Transcript:

[0:00]

Hi everyone, welcome back to Mad Barn Academy, and if you're new here, then welcome — we hope to earn your subscription today. I'm Dr. Fran Row, one of the veterinary nutritionists here at Mad Barn, and today's video is part two of osteoarthritis. We'll be focusing today on diagnosis and management of OA.

[0:21]

If you haven't seen the part one video for this little two-part series on osteoarthritis, I recommend that you go ahead and do that now. I've included a link to that video in the description below. It'll give you some necessary background on the pathology of osteoarthritis, which definitely informs our management decisions — so you'll have a better understanding of why we undertake certain management options, which we'll be discussing today. Okay, let's get started.

[0:51]

All right, so we left off that part one video with this concept that osteoarthritis is really a cycle of degeneration that feeds into itself. These degenerative changes, once they start in the joint, are going to incite inflammation, and that's going to lead to even more degenerative change, which will lead to more inflammation, and so on and so on. So when we talk about treatment or management strategies, we'll be looking to target these two big categories: degenerative change on the one hand, and inflammation on the other.

[1:33]

But first, let's quickly talk about how osteoarthritis is actually diagnosed. In many cases, we can diagnose OA based on the horse’s history, their physical exam, and a lameness exam — and that'll be called a presumptive diagnosis. Response to therapy can also be helpful in supporting our presumptive diagnosis, because if the horse responds favorably to our therapy, then we'll feel more confident that we're actually targeting the right thing.

[2:03]

Nonetheless, many times it's helpful to get some extra information with diagnostic imaging. In the farm setting, your vet is most likely going to be able to perform radiographs or ultrasound, and getting an inside look really aids in diagnosis. It's also going to help characterize the extent of degenerative change in that particular joint, and it gives you a starting point to track those changes over time. That latter point might be really important for the performance horse, especially if that horse has sale potential in the future.

[2:51]

Advanced imaging — like MRI, CT, or nuclear scintigraphy (bone scan) — could be necessary if the suspected location of arthritis is inaccessible or difficult to image with routine radiographs or ultrasound, such as in the hip or the shoulder.

[3:11]

In this radiograph image here, this is a radiograph of a hock, and the arrow is pointing to arthritic changes in the distal intertarsal joint, or the DIT. All of that fuzziness that you see really shouldn't be there — it should be this nice, clean, straight line through the joint space, just like the joint right below it, which is a nice, clean, straight line. That fuzziness is indicative of bony change and bony remodeling.

[3:50]

It's really important to realize that osteoarthritis is a manageable condition, but it doesn't have a definitive cure. We can certainly slow down disease progression, improve the horse's comfort, and promote repair in the joint, but we really can't reverse the changes that have already happened and go back to a normal joint.

[4:16]

So our two big targets, which we already talked about, are going to be reducing inflammation in the joint and promoting repair in order to combat some of those degenerative changes in that affected joint or joints. Some of our strategies overlap in these two departments, so let's walk through what some of our options are.

[4:44]

When it comes to targeting inflammation in an arthritic joint, we can either take the approach of a non-specific anti-inflammatory that targets the whole body — such as with systemic anti-inflammatories like Bute or Equioxx — or we can take a more direct approach by administering that medication directly into the affected joint. That would be via intra-articular injections of, most often, steroids into the joint, though there are other substances that can be injected for this purpose.

[5:25]

Systemic anti-inflammatories — systemic just meaning “whole body” — would be given every day. This is kind of our non-specific approach. When we take ibuprofen or Advil, it's going to provide anti-inflammatory support throughout the body; the same is true for the horse. This strategy is going to target multiple joints, versus our joint injections, which are performed on an as-needed basis — generally every six months or maybe every 12 months, depending on the horse and the degree of arthritis in that particular joint. This is a really targeted approach that's specific to the affected joint and leaves all the other joints as is.

[6:28]

In addition to trying to interrupt the inflammatory cycle in the joint, we can also aim to provide the body with building blocks that help facilitate the natural healing processes within the joint. One of the most common ways to do this is via administration of a chondroprotectant — a fancy name for any substance or medication that supports joint cartilage health.

[6:55]

Some of the chondroprotectants you might be familiar with are hyaluronic acid (HA) and glycosaminoglycans like Adequan or Pentosan. HA can be given orally, intravenously (Legend), or combined with steroids and injected directly into a joint, which is very common. Adequan and Pentosan are most often given intramuscularly, though there is a formulation of Adequan available for joint injection.

[7:46]

Another avenue becoming more popular and accessible is regenerative medicine. As the name implies, regenerative medicine supplies the body with mediators and beneficial factors that promote the regeneration or healing of damaged tissues. PRP (platelet-rich plasma), IRAP (interleukin-1 receptor antagonist protein), and Pro-Stride (autologous protein solution) are derived from the horse's own blood, processed to concentrate anti-inflammatory mediators, growth factors, and specific proteins, and then injected back into a joint.

[9:13]

Stem cell therapy is a bit different — stem cells are harvested from the bone marrow, most often from the sternum or pelvis, processed to isolate the cells, and then injected back into a specific site of interest. Just like other joint injections, these are performed on an as-needed basis. These therapies are becoming more popular because they offer both anti-inflammatory and tissue repair benefits, and they're a great option for horses that cannot tolerate steroids.

[10:27]

Last on our list for direct or whole-body joint support is the use of nutraceutical or nutritional supplements. There are many on the market, which can be overwhelming. My recommendation is to focus on products or ingredients backed by strong scientific evidence. Two we recommend most often are DHA (an omega-3 fatty acid with anti-inflammatory benefits) and MSM (an antioxidant that supports inflammation regulation and joint health). There's also promising early research for resveratrol, green-lipped mussel, and avocado or soybean unsaponifiables.

[11:52]

You might be wondering about glucosamine or chondroitin sulfate, which are very common in joint supplements. Research has shown they have poor oral bioavailability, so even if we're providing them, they may not be doing much if they're not being absorbed from the gut.

[12:32]

Lastly, there are additional considerations for reducing wear and tear on the joints to slow osteoarthritis progression. This includes modifying workload — such as minimizing days of strenuous exercise, especially for seasoned horses — following age-appropriate exercise programs for young horses, and avoiding difficult terrain or excessive lunging.

[13:30]

Body condition is also key. Excess weight adds strain on joints, so for horses with OA, it's recommended to maintain a lean-to-ideal body condition (4/9 or 5/9 on the Henneke scale).

[13:57]

Okay, here are our references for today, and thanks so much for listening. Check out the additional links in the description for more on arthritis management, joint injections, and research on joint supplements. Don't forget to like and subscribe to our channel, explore our other videos, and check back soon. Until next time!