of synovial fluid for evidence of doping by intra-articular corticosteroid injection. Published methods for corticosteroid analysis in synovial fluid are primarily singleplex methods, do not screen for all corticosteroids of interest and are not adequately sensitive. The purpose of this study is to develop a rapid and sensitive liquid chromatography-tandem mass spectrometry (LC-MS-MS) screening method for the detection of four of the most common intra-articularly administered corticosteroids-betamethasone, methylprednisolone, methylprednisolone acetate and triamcinolone acetonide. Sample preparation consisted of protein precipitation followed by a basified liquid-liquid extraction. LC-MS-MS experiments consisted of a six-min isocratic separation using a Phenomenex Polar-RP stationary phase and a mobile phase consisting of 35% acetonitrile, 5 mM ammonium acetate and 0.1% formic acid in nanopure water. The detection system used was a triple quadrupole mass analyzer with thermospray ionization, and compounds were identified using selective reaction monitoring. The method was validated to the ISO/IEC 17025 standard, and real synovial fluid samples were analyzed to demonstrate the application of the method in an antidoping context. The method was highly selective for the four corticosteroids with limits of detection of 1-3 ng/mL. The extraction efficiency was 50-101%, and the matrix effects were 14-31%. These results indicate that the method is a rapid and sensitive screen for the four corticosteroids in equine synovial fluid, fit for purpose for equine antidoping assays.
... [12][13][14][15][16] Corticosteroids have been the subject of numerous studies related to joint disease treatment and respiratory problems. [17][18][19][20][21][22] Triamcinolone acetonide (TA), methylprednisolone acetate (MPA) and betamethasone acetate are primarily used for intra-articular injection. 23 A 2009 survey regarding joint therapy in equine practice reported that 73% of equine practitioners use TA in higher motion joints and 73% MPA in lower motion joints. ...
Background
Intra‐articular (IA) administration of corticosteroids is performed routinely in equine practice. The lung function of severe asthmatic horses has recently been shown to be improved by IA triamcinolone acetonide (TA). We therefore hypothesised that IA methylprednisolone acetate (MPA), another commonly used corticosteroids, would also decrease the airway obstruction in severe asthmatic horses.
Objectives
To compare the effects of intra‐articular (IA) and intramuscular (IM) methylprednisolone acetate (MPA) administration on lung function and serum cortisol levels in horses with severe asthma.
Study design
Randomised and controlled experiments on severe asthmatic research animals.
Methods
Severe asthmatic horses in exacerbation were administered 200 mg of MPA either intramuscularly (n = 6) or via intra‐articular injections in the tarsocrural joints (n = 6; 100 mg/joint). Serum cortisol concentration and pulmonary function was measured for 8 days.
Results
A significant decrease in pulmonary resistance in the IA group (P = .003, mean diff 1.14) on day 1 in comparison with baseline was observed. A significant decrease from baseline was also observed on serum cortisol values in the IA group 6 hours after injection (P = .001, mean diff 44.5), and at day 1 (P = .003, mean diff 45.1).
Main limitations
Joint health was not evaluated in the current study and the physiological response of the severe asthmatic horses might deviate from that of the milder forms of asthma.
Conclusions
MPA IA administration improves the lung function of severe asthmatic horses. However, this effect was mild and of a short duration.
... When joint problems occur, the athletic horse may not perform to his normal capability, or, worse, may become lame, so the importance of preventing and treating joint disease appears as crucial in equine athletes. In treating the horse with joint disease, there are two basic objectives; to reduce the symptoms of the disease (particularly pain and inflammation), and to decrease or stop the progression of the disease (McIlwraith, 2010). While some treatments may just decrease the symptoms of joint disease, others can decrease disease progression particularly if they can reduce the severity of joint inflammation for a period of time. ...
Joint disease is one of the most common issues effecting sport horses. Because there is no cure for joint disease, treatment goals surround slowing progression of the disease, minimizing pain, increasing function, and optimizing performance. Accomplishing these goals often requires a multimodal approach that combines systemic medications or supplements; intra-articular therapies, such as corticosteroids or biologics; management considerations; and physical therapy exercises.
The aim of the study was to determine which types of nutritional supplements were used in dressage and eventing horses, and the reasons that owners used supplements. An online questionnaire was distributed through British Eventing and Dressage websites, to collect data on demographics of owners and their horses, supplements used and their opinion on health and performance problems. Data were evaluated using descriptive analysis, Sign and Fisher's exact tests for quantitative data, and categorisation of qualitative data. In total, 599 responses met the inclusion criteria (441 dressage and 158 eventing horse owners). Participants had 26.4 (3-60) (mean (range)) years of riding experience, owned 1.2 (0-10) horses and used 2 (0-12) supplements in their highest performing horse. The main health and performance issues identified for dressage were 'energy/behaviour', 'lameness' and 'back and muscle problems'. The main issues for eventing were 'stamina and fitness levels',' lameness' and 'energy/behaviour'. The main reasons for using supplements in their highest performing horse were 'joints and mobility', and 'behaviour' for dressage, and 'electrolytes', and 'joints and mobility' for eventing. Lameness and behavioural problems were significant concerns within both disciplines. There was incongruence between owners' opinions of problems within their discipline and their reasons for using supplements.
Topical application of diclofenac liposomal cream over specific painful joint areas reduces pain and lameness when compared with placebo in a blinded study. Topical application is more convenient for lay person application and is likely to reduce the risk of toxicity and adverse effects typically associated with nonsteroidal anti-inflammatory drugs. Authors' addresses: Alpine Animal Hospi-tal, 17776 Highway 82, Carbondale, CO 81623 (Bertone); IDEXX Pharmaceuticals, Inc., 4249 –105 Piedmont Parkway, Greensboro, NC 27410 (Lynn, Hepler); and Bradford Park Veterinary Hospital, 1255 E. Independence Street, Springfield, MO 65804 (Sifferman). Dr. Vatistas is deceased. His former address was 7650 Olivas Lane, Vacaville, CA 95688.Dr. Kelch's present address is 1316 Beacon Hill Lane, Knoxville, TN 37919. © 2002 AAEP.
A glycosaminoglycan polysulfate ester, L-1016, was administered intra-articularly over a period of six-weeks to selected horses with joint disorders which demonstrated by synovial fluid analysis lesions and/or degeneration of the articular cartilage and impairment of synovial membrane function. Over the course of treatment, significant changes in synovial fluid viscosity and protein were observed. In general, these laboratory data were reflected directly in clinical observations. Response to the treatment was characterized by decreases in outward signs of swelling, increases in flexion and lessening of lameness.
Osteochondral fragments were created arthroscopically on the distal aspect of both radial carpal bones in 12 horses. On day 14 after surgery, one middle carpal joint of each horse was injected with 2.5 mL Betavet Soluspan (3.9 mg betamethasone sodium phosphate and 12 mg betamethasone acetate per milliliter) and the contralateral joint was injected with 2.5 mL saline as a control. Intra-articular treatments were repeated on day 35. On day 17, six horses began exercising 5 days per week on a high-speed treadmill. The other six horses were kept in box stalls throughout the study as nonexercised controls. On day 56, all horses were examined clinically and radiographically and then were euthanatized. Samples were obtained for histological, histochemical, and biochemical evaluation. Mild lameness was observed in five of the six exercised horses at day 56; four horses were lame in the control limb and one horse was lame in the treated limb. Of the five nonexercised horses evaluated for lameness, two were lame in the control limb, two were lame in the treated limb, and one was lame in both the control and the treated limb. No differences were noted on radiographs or palpation of steroid treated limbs versus control limbs. Firm reattachment of the osteochondral fragment to the radial carpal bone occurred in all but three joints. Gross cartilage damage was not different between steroid-treated joints and joints injected with saline. Histologically, there were no significant detrimental effects of beta-methasone with or without exercise, but there was a tendency for more pathological change in treated joints. No significant difference in the water content or uronic acid concentration was detected between treated and control joints. Intra-articular betamethasone administration in this carpal chip model was not associated with any significant detrimental effects in either rested or exercised horses.