Editor's Note: This article is part of TheHorse.com's ongoing coverage of topics presented at the British Equine Veterinary Association's 51st annual Congress, held Sept. 12-15 in Birmingham, U.K.
Equine veterinary advances and technologies generally come with a hefty price tag. The economics of diagnosis especially become a concern when treating older horses for OA, which can result from years of joint wear. One veterinarian described ways to manage equine arthritis on a budget at the British Equine Veterinary Association's 51st annual Congress, held Sept. 12-15 in Birmingham, U.K.
"For many equine clients it is an economic fact that, while the utilization of advanced diagnostic techniques may provide the 'gold standard' in service and diagnostic certainty, they are too expensive," explained Emma Jones, MA, VetMB, CertES(Orth), MRCVS, from Abbey Equine Centre, in Monmouthshire, U.K. "In the present economic climate the diagnostic work up may cost in excess of the monetary value of the horse."
She added that many insurance companies don't offer life coverage or don't cover these treatments past a certain age. So she proposed that veterinarians work with owners to extract as much information as possible from routine tests before resorting to diagnostic imaging. "We're not doing enough with the whole horse basic workup," she said.
Jones suggested looking for basic clinical signs of OA, such as increased respiratory rate; changes in normal behavior, such as eating less; abnormal behaviors, such as shifting weight; and increased behaviors, such as lying down. When assessing the horse, the veterinarian should use easily gleaned information such as the horse's history, conformation, joint palpation, range of motion, heat or pain upon limb flexion, and a comparison of limbs. Further, he or she should evaluate what effect exercise and ground surface have on the horse both immediately (during the lameness exam) and the following day.
As a money-saver, Jones advised caution when using diagnostic regional anesthesia (nerve blocks). "A lack of confidence in block results can lead to overuse of imaging with budget implications," she said.
She also warned that when taking radiographs (X rays), the correlation between X ray results and what is actually going on in the joint can be poor (e.g., a horse with significant lameness might show little change on radiographs, while a horse with no lameness might show significant change on radiographs), and "poor-quality X rays don't help."
Jones believes ultrasound, on the other hand, to be an excellent tool for evaluating OA. "It's underused, cost-effective, noninvasive, and can detect osteophyte (bony growths at the margins of the joint that form during remodeling) formation," she explained.
She also said that intra-articular anesthesia as part of a diagnostic work up can provide additional information about synovial fluid and its viscosity.
When it comes to treating the condition and the horse's pain, Jones advised that owners only pursue methods that will either improve athletic function or general welfare.
Ultimately, she believes the best thing owners can do is get the most information from their veterinarians as possible about how to help these horses. For instance, veterinarians can offer a wealth of information about appropriate weight, exercise, farriery, and expectations of future function to help give horses with OA the best quality of life.
Because there is not likely to be a cure for OA anytime soon, and therapies for affected horses might be expensive and required for many years, owners and veterinarians must extract as much information from routine tests as possible, and owners need to communicate their expectations and budget constraints with their veterinarian beforehand.
Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.