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Topic:Joint Health

Joint health in horses involves the study of anatomical structures such as cartilage, synovial fluid, ligaments, and bones that contribute to the function and mobility of equine joints. Research in this area focuses on understanding the physiology of equine joints, the mechanisms of joint disorders, and the effects of wear and tear over time. Common joint issues in horses include osteoarthritis, synovitis, and joint effusion, which can impact performance and quality of life. Diagnostic techniques often involve imaging, synovial fluid analysis, and clinical evaluation to assess joint condition. This page compiles peer-reviewed research studies and scholarly articles that explore the anatomy, pathology, diagnostics, and therapeutic approaches related to joint health in horses.
Preliminary data on the effect of osseous anatomy on ex vivo joint mobility in the equine thoracolumbar region.
Equine veterinary journal    July 23, 2015   Volume 48, Issue 4 502-508 doi: 10.1111/evj.12461
Jones KE.The thoracolumbar region is clinically important in horses; however, the link between joint mobility and bony joint morphology has not been tested quantitatively. Objective: To establish which aspects of vertebral morphology correlate with ex vivo range of motion in the thoracolumbar region of Equus caballus, and demonstrate methodologies for linking vertebral form and function. Methods: Morphometric study of osteological specimens. Methods: A digital model was created of a disarticulated thoracolumbar region to examine bone-to-bone interactions during in silico bending. Linear measurements a...
Influence of an n-3 long-chain polyunsaturated fatty acid-enriched diet on experimentally induced synovitis in horses.
Journal of animal physiology and animal nutrition    July 20, 2015   Volume 100, Issue 3 565-577 doi: 10.1111/jpn.12359
Ross-Jones TN, McIlwraith CW, Kisiday JD, Hess TM, Hansen DK, Black J.Dietary n-3 long-chain polyunsaturated fatty acid (LCPUFA) supplementation has previously been shown to modify joint-related inflammation in several species, although information in the horse is lacking. We investigated whether dietary supplementation with n-3 LCPUFA would modify experimentally induced synovitis in horses. Twelve, skeletally mature, non-pregnant mares were randomly assigned to either a control diet (CONT) or an n-3 long-chain fatty acid-enriched treatment diet (N3FA) containing 40 g/day of n-3 LCPUFA for 91 days. Blood samples taken on days 0, 30, 60 and 90, and synovial flu...
The centrodistal joint interosseous ligament region in the tarsus of the horse: Normal appearance, abnormalities and possible association with other tarsal lesions, including osteoarthritis.
Equine veterinary journal    July 14, 2015   Volume 48, Issue 4 457-465 doi: 10.1111/evj.12457
Skelly-Smith E, Ireland J, Dyson S.There have been no detailed descriptions of the radiological appearance of the centrodistal joint interosseous ligament region in horses with and without distal tarsal joint pain. Objective: To describe the normal radiological appearance of the centrodistal joint interosseous ligament region; to determine the prevalence of mineralisation or ossification of the interosseous ligament; and to describe radiological abnormalities surrounding the interosseous space and concurrent radiological abnormalities in the tarsus. The association between interosseous ligament region abnormalities and radiolog...
mRNA expression of genes involved in inflammation and haemostasis in equine fibroblast-like synoviocytes following exposure to lipopolysaccharide, fibrinogen and thrombin.
BMC veterinary research    June 27, 2015   Volume 11 141 doi: 10.1186/s12917-015-0448-z
Andreassen SM, Berg LC, Nielsen SS, Kristensen AT, Jacobsen S.Studies in humans have shown that haemostatic and inflammatory pathways both play important roles in the pathogenesis of joint disease. The aim of this study was to assess mRNA expression of haemostatic and inflammatory factors in cultured equine fibroblast-like synoviocytes exposed to lipopolysaccharide (LPS), fibrinogen and thrombin. Synovial membranes were collected from metacarpo-phalangeal joints of 6 skeletally mature horses euthanized for non-orthopaedic reasons. Passage 4 fibroblast-like synoviocytes were left non-treated or treated with either 0.1 μg/ml LPS, 5 mg/ml fibrinogen or 5 U...
Changes in synovial fluid biomarker concentrations following arthroscopic surgery in horses with osteochondritis dissecans of the distal intermediate ridge of the tibia.
American journal of veterinary research    June 26, 2015   Volume 76, Issue 7 599-607 doi: 10.2460/ajvr.76.7.599
Brink P, Smith RK, Tverdal A, Dolvik NI.To quantify concentrations of cartilage oligomeric matrix protein (COMP) and fibromodulin in synovial fluid from the tarsocrural joints (TCJs) of horses with osteochondritis dissecans (OCD) of the distal intermediate ridge of the tibia and determine whether concentrations would change following arthroscopic removal of osteochondral fragments. Methods: 115 client-owned horses with OCD of the TCJ and 29 control horses euthanized for unrelated reasons. Methods: COMP and fibromodulin concentrations were measured in synovial fluid from the TCJs of the affected horses before and after osteochondral ...
The effect of acute unilateral inflammation of the equine temporomandibular joint on the kinematics of mastication.
Equine veterinary journal    June 18, 2015   Volume 48, Issue 4 523-527 doi: 10.1111/evj.12452
Smyth TT, Carmalt JL, Treen TT, Lanovaz JL.Diseases of the temporomandibular joint (TMJ) are well reported in man and some domestic animals other than the horse. The pathophysiology of equine TMJ disease and the effects of disease on the kinematics of mastication are unknown. Objective: To determine whether transient unilateral inflammation of the equine TMJ results in alterations in the masticatory cycle. Methods: An experimental controlled study utilising 6 horses of various ages with normal dentition. Methods: Each horse was equipped with an optical motion tracking (kinematic) system. Horses were observed chewing grass hay over 3 m...
Animal Models of Osteoarthritis: Comparisons and Key Considerations.
Veterinary pathology    June 10, 2015   Volume 52, Issue 5 803-818 doi: 10.1177/0300985815588611
McCoy AM.Osteoarthritis (OA) is unquestionably one of the most important chronic health issues in humans, affecting millions of individuals and costing billions of dollars annually. Despite widespread awareness of this disease and its devastating impact, the pathogenesis of early OA is not completely understood, hampering the development of effective tools for early diagnosis and disease-modifying therapeutics. Most human tissue available for study is obtained at the time of joint replacement, when OA lesions are end stage and little can be concluded about the factors that played a role in disease deve...
International joint statements address horse slaughter, rabies in dogs.
Journal of the American Veterinary Medical Association    June 2, 2015   Volume 246, Issue 6 578 
No abstract available
Diffusion of mepivacaine to adjacent synovial structures after intrasynovial analgesia of the digital flexor tendon sheath.
Equine veterinary journal    May 23, 2015   Volume 48, Issue 3 326-330 doi: 10.1111/evj.12447
Jordana M, Martens A, Duchateau L, Haspeslagh M, Vanderperren K, Oosterlinck M, Pille F.Controversy exists about the specificity of diagnostic analgesia of the digital flexor tendon sheath (DFTS) in horses. Objective: To evaluate the degree of diffusion of mepivacaine from the equine DFTS to adjacent synovial structures. Methods: Crossover experiment. Methods: Under general anaesthesia, the DFTS of one front and one hindlimb of 8 horses were injected simultaneously with mepivacaine. Synovial fluid samples of the injected DFTS, the adjacent metacarpo-/metatarsophalangeal (MCP/MTP) joint, proximal interphalangeal joint, distal interphalangeal joint, navicular bursa and contralatera...
Resveratrol and N-acetylcysteine influence redox balance in equine articular chondrocytes under acidic and very low oxygen conditions.
Free radical biology & medicine    May 19, 2015   Volume 86 57-64 doi: 10.1016/j.freeradbiomed.2015.05.008
Collins JA, Moots RJ, Clegg PD, Milner PI.Mature articular cartilage is an avascular tissue characterized by a low oxygen environment. In joint disease, acidosis and further reductions in oxygen levels occur, compromising cartilage integrity.This study investigated how acidosis and very low oxygen levels affect components of the cellular redox system in equine articular chondrocytesand whether the antioxidants resveratrol and N-acetylcysteine could modulate this system. We used articular chondrocytes isolated from nondiseased equine joints and cultured them in a 3-D alginate bead system for 48h in <1, 2, 5, and 21% O2 at pH 7.2 or ...
Platelet-Rich Gel Supernatants Stimulate the Release of Anti-Inflammatory Proteins on Culture Media of Normal Equine Synovial Membrane Explants.
Veterinary medicine international    May 18, 2015   Volume 2015 547052 doi: 10.1155/2015/547052
Ríos DL, López C, Carmona JU.The aims were as follows: (1) to evaluate the effects at 48 and 96 h of two concentrations (25 and 50%) of leukocyte and platelet-rich gel (L-PRG) and pure PRG (P-PRG) supernatants on the production/degradation in normal equine synovial membrane explants (SME) of platelet derived growth factor isoform BB, transforming growth factor beta-1, tumor necrosis factor alpha, interleukin (IL-) 4 (IL-4), IL-1 receptor antagonist (IL-1ra), and hyaluronan (HA) synthesis and (2) to correlate these molecules with their respective PRG supernatant treatments. SME from 6 horses were cultured for 96 h with...
Arthroscopic removal of discrete palmar carpal osteochondral fragments in horses: 25 cases (1999-2013).
Journal of the American Veterinary Medical Association    April 16, 2015   Volume 246, Issue 9 998-1004 doi: 10.2460/javma.246.9.998
Lang HM, Nixon AJ.To characterize discrete palmar carpal osteochondral fragmentation in horses and to document the effect of osteoarthritis and surgical removal of these fragments on functional outcome. Methods: Retrospective case series. Methods: 25 horses. Methods: Medical records and radiographic views were reviewed to identify horses that had radiographic evidence of palmar carpal fragmentation, which was subsequently treated by arthroscopic removal. Information collected included cause of fracture, initial and long-term clinical and radiographic findings, and functional outcome. Results: Palmar carpal frag...
An international multi-centre prospective study on the efficacy of an intraarticular polyacrylamide hydrogel in horses with osteoarthritis: a 24 months follow-up.
Acta veterinaria Scandinavica    April 15, 2015   Volume 57, Issue 1 20 doi: 10.1186/s13028-015-0110-6
Tnibar A, Schougaard H, Camitz L, Rasmussen J, Koene M, Jahn W, Markussen B.Polyacrylamide hydrogel (PAAG) was evaluated recently to treat osteoarthritis (OA) in horses with highly encouraging results; however no long term field-study was done to explore its clinical efficacy and lasting effect. The objective of this study was to evaluate the efficacy of PAAG in improving clinical signs of OA in horses. We hypothesized that lameness grade would significantly improve and the effect would last at least 2 years in osteoarthritic joints treated with PAAG. Forty three horses older than 2 years with OA in only one joint based on clinical evaluation, intra-articular anaesthe...
Comprehensive protein profiling of synovial fluid in osteoarthritis following protein equalization.
Osteoarthritis and cartilage    March 26, 2015   Volume 23, Issue 7 1204-1213 doi: 10.1016/j.joca.2015.03.019
Peffers MJ, McDermott B, Clegg PD, Riggs CM.The aim of the study was to characterise the protein complement of synovial fluid (SF) in health and osteoarthritis (OA) using liquid chromatography mass spectrometry (LC-MS/MS) following peptide-based depletion of high abundance proteins. Methods: SF was used from nine normal and nine OA Thoroughbred horses. Samples were analysed with LC-MS/MS using a NanoAcquityâ„¢ LC coupled to an LTQ Orbitrap Velos. In order to enrich the lower-abundance protein fractions protein equalisation was first undertaken using ProteoMinerâ„¢. Progenesis-QIâ„¢ LC-MS software was used for label-free quantification. ...
Sustained intra-articular release of celecoxib from in situ forming gels made of acetyl-capped PCLA-PEG-PCLA triblock copolymers in horses.
Biomaterials    March 18, 2015   Volume 53 426-436 doi: 10.1016/j.biomaterials.2015.02.109
Petit A, Redout EM, van de Lest CH, de Grauw JC, Müller B, Meyboom R, van Midwoud P, Vermonden T, Hennink WE, René van Weeren P.In this study, the intra-articular tolerability and suitability for local and sustained release of an in situ forming gel composed of an acetyl-capped poly(ε-caprolactone-co-lactide)-b-poly(ethylene glycol)-b-poly(ε-caprolactone-co-lactide) (PCLA-PEG-PCLA) copolymer loaded with celecoxib was investigated in horse joints. The systems were loaded with two dosages of celecoxib, 50 mg/g ('low CLB gel') and 260 mg/g ('high CLB gel'). Subsequently, they were injected into the joints of five healthy horses. For 72 h after intra-articular injection, they induced a transient inflammatory response,...
Joint-dependent response to impact and implications for post-traumatic osteoarthritis.
Osteoarthritis and cartilage    February 26, 2015   Volume 23, Issue 7 1130-1137 doi: 10.1016/j.joca.2015.02.023
Novakofski KD, Berg LC, Bronzini I, Bonnevie ED, Poland SG, Bonassar LJ, Fortier LA.The prevalence of osteoarthritis (OA) varies between joints. Cartilage in eight different joints was evaluated to elucidate the disparate susceptibilities between joints to post-traumatic OA (PTOA) and provide evidence for joint-specific clinical treatments. The hypothesis was that cartilage in different joints would have varying cell death and anabolic gene expression profiles after injury. Methods: Adult equine cartilage explants were harvested from shoulder (SH), elbow (EL), carpal (CA), metacarpophalangeal (MC), patellofemoral (FP), tarsal (TA), metatarsophalangeal (MT), and proximal inter...
Intra-articular treatment with triamcinolone compared with triamcinolone with hyaluronate: A randomised open-label multicentre clinical trial in 80 lame horses.
Equine veterinary journal    February 2, 2015   Volume 48, Issue 2 152-158 doi: 10.1111/evj.12383
de Grauw JC, Visser-Meijer MC, Lashley F, Meeus P, van Weeren PR.Intra-articular (IA) injection of corticosteroids with or without hyaluronate (HA) has been used for decades in equine practice for treatment of noninfectious synovitis and osteoarthritis. However, to date, no large-scale randomised equine field trials have been reported that address the supposed superior clinical efficacy of the combination of corticosteroid + HA compared with IA injection of corticosteroid alone. Objective: To compare the clinical efficacy of IA triamcinolone acetonide (TA, 12 mg) compared with IA TA (12 mg) + high molecular weight HA (20 mg) in horses with clinical jo...
Detection of early osteoarthritis in the centrodistal joints of Icelandic horses: Evaluation of radiography and low-field magnetic resonance imaging.
Equine veterinary journal    January 30, 2015   Volume 48, Issue 1 57-64 doi: 10.1111/evj.12370
Ley CJ, Björnsdóttir S, Ekman S, Boyde A, Hansson K.Validated noninvasive detection methods for early osteoarthritis (OA) are required for OA prevention and early intervention treatment strategies. Objective: To evaluate radiography and low-field magnetic resonance imaging (MRI) for the detection of early stage OA osteochondral lesions in equine centrodistal joints using microscopy as the reference standard. Methods: Prospective imaging of live horses and imaging and microscopy of cadaver tarsal joints. Methods: Centrodistal (distal intertarsal) joints of 38 Icelandic research horses aged 27-29 months were radiographed. Horses were subjected to...
Relationship between the shape of the central and third tarsal bones and the presence of tarsal osteoarthritis.
Veterinary journal (London, England : 1997)    January 13, 2015   Volume 204, Issue 1 94-98 doi: 10.1016/j.tvjl.2015.01.006
Sprackman L, Dakin SG, May SA, Weller R.Osteoarthritis (OA) of the low motion joints of the tarsus, commonly termed 'bone spavin', is common in horses. Whilst the aetiology of this condition is multifactorial, it has been suggested that dorsal wedging of the central tarsal bone (CTB) and third tarsal bone (TTB) may predispose to the development of this disease. The aim of this study was to investigate the relationship between tarsal bone conformation and osteoarthritis of the proximal intertarsal (PIT), distal intertarsal (DIT) and tarsometatarsal (TMT) joints. It was hypothesised that wedging of the CTB and TTB would be associated ...
A chondrocyte infiltrated collagen type I/III membrane (MACI® implant) improves cartilage healing in the equine patellofemoral joint model.
Osteoarthritis and cartilage    January 7, 2015   Volume 23, Issue 4 648-660 doi: 10.1016/j.joca.2014.12.021
Nixon AJ, Rickey E, Butler TJ, Scimeca MS, Moran N, Matthews GL.Autologous chondrocyte implantation (ACI) has improved outcome in long-term studies of joint repair in man. However, ACI requires sutured periosteal flaps to secure the cells, which precludes minimally-invasive implantation, and introduces complications with arthrofibrosis and graft hypertrophy. This study evaluated ACI on a collagen type I/III scaffold (matrix-induced autologous chondrocyte implantation; MACI(®)) in critical sized defects in the equine model. Methods: Chondrocytes were isolated from horses, expanded and seeded onto a collagen I/III membrane (ACI-Maix™) and implanted into o...
Effect of hoof angle on joint contact area in the equine metacarpophalangeal joint following simulated impact loading ex vivo.
Equine veterinary journal    December 30, 2014   Volume 47, Issue 6 715-720 doi: 10.1111/evj.12354
McCarty CA, Thomason JJ, Gordon K, Hurtig M, Bignell W.To add to the existing data on impact loading of the metacarpophalangeal (MCP) joint as a precursor to assessing the potential role of impact in joint disease. Objective: To examine the effect of impact loading on contact areas of the first phalanx (P1) and proximal sesamoids (PS) with the third metacarpal (McIII) under 3 hoof-strike conditions (toe-first, flat, heel-first). Methods: Randomised, repeated controlled experiment using cadaver material. Methods: Eight cadaver limbs were subjected to randomised, repeated controlled trials where the hoof was struck by a pendulum impact machine (impa...
Synovial Fluid Lubricant Properties are Transiently Deficient after Arthroscopic Articular Cartilage Defect Repair with Platelet-Enriched Fibrin Alone and with Mesenchymal Stem Cells.
Orthopaedic journal of sports medicine    December 23, 2014   Volume 2, Issue 7 doi: 10.1177/2325967114542580
Grissom MJ, Temple-Wong MM, Adams MS, Tom M, Schumacher BL, McIlwraith CW, Goodrich LR, Chu CR, Sah RL.Following various types of naturally-occurring traumatic injury to an articular joint, the lubricating ability of synovial fluid is impaired, with a correlated alteration in the concentration and/or structure of lubricant molecules, hyaluronan and proteoglycan-4. However, the effect of arthroscopic cartilage repair surgery on synovial fluid lubricant function and composition is unknown. Objective: Arthroscopic treatment of full-thickness chondral defects in horses with (1) platelet-enriched fibrin or (2) platelet-enriched fibrin+mesenchymal stem cells leads to equine synovial fluid with impair...
Magnetic Resonance Imaging of the Dorsal Proximal Synovial Plica of the Equine Metacarpo-/Metatarsophalangeal Joint.
Anatomia, histologia, embryologia    December 4, 2014   Volume 45, Issue 1 19-27 doi: 10.1111/ahe.12166
Hauspie S, Vanderperren K, Gielen I, Pardon B, Kromhout K, Martens A, Saunders JH.A synovial plica is present at the dorsoproximal aspect of the fetlock joint. The objective of this study was to describe the location of the synovial plica during induced hyperextension using Magnetic Resonance Imaging. For this study 20 cadaver limbs from five Warmblood horses were used. Measurements were made of the dorsal; palmar/plantar length and the thickness of the plica with the joint in a normal position. During induced hyperextension of the joint, the position of the plica was described; the dorsal angle of extension and angle of contact between the proximal phalanx (P1) and the con...
Survey of the therapeutic approach and efficacy of pentosan polysulfate for the prevention and treatment of equine osteoarthritis in veterinary practice in Australia.
Australian veterinary journal    November 27, 2014   Volume 92, Issue 12 482-487 doi: 10.1111/avj.12266
Kramer CM, Tsang AS, Koenig T, Jeffcott LB, Dart CM, Dart AJ.To survey veterinary practitioners in Australia on how they administer pentosan polysulfate (PPS) to horses and their perceptions of the efficacy of PPS for: the prevention and treatment of osteoarthritis (OA), the treatment of OA when PPS is combined with other drugs, and the efficacy of PPS compared with other disease-modifying osteoarthritic drugs. Methods: Practitioners were contacted by email, which contained a link to an online survey. Results: A total of 76 responses (34.5%) to the survey were received. Respondents most commonly used PPS as prophylactic therapy prior to competition (80....
Minimally invasive proximal interphalangeal joint arthrodesis using a locking compression plate and tissue engineering in horses: a pilot study.
The Canadian veterinary journal = La revue veterinaire canadienne    November 14, 2014   Volume 55, Issue 11 1050-1056 
Seo JP, Yamaga T, Tsuzuki N, Yamada K, Haneda S, Furuoka H, Tabata Y, Sasaki N.This pilot study assessed the efficacy of 2 minimally invasive techniques for proximal interphalangeal (PIP) joint arthrodesis in horses. The PIP joints of both forelimbs (n = 6) were stabilized with locking compression plates (LCP) using a minimally invasive technique (LCP technique). Subsequently, for 1 randomly selected PIP joint of each horse, surgical drilling (SurD) was performed and tissue engineering (TE) was applied (LCP/SurD/TE technique). Minimally invasive PIP joint arthrodesis with LCP demonstrated low postoperative infection rates. Gross and histological evaluations revealed cons...
Use of firocoxib for the treatment of equine osteoarthritis.
Veterinary medicine (Auckland, N.Z.)    November 4, 2014   Volume 5 159-168 doi: 10.2147/VMRR.S70207
Donnell JR, Frisbie DD.This review presents the pathogenesis and medical treatment of equine osteoarthritis (OA), focusing on firocoxib. Inhibition of prostaglandin E remains a fundamental treatment for decreasing clinical symptoms (ie, pain and lameness) associated with OA in horses. Nonsteroidal anti-inflammatory drugs (NSAIDs), which inhibit the production of prostaglandin E from the arachidonic acid pathway, continue to be a mainstay for the clinical treatment of OA. Firocoxib is a cyclooxygenase (COX)-2-preferential NSAID that has been shown to be safe and to have a 70% oral bioavailability in the horse. Three ...
[Feed management in horse husbandry].
Tijdschrift voor diergeneeskunde    October 3, 2014   Volume 139, Issue 9 43-45 
Errens AV.No abstract available
Autologous processed plasma: cytokine profile and effects upon injection into healthy equine joints.
Journal of veterinary science    September 30, 2014   Volume 16, Issue 1 47-55 doi: 10.4142/jvs.2015.16.1.47
Moreira JJ, Moraes AP, Brossi PM, Machado TS, Michelacci YM, Massoco CO, Baccarin RY.This experimental controlled study was performed to evaluate the composition of autologous processed plasma (APP), and the effects of APP intra-articular injection into healthy equine metacarpophalangeal joints. The effects on joints were analysed with a short-phase protocol and a prolonged-phase protocol using saline-injected joints as controls. For the short protocol, horses received one intra-articular APP injection. Synovial fluid samples were collected prior to the injection and 3, 6, 24, 48, and 16 h after treatment. For the prolonged protocol, the joints received three weekly injections...
Effects of low and high dose intraarticular tiludronate on synovial fluid and clinical variables in healthy horses-a preliminary investigation.
PeerJ    September 4, 2014   Volume 2 e534 doi: 10.7717/peerj.534
Duesterdieck-Zellmer KF, Moneta L, Ott JF, Larson MK, Gorman EM, Hunter B, Löhr CV, Payton ME, Morré JT, Maier CS.To determine effects of intraarticularly administered tiludronate on articular cartilage in vivo, eight healthy horses were injected once with tiludronate (low dose tiludronate [LDT] 0.017 mg, n = 4; high dose tiludronate [HDT] 50 mg, n = 4) into one middle carpal joint and with saline into the contralateral joint. Arthrocentesis of both middle carpal joints was performed pre-treatment, and 10 min, 24 h, 48 h, 7 and 14 days after treatment. Synovial nucleated cell counts and total solids, tiludronate, sulfated glycosaminoglycan (sGAG), chondroitin sulfate 846 epitope (CS-846, a measure of aggr...
Application of stem cells for the treatment of joint disease in horses.
Methods in molecular biology (Clifton, N.J.)    September 1, 2014   Volume 1213 215-228 doi: 10.1007/978-1-4939-1453-1_18
Brehm W, Burk J, Delling U.Stem cells in the form of mesenchymal stromal cells derived from various sources have been identified to have the potential of supporting the therapy of joint disease in the horse, and preliminary data has been published about the clinical application of stem cells in horses suffering from clinical joint disease. Furthermore, the horse is recognized to be the ideal large animal model for the preclinical study of cell therapy in joints. The advantage of this species in this respect is the size of the joints, which makes surgical applications practically feasible in analogy to human surgery. Add...
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