osteoarthritis | Horse Racing Free Tips

Efficacy Of Oral Joint Supplements: Which Ingredients Actually ‘Work?’

Dr. Rachel Tucker, an associate at Liphook Equine Hospital in the United Kingdom, was on a quest to determine which ingredients, if any, contained in popular equine joint supplements actually worked.

Many oral supplements claim a wide array of effects, including maintaining joint health, offering anti-inflammatory benefits, improving welfare, reducing joint stiffness and pain, and slowing osteoarthritis progression, reports The Horse.

Since most supplements are sold as food products, they are not required to conform to regulations or quality — or to have demonstrated efficacy.

Tucker considered ingredients effective if they achieved a desired response in the joint. They must also be bioavailable when administered orally, and have an appropriate formulation and concentration that matches published studies.

Chondroitin sulfate is a building block of joints; it is bioavailable and reaches synovial fluid and cartilage. It has an anti-inflammatory effect on human joint tissues and has been shown to reduce pain and swelling, as well as to prevent joint space narrowing. Equine-specific studies, however, have shown that chondroitin sulfate has no measurable effect on the horse.

Glucosamine is present in cartilage and synovial fluid; the amino monosaccharide prevents joint breakdown and acts as an anti-inflammatory. Research has shown conflicting evidence: some studies show that glucosamine has slow or no utilization in tissue, while others find that it does have an effect on pain or function.

Boswellia serrata, also called Indian frankincense, claims to be an anti-inflammatory. There have been no veterinary studies on Boswellia serrata's use, so additional investigation is needed, Tucker said. It has shown some benefit in humans who have taken it.

[Story Continues Below]

Turmeric use in humans has demonstrated anti-inflammatory and antioxidant properties, but it has poor bioavailability. Only one veterinary study has been done to date, and the vets involved thought it showed significant improvement in dogs that consumed it.

While Tucker concluded that there is no concrete evidence that supplements work, they are safe to feed horses.

Pros And Cons Of Antibiotic Injections In Equine Joints

Because of the finesse with which equine veterinarians inject medications into joints, the procedure can appear uncomplicated. While injecting joints with antibiotics can help clear infections, the procedure is not without risks. Veterinarians must therefore consider a number of important factors before moving forward with intra-articular antibiotic therapies.

Managing Osteoarthritis

Medicating joints with corticosteroids, polysulfated glycosaminoglycans, or hyaluronic acid is commonplace in equine sports medicine. Intra-articular injection is often used in conjunction with other modalities, including oral joint health supplements. Oral products decrease inflammation and improve mobility, boosting the overall health of joints. Examples of appropriate products include high-quality supplements that contain proprietary combinations of glucosamine hydrochloride, chondroitin sulfate, MSM, and hyaluronic acid.

According to a recent review of intra-articular antibiotic use, 78 percent of veterinarians use intra-articular antibiotics in combination with other medications.^* By adding an antibiotic, often amikacin, to corticosteroid or polysulfated glycosaminoglycan, veterinarians hope to sidestep the development of a septic joint.

Considering the low risk of infection following joint injections, the question then becomes whether or not veterinarians should use prophylactic antibiotics. Moreover, because intra-articular antibiotics are used “off-label,” no researched guidelines for appropriate intra-articular use exist.

Prophylactic intra-articular antibiotic use therefore has two major ramifications:

Veterinarians may administer an excessively high dose. “According to some evidence, antibiotics like amikacin have toxic effects on cartilage cells and other joint tissues,” said Peter Huntington, B.V.Sc., M.A.C.V.Sc., director of nutrition at Kentucky Equine Research.
Unnecessary use of antibiotics contributes to antibiotic resistance. “With few new antibiotics in development and growing multidrug resistance to currently available medication, revisiting the practice of prophylactic antibiotic use in horses may be warranted,” Huntington added.

These concerns associated with intra-articular antibiotic administration supports alternative strategies for maintaining joint health.

Managing Septic Joints

Intra-articular antibiotics are indispensable in the face of a septic joint because direct administration into the joint can achieve high local drug concentrations. If, on the other hand, antibiotics are offered orally, high dosages would be needed for longer durations to achieve the same result as an intra-articular injection.

[Story Continues Below]

“Systemic antibiotics, however, may be associated with important and potentially life-threatening side effects such as gastrointestinal disturbances that disrupt the microbiome. In the face of microbiome disarray, pathogenic bacteria may proliferate, altering immunity and increasing the risk of diarrhea or laminitis,” Huntington explained. When systemic antibiotics must be administered, gastrointestinal support in the form of research-proven supplements should be considered.

Local antibiotic delivery directly into a joint may also:

Improve owner compliance as injections do not rely on the owner administering the entire course of oral antibiotics;
Make treatment more affordable, as a systemic antibiotic maybe be cost prohibitive for an owner;
Shorten the course of treatment and improve outcomes; and
Result in high concentrations at the site of infection that may be particularly useful for fighting “floating biofilm,” which is an accumulation of microbes embedded within a self-produced extracellular matrix that helps protect the bacteria from antibiotics.

^*Pezzanite, L.M., D.A. Hendrickson, S. Dow, L. Chow, D. Krause, and L. Goodrich. 2021. Intra-articular administration of antibiotics in horses: Justifications, risks, reconsideration of use and outcomes. Equine Veterinary Journal:13502.

Questionnaire May Help Arthritic Equines Get Help Earlier

Osteoarthritis can be a painful condition in horses but, unlike people, horses can't talk with their veterinarians about where and how much it hurts. Now, a newly funded study from Morris Animal Foundation is testing to see if a simple questionnaire can help horse owners recognize and monitor signs of chronic osteoarthritis (OA) pain in their horses – helping their equine charges get earlier, more effective treatment and improving their quality of life.

Dr. Janny de Grauw, from Utrecht University in the Netherlands, and Diane Howard, PhD, MSc., Equine Science Master graduate from the University of Edinburgh, in the United Kingdom, are the recipients of the Donor-Inspired Study grant, funded by Dr. Wendy Koch, a veterinarian who has supported the Foundation for nearly 30 years. Dr. Koch has closely followed equine behavior and welfare research over the years and wanted to increase the amount of funding available for studies in these fields.

To effectively treat pain, caregivers and clinicians need a way of monitoring and quantifying the amount of discomfort felt. However, a survey of horse owners in the United Kingdom found that owners have limited ability to identify pain and disease in their horses, underlining the need for a simple way of helping people to recognize chronic pain in their equine companions.

“As veterinarians, we want to treat horses with painful and debilitating conditions like OA as effectively as possible,” said de Grauw. “How well we can manage their condition critically relies on recognition of subtle signs of (worsening) pain by owners and caregivers, who can then seek help.”

Under Dr. de Grauw's supervision, Howard developed the 15-item questionnaire based on changes in horse behavior through interviews with owners of horses diagnosed with osteoarthritis. The questions cover posture, facial expressions, movement and behavior.

She will validate the questionnaire by having 60 owners of horses with chronic OA pain and 20 owners of horses without OA complete it. The owners with OA horses will complete the questionnaire twice in two days while their horse's pain does not fluctuate, to evaluate how robust and reproducible the scoring instrument is.

The research team hopes the easy-to-use questionnaire will help horse owners recognize when their animals are in pain and contact a veterinarian for appropriate treatment. The instrument also may help owners monitor treatment effectiveness and pain progression over time, and guide owners and veterinarians in making quality-of-life decisions.

“Many horses may deal with pain that is not recognized, particularly in its early stages,” said Dr. Janet Patterson-Kane, Morris Animal Foundation Chief Scientific Officer. “Giving their caregivers effective tools for detection, monitoring and decision-making has the potential for significant animal welfare impact.”

Osteoarthritis is a major cause of chronic pain in horses but is an underrecognized and undertreated condition. Though often associated with advanced age, it can also occur in young horses. In addition to being painful, OA can severely curtail a horse's athletic career, and impact the bond between horse and owner if the condition limits a horse's ability to be ridden.

The Foundation's Donor-Inspired Study program allows individual donors and foundations to directly support research topics for which they have a passion and there is a pressing need. Applications for this grant were reviewed and rated, based on impact and scientific rigor, by a scientific advisory board, made up of equine behavior and welfare experts.

Morris Animal Foundation is one of the largest nonprofit organizations worldwide that funds health studies benefiting cats, dogs, horses, llamas, alpacas and wildlife. The Foundation currently is funding 150 studies encompassing a broad spectrum of species and diseases.

FDA Approves First Generic Ketoprofen For Use In Horses

The FDA has approved KetoMed, the first generic ketoprofen for the alleviation of inflammation and pain associated with musculoskeletal disorders in horses.

Musculoskeletal disorders are prevalent in aging horses and can cause pain, weakness, stiffness and decreased range of motion in the animals' joints. Osteoarthritis and chronic laminitis are among the most common musculoskeletal disorders in horses and can greatly impact a horse's performance and quality of life.

KetoMed contains the same active ingredient (ketoprofen) in the same concentration and dosage form as the approved brand name drug product, Ketofen, which was first approved on September 26, 1990. In addition, the FDA determined that KetoMed contains no inactive ingredients that may significantly affect the bioavailability of the active ingredient.

The data submitted in support of the Abbreviated New Animal Drug Application demonstrate that KetoMed, when used according to its label, is safe and effective.

KetoMed is a prescription product because a veterinarian's expertise is required to diagnose musculoskeletal disorders and to determine whether ketoprofen is an appropriate treatment.

KetoMed is supplied in 50 mL and 100 mL multidose bottles. The recommended dosage is 1 mg/lb (1 mL/100 lbs) of body weight once daily. Treatment is administered by intravenous injection and may be repeated for up to five days.

KetoMed is sponsored by Bimeda Animal Health Ltd. based in Dublin, Ireland.