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Equine osteoarthritis (OA) is a common cause of lameness, particularly in senior horses. Sometimes referred to as degenerative joint disease, OA occurs when the cartilage in a joint begins to break down over a period of time. OA is commonly seen in the joints of the leg, like the hock, stifle, knee, and fetlock. Primary OA is the result from overall wear and tear of the joint, while secondary OA can occur from a specific joint injury.

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What are the signs of equine osteoarthritis (OA)? Since OA is a chronic degenerative condition, common signs to watch for include stiffness, pain, lameness, heat and/or swelling of the affected joint, and popping or grinding noises in the joint. If you've noticed any of these signs in your horse, contact the clinic at [INSERT CLINIC CONTACT INFO] for an exam.

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In order to diagnose osteoarthritis (OA), your veterinarian will first perform a standard lameness examination where they might include things like a flexion test and/or anesthetic blocks. From there, they may perform diagnostic imaging tests--like radiographs (x-rays) and ultrasound-on the affected joint. Once a diagnosis of OA is reached, your veterinarian will discuss recommended treatments and management options.

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There are several products that are used to treat horses with osteoarthritis (OA). Some of these drugs have been approved for several decades, and one such drug is hyaluronate sodium.

Hyaluronate sodium is a large, naturally occurring molecule found in many parts of the body. It is a major component of synovial (joint) fluid that serves as both a lubricant and a protective buffer for joint cartilage by absorbing mechanical stress. There is currently an injectable formulation of hyaluronate sodium available for intravenous (IV) use in horses with OA.

The drug was approved for use in horses over 30 years ago with the label indication for use in horses with inflammation of the joint lining (synovitis). The recommended dose is a series of three injections at one-week intervals. The drug has demonstrated a positive effect on lameness, and some additional measures, in a group of horses with lameness caused by synovitis. In clinical practice this drug is often given to "prevent" the development of OA yet there have not been any studies to show that it has benefit when used that way.

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There are a variety of products on the market that are used to treat horses with osteoarthritis (OA). Some of these drugs have been approved for several decades like polysulfated glycosaminoglycan (PSGAG). PSGAG is a large molecule made of strings of sugar-like units with other groups (sulfates) attached. The molecule is like a molecule that makes up part of the "backbone" of joint cartilage. While the exact mechanism of action is not clearly known, PSGAG is thought to protect joint cartilage by inhibiting some of the enzymes that breakdown the cartilage and by possibly stimulating cartilage repair. There is a drug approved for intramuscular (IM) use in horses with joint-related lameness.

PSGAG has been available for almost 35 years for use to help alleviate the lameness caused by degenerative joint problems. The recommended dose is a series of seven injections given every four days. The drug has demonstrated a beneficial effect in some studies on horses with clinical lameness. Like the intravenous (IV) hyaluronate sodium product discussed earlier, in clinical practice this drug is used most often to "prevent" OA, but there have not been any studies to support that claim.

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There are multiple products currently available for the management of equine osteoarthritis (OA), and while some have been available for several decades, newer options have received FDA approval and entered the market.

Pentosan polysulfate (PPS) is in the same class of drugs as polysulfated glycosaminoglycan (PSGAG) and is considered to be a disease-modifying osteoarthritis drug (DMOAD). The mechanism of action includes a variety of effects. Pentosan polysulfate has been shown to have an anti-inflammatory effect and decrease cartilage degradation by affecting some of the inflammatory mediators that drive OA, and to increase the production of hyaluronan (a key component of joint fluid) by the cells of the joint lining (synovium).

A pentosan polysulfate product has been licensed for use in horses in Australia for several years, and at the end of 2022, a new pentosan polysulfate product was approved in the United States for control of the clinical signs of OA in horses. The drug is to be given in a series of four intramuscular (IM) injections at one-week intervals. A study published in 2012 using a different formulation of PPS (not the approved drug) showed beneficial effects on joint cartilage in the group of horses treated with PPS.¹ The newly-approved drug demonstrated effectiveness improving lameness at least one grade on the American Association of Equine Practitioners (AAEP) Lameness Scale when used for clinical cases of lameness.

¹McIlwraith C. Wayne, Frisbie David D., Kawacak, Christopher E. Evaluation of intramuscularly administered sodium pentosan polysulfate for treatment of experimentally induced osteoarthritis in horses. AJVR. 2012;73(5):628-633.

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There are a few assorted products available for use in horses with osteoarthritis that are not approved drugs but are classified as veterinary devices. This means that they have not been reviewed for safety and effectiveness by the Food and Drug Administration- Center for Veterinary Medicine (FDA-CVM). There are currently three products that are available for injection into the joints of horses; two products that are made of polyacrylamide gel and one that is made of collagen. The idea behind these products is that they provide a physical "cushion" in the joint and may have some beneficial effects on the synovium (joint lining). There have been some studies done on horses with clinical lameness that have shown some improvement in lameness in those groups of horses. In clinical practice, these products are often used after other treatments have been tried without success.

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There are non-pharmaceutical options to manage osteoarthritis (OA) in horses. Rest is an often overlooked--yet effective-form of management. By simply backing off a horse's exercise regimen, it may be possible to decrease the inflammation associated with OA and improve the horse's comfort level. Rest, in conjunction with a well-designed rehabilitation program, can have many beneficial effects on a horse's comfort level. The American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR) certifies veterinarians that have pursued specialty training in managing performance horses that experience athletic-related problems, including lameness secondary to OA. Some rehabilitation programs include exercise programs that are meant to help keep a horse moving and fit while decreasing the weight-bearing load on their legs. These programs can use swimming pools designed for horses or underwater treadmills. Limiting exercise and appropriate exercise can be a helpful adjunct to other ways of managing OA in horses.

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Shockwave therapy has been used in equine practice for about 30 years and can be a non-pharmaceutical option for the management of equine osteoarthritis (OA). Shockwave therapy uses high energy pressure waves (shock waves) delivered to the treated site to cause changes in the tissues. The tissue translates the physical waves into signals to the cells. The result is control of inflammation, decreased pain, increased blood flow, and beneficial cell signaling because of cytokine release. Shockwave therapy has been reported to have beneficial effects in managing OA of the lower hock joints, fetlocks, knees, stifles, and facet joints of the neck. In recent years, shockwave therapy has been used together with regenerative medicine therapies to help manage OA in horses.

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In recent years, use of regenerative therapies for conditions like equine osteoarthritis (OA) has become more common. Regenerative therapies work by using specific healing components from the horse's body to promote self-healing.

Serum-based therapies-like ACS/IRAP-use fluid that remains after blood has clotted and processed in a centrifuge. On the other hand, plasma-based therapies-like platelet rich plasma (PRP) and autologous protein solution (APS)-consist of fluid that remains when clotting is prevented by an anticoagulant and processed in a centrifuge.