Joint Problems

PubMed

Relationship between biochemical markers and radiographic scores in the evaluation of the osteoarticular status of Warmblood stallions by Verwilghen D., Busoni V., Gangl M., Franck T., Lejeune J.P., Vanderheyden L., Detilleux J., Grulke S., Deberg M., Henrotin Y., Serteyn D.
Department of Clinical Sciences, Equine Clinic, Faculty of Veterinary Medicine of Liege, B-4000 Liege, Belgium.

"Establishing the osteoarticular status of the horse is often performed by means of radiological screening of the animals. Widespread blood sampling could reveal to be an interesting alternative to this procedure which is time consuming and sometimes technically difficult. The aim of this study was to investigate the relationship between the radiological status of the horses and the levels of biochemical markers of cartilage degradation and synovial inflammation. A specific radiological scoring and classification system was therefore developed and applied on 63 stallions presented for studbook admission. Additionally, groups of horses were established according to the occurrence of osteochondrosis, degenerative joint disease and distal interphalangeal joint effusion. Insulin growth factor-I, myeloperoxidases, Coll2-1 and Coll2-1NO(2) were used as blood markers. The combination of the blood parameters did not seem to correlate with the used scoring system. Coll2-1NO(2) levels however tended to increase with poorer radiological class and this could therefore potentially be a useful predictor of the osteoarticular status in the horse. Coll2-1 levels were significantly higher in the degenerative joint disease group. A high percentage of horses with distal interphalangeal joint effusion was present in this study and was associated with decreased IGF-I and increased Coll2-1 levels."

Update on Joint Injections: Joint Injections/A Good Idea?

February 7, 2009, my husand and I attended a Seminar. One of the speakers was Dr. James Casey. This link will provide you with some of the latest information on joint problems and how to treat them: Dr. James Casey on Joint Problems The Horse.com ran an article on the exact presentation that we heard. A Power Point Presentation is also available on Dr. Casey's web site: Power Point Presentation

We ask our equine friends to perform many tasks that they may not be doing in the wild. This can often lead to problems. Joint problems and associated muscles, ligaments, tendons, capsules and membranes may also be affected. Degenerative joint disease or osteoarthritis is often the outcome and often causes lameness in affected horses. When the cartilage that protects the bones of the joint is destroyed, problems arise. Osteoarthritis can develop in any joint, however, areas that are most commonly affected are the upper knee joints, front fetlocks (Ringbone), hocks or ankles (bone spavin), coffin joints in the forefeet, stifles or knees, and less commonly the spine. Degenerative joint disease may be the result of injury, loose joints, abnormal growth patterns, inherited factors, improper shoeing, over work, lack of rest, lack of exercise, and obesity. Eventually degeneration of the protective cartilage may result in bone-on-bone grinding.

Joint Injections and Cartilage Health: More Fuel for the Fire

There are three types of joints.

• Fibrous Joints - Fibrous joints are immobile. They are found in the skull and between some long bones. Since these joints are do not move they are not usually affected by disease.
• Cartilaginous Joints - Cartilaginous joints are found in the pelvis, vertebrae and in the growth plates. Growth plates extend the bone during the horse's growing age. These joints have limited movement so, therefore, they are not usually the source of problems.
• Synovial Joints - Synovial joints are the moving joints. Think of your own body and your long bones in your leg. Where the bones come together you have the bone ends, cartilage, lubrication, joint capsules and ligaments. Injury, stress on the area, and genetics can all play a part in causing problems with synovial joints. These are the active joints. The fibrous joint capsule attaches to both bones and to the collateral ligaments located on either side of the joints. These give the joint stability. You also have the cartilage within the joint which is lubricated. This lubrication allows the joints to move without friction. If anything goes wrong with any part of the mechanism there are problems. In the horse the fetlock, knee, elbow, hock and stifle joints are all examples of synovial joints. They are often the source of problems.

Since the forelimbs of the horse carry the majority of the horse's weight, logically, there would be more joint problems in the front limbs. (60-65% of the horse's weight) There is more impact on the front legs, joints, ligaments, tendons, hooves, etc. In the wild that would be true. However, we ask our horses to perform in ways that place stress on areas that would not usually be impacted in such a way.

A closer look at the disciplines of the performance horse will shed light on why these problems may arise.

• Dressage - Advanced dressage horses put a lot of stress on their hind quarters. They shift their center of gravity more to the rear. Movements such as the shoulder-in and half-pass place stress on the hock because they are lateral movements. This causes stress. Degenerative joint disease of the hocks, inflammation and degenerative joint disease of the front pasterns, fetlock, and inflammation of the middle knee joint are types of problems that are associated with dressage horses.
• Jumpers - Jumpers are asked to perform feats that put great stress on both their forelimbs and hind limbs. On take-off stress is put on the hind limbs such as the stifle and on landing on the entire forelimb suspensory apparatus. The show jumper is often asked to complete one jump, then make a sharp turn to line up for another. This places severe stress on the hocks. Sometimes the stress placed on the joint ligaments of the jumping horse causes inflammation and lameness.
• Fox Hunting Horses - This sport puts a lot of stress on the horse's joints. Much of the same impact on the Jumper can be seen in the Hunter.

Gaited Horses - Many gaited show horses tend to shift their center of gravity to the rear. This places more stress on the hind limbs such as the hock and pastern joints. These horses have high front end action such as the Tennessee Walking Horse, Racking Horse, and Saddlebred. Horses which load more weight on the rear are going to be prone to hock, rear fetlock, and stifle injuries and disease. Many of the gaited breeds are prone to stifle problems because the breeders bred for more action and for the horse to get further "under himself." This gives a longer stride from back to front. Many gaited horses have a tendency to "hitch." Hitching is a term used to describe a ligament that catches as it glides over the stifle joint bones. Sometimes the ligament will not glide and gets stuck. This is severe. The horse's hind leg will lock in a backward, extended position. The horse will be unable to bring that hind leg forward. A vet must be called.

Western horses are also stressed with competition. There is a lot of torque on the rear joints when a cutting horse drops its hindquarters toward the ground and spins a split second before accelerating to stop the movement of the calf it is seeking to hold away from the herd. Some cutting horses are susceptible to injuries and disease involving the hock and stifle joints.

• Reining Horse - The reining horse is asked to run down an arena at speed, slide to a stop, and spin in a circle, with the rear end anchored in place. This produces a great deal of torque on the hind limbs, especially the hocks.
• Roping Horses - Roping horses also put heavy pressure on their joints. The calf roping horse is asked to slide to a stop as the loop settles over the calf's neck. The sliding stop and the jerk from the calf hitting the end of the rope put stress on the hock and pastern joints.
• Header's Team Roping Horse - The Header's team roping horse is asked to swing sideway while pulling a steer into position for the heeler to rope the hind feet. The header's horse places added stress on his lower forelimbs, especially the left, while turning the steer.
• Barrel Racing - A barrel racing horse speeds through the cloverleaf course placing severe stress on the joints of his front and rear limbs.
• Western Pleasure Horse - Western pleasure horses have often been bred and selected to have straighter shoulders and more upright pasterns than horses which perform at speed. This type of conformation often leads to joint disease because of poor shock absorption.

• Lameness
• Swellings around a joint that lasts for more than 2 weeks
• Excessive synovial fluid
• Pain on flexion
• Heat around the joints
• Crepitus upon joint use
• Stiffness that follows periods of inactivity
• Bumps and swellings on the extremities or on the spine

A vet should be called to examine the affected horse. A physical exam will be performed. A lameness exam will identify the affected limb or limbs. This can be done in several ways. Often you will be asked to longe your horse, trot your horse in hand, or ride your horse under saddle. The vet will do flexion tests to try to pin down what is affected. After your vet has determined a gait deficit in a specific limb or limbs, regional anesthesia is often done. An anesthetic will be injected into a joint or surrounding nerves that supply the suspected joint. If the lameness disappears, chances are that the vet has determined the problem area. Radiographs can also be done. Sometimes bone scans are performed to detect a subtle area of lameness.

Acetaminophen - For mild to moderate arthritis in horses, your veterinarian may recommend acetaminophen (Tylenol®, Panadol®, Exdol®, etc.) to relieve pain. Since acetaminophen is only a pain reliever and has no anti-inflammatory properties, it can generally be safely combined with anti-inflammatory medications. Too-high doses of acetaminophen can cause liver damage.

Non-steroidal anti-inflammatory drugs (NSAIDs) NSAIDs help reduce the pain and swelling of the joints and decrease stiffness. When taken at a low dose, NSAIDs reduce pain; when taken at a higher dose, NSAIDs can also reduce inflammation. NSAIDs do not prevent joint damage and when used long-term, may accelerate joint breakdown. Taking more than one NSAID at a time increases the possibility of severe side effects such as ulcers and bleeding. NSAIDS affect normal blood clotting and therefore may interact with other blood-thinning medications, such as warfarin.

Cprtospme - Cortisone is a corticosteroid that reduces inflammation and swelling. For severe pain and inflammation, a corticosteroid, such as cortisone, may be injected directly into the affected joint. Although corticosteroids closely resemble cortisol, they exert a much more powerful anti-inflammatory effect. An injection can provide almost immediate relief for a tender, swollen and inflamed joint.

Visco-Supplementation - Visco-supplementation is the process of injecting a gel-like substance into the joint. This substance lubricates the cartilage, reducing pain and improving flexibility. Visco-supplementation decreases friction within the joint, thus reducing pain and allowing greater mobility. This method of treatment requires ongoing injections as benefits are only temporary. Substances used in visco-supplementation include hyaluronic acid, or HA (Legend®, Hylartin® and Synacid®), and poly-sulfated glycosaminoglycans (PSGAGS) such as Adequan® Joint Problems

Recently, at the 2007 annual American Association of Equine Practitioners' conference, findings of a study were presented which showed: "Both Surpass and Bute had symptom-modifying effects, but Surpass alone had disease-modifying (curing) effects,...Diclofenac liposomal cream (Surpass) applied to a joint with experimental osteoarthritis provides a significantly better outcome than a similar joint treated with systemic phenylbutazone." (David Frisbie, DVM, PhD, Dipl. ACVS, associate professor of veterinary clinical sciences at Colorado State University (CSU)

For more information on joints, forelimb and hind limb: Joints

"...The joint is a very well-engineered structure. Frictionless motion is provided by the combination of a smooth articular cartilage surface as well as lubrication of both the articular cartilage and the synovial membrane, together which make up the entire surface area of the inside of the joint.

"Shock absorption to the joint is provided by a combination of structures, including articular cartilage, subchondral bone (the bone beneath the cartilage), and the soft tissue structures (joint capsule and ligaments). Because of its resilient nature and ability to compress, articular cartilage in itself is a good shock absorber, but its thickness and overall volume is far less than bone or soft tissues. Hence, the soft tissues and the bone are the primary shock absorbers in the joint and any disease that affects bone (fractures, etc.) or soft tissue (fibrosis due to chronic inflammation) is going to interfere with this shock absorption.

"Resilience of the soft tissue is important for normal motion as well as shock absorption. It has been alluded to previously that friction comes from both articular cartilage and synovial membrane. Hyaluronic acid provides lubrication to the synovial membrane surface.

"Until recently it has been felt that it does not provide any lubrication to the articular cartilage, but more recently with some new research, it has been shown that hyaluronic acid, in addition to another protein structure called lubricin, is involved in the lubrication of articular cartilage. This substance moving over the surface of the joints is called boundary lubrication.

"A second mechanism of lubrication of the cartilage is effected by fluid being squeezed out of the cartilage onto the surface when weight-bearing occurs. When weight-bearing ceases, the fluid is absorbed back into the cartilage, ready for a next cycle of weight-bearing..."

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