Current Joint Therapies in Equine Veterinary Practice

The results of a veterinarian survey on joint therapies were summarized by Dora Ferris, DVM, a staff veterinarian in Colorado State University's Orthopaedic Research Center, at the 2009 American Association of Equine Practitioners (AAEP) convention, held Dec. 5-9 in Las Vegas, Nev. In a 2009 survey of veterinarians, of 831 respondents, 80% practice exclusively on horses. Over half the respondents focus on lameness and performance practice at least half the time; most respondents have been in practice more than 10 to 20 years.

Seventy percent of the respondents use corticosteroids in their intra-articular therapeutic strategy, usually combined with another medications, such as hyaluronic acid (HA) or the antibiotic amikacin. For 22%, personal experience is relevant as to which intra-articular corticosteroid they select. Scientific data on efficacy determines what medication 38% use. For high-motion joints (coffin, fetlock, carpus), the vets most commonly use triamcinolone (TCA). For low-motion joints (distal hocks), methylprednisolone acetate (MPA) is the corticosteroid of choice. Because MPA is known to increase cartilage pathology (damage) at a 100-mg dose, most respondents inject far less.

Most practitioners (70%) do not use compounded medications in the joints, preferring FDA-approved and tested products specifically formulated to target joint therapy. Only 4.1% rarely or never use corticosteroids for joint therapy.

For joints that are unresponsive to corticosteroid therapy, 38% of respondents turn to autologous conditioned serum treatment, which uses the horse's own blood to produce interleukin-1 receptor antagonist protein (IRAP) and other anti-inflammatory proteins to combat pro-inflammatory molecules. Reporting response to IRAP therapy, 37% feel the fetlock responds best, 22% feel the stifle responds best; and 20% are "encouraged by results" in coffin joints. English performance horse practitioners are most likely to use IRAP in their cases.

Also used by practitioners are noncorticosteroid joint therapies such as intravenous hyaluronic acid and/or polysulfated glycosaminoglycan (PSGAG) intramuscularly and/or in the joint. Eithy-four percent of survey respondants use IM Adequan (PSGAG), and 77% use Legend IV (an HA product), with these two products dominating preventive and prophylactic use.

A previous survey (1996) indicated practitioners perceived the efficacy of PSGAG to be similar to that of hyaluronic acid, and 77% used corticosteroids in joint injections.

Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.