There are many options available to treat horses with arthritis, and it can often feel overwhelming to sort through what is best for you and your horse. We’ve put together a clear, concise list to help you understand the therapeutic options available for your horse, as well as the pros and cons associated with some of these options. As always, we are more than happy to review these options with you to ascertain the best approach for your horse.
TIER 1 consists of feed-through joint supplements and is the most conservative, proactive approach. It is best used in horses with mild, osteoarthritic conditions that are demonstrating little to no discomfort in their joints. It is also often used for sound horses in work that are sustaining daily, routine wear and tear on their joints.
We recommend the utilization of a product with peer reviewed, scientific data supporting its efficacy, such as:
- Cosequin ASU
- Platinum Performance CJ
TIER 2 is a more proactive, assertive approach consisting of systemic injectable products. These are best used in horses with mild to moderate osteoarthritic conditions that are demonstrating moderate to no discomfort in their joints.
The emphasis with these products is on the SYSTEMIC approach and addresses ALL the joints in the horse. Examples of systemic products include the following, and are often used together for maximal effect:
- Adequan (polysulfated glycosaminoglycan)
- Given in the muscle of the neck or chest, once every four days, for 28 days (7 doses)
- Owners can administer this on their own
- No known negative side effects
- Legend (low molecular weight hyaluronic acid)
- Given IV once a week for the first three weeks then once a month afterward
- May be difficult for owners to administer
- No known negative side effects
TIER 3, intraarticular therapy (joint injections), is the most aggressive approach, best used in horses with moderate to severe osteoarthritic conditions, or in those unresponsive to Tier 1 and 2 approaches.
Tier 3 is a more localized approach that only treats the joint that is injected, and is best used in conjunction with Tier 1 or 2 therapy to support additional joints not being injected.
Several products are available for intraarticular use:
- Steroids – used to quickly reduce inflammation in the joint. Note there is some evidence to suggest that routine use of steroids in the synovial structure can result in deterioration of the cartilage of the joint.
- High molecular weight hyaluronic acid (HA) – used to restore viscosity and vital nutrients to the joint environment. No known negative side effects.
- IRAP (Interluekin-1 Receptor Antagonist Protein) – this product is processed from the horse’s own blood. It works by temporarily inhibiting the initiation of inflammatory processes within the treated joint. It requires a series of injections into the joint, two weeks apart.
- Pros: less detrimental to the cartilage and less likely to produce an inflammatory flare within the joint (in those horses historically proven sensitive to steroids or HA)
- Cons: more expensive than steroids, requires more injections/visits than steroids, may have a shorter duration of efficacy than steroids/HA, requires prolonged incubation period of product, resulting in two visits.
- PRP (Platelet Rich Plasma) – this product is processed from the horse’s blood. Preparation of the PRP increases the amount of healing and anti-inflammatory growth factors in the sample, which is then injected back into the joint.
- Pros: less detrimental to the cartilage, and less likely to produce an inflammatory flare in the joint after administration. This procedure does not require subsequent repeat injections over a several week time period and can be processed at the time of injection.
- Prostride – this product is processed from the horse’s blood and works by concentrating growth factors, platelets, cells, and anti-inflammatory cytokines to provide the most extensive approach to alleviating lameness associated with synovitis and arthritis. This product does help to promote healing of damaged tissues within the joint as well as reducing inflammation.
- Only one injection is required.
- This product combines the positive effects of both PRP and IRAP.
- This product is processed at the time of injection.
- Polyacrylamide gels (Arthramid and Noltrex) – These products act as a synthetic “filler” to fill in cartilaginous defects within the joint and to create a bio scaffold to provide the lining of the joint ample opportunity to function at an optimal level.
- Pros: These products can be used alongside PRP and IRAP and have significantly improved the quality of life in patients with end stage joints. They prolong the duration of efficacy of intraarticular steroids as well.
- Cons: It is impossible to remove this product form the joint after injection so all considerations regarding cleanliness and sterility are of the utmost importance.
**There is always the risk of joint infection, post injection, but all attempts are made to mitigate the risk of infection**
