Laminitis in the 21st century.

This research article discusses the understanding, diagnosis, treatment and management of laminitis – a debilitating condition impacting horses. It highlights the challenges veterinarians and farriers face in managing this condition, despite technological and medical advances, while also suggesting potential areas for further research.

Understanding and History of Laminitis

• The article starts by tracing the understanding of Laminitis, an ancient yet severe illness affecting horses. It has been found in prehistoric horses, millions of years before horses were domesticated.
• Paleopathological studies have shown evidence of laminitis in prehistoric horses. Moreover, research on wild horses has identified laminitis pathology that may be influenced by environmental factors.

Prevalence of Laminitis

• In domesticated horses, the frequency of laminitis has been reported to range from 3 to 17.1 per cent. However, a recent study in Great Britain showed that active episodes of laminitis accounted for nearly one in 200 veterinary visits which suggests its significance.
• A study in the UK found that supporting limb laminitis‘ prevalence in a particular referral practice was observed to be 0.02 per cent.

Challenges in Laminitis Management

• The article raises the question, why despite the long history of laminitis and advancements in understanding its pathophysiology do veterinarians and farriers still struggle with managing this condition?
• Techniques like lamellar microdialysis have helped in understanding the initiating causes of laminitic episodes and measuring lamellar energy metabolism. Furthermore, discovering that experimentally induced hyperinsulinemia causes laminitis has improved the understanding and management of cases with underlying metabolic conditions. Despite these advancements, horses continue to be euthanized due to clinical deterioration of many laminitis cases.

Classification of Laminitis

• Typically, laminitis is classified as being sepsis-associated, endocrine-associated, or associated with supporting limb laminitis. However, in reality, individual cases of laminitis may not be as straightforward, indicating there can be a crossover between these categories.
• The article raises hypotheses around why all cases with certain conditions (like colitis) don’t always develop laminitis, suggesting underlying factors like a co-existing endocrine disease could predispose the lamellar attachment to severe damage.
• It further emphasizes the complex nature of laminitis with the ‘perfect storm’ scenario, where multiple risk factors culminate in a severe episode of laminitis, stressing the importance of identifying at-risk cases to implement preventive measures.