IN-DEPTH: RACING-RELATED LAMENESS
months as well as a significant increase in aggrecan content in the repair tissue. As a potential alternative for the use of acute traumatic synovitis and capsulitis, MSCs would not appear to be an option. There are good indications that MSCs have long-term effects for soft tissue inflammation within the joint as well as articular cartilage repair. The amount of DMOAD effects is less certain; their use is important in long-term regenerative therapies but not in the acute situation.
11. Systemic (Parenteral) Medications
Polysulfated Glycosaminoglycan Polysulfated glycosaminoglycan administered intra- muscularly is still very popular, but evidence is lim- ited to anecdotal opinion. Intramuscular injections of 500 mg after surgery were commonly recom- mended by the author until a controlled study in experimentally induced equine OA showed no sig- nificant difference in the administration of intra- muscular PSGAG (every 4 days for 28 days) as a positive control treatment in an evaluation of ESWT on experimentally induced osteoarthritis in the mid- dle carpal joints of horses.5 Consequently, it is thought that the use of intramuscular PSGAG is very limited as a treatment. Any prophylactic value is still unproven.
Pentosan Polysulfate
Intramuscularly administered sodium pentosan polysulfate (NaPPS) has been commonly used out- side the United States for the treatment of osteoar- thritis as well as after surgery. Recently, NaPPS at a dose of 3 mg/kg intramuscularly at 15, 22, 29, and 36 days after induction of experimental carpal osteoarthritis caused a significant reduction in ar- ticular cartilage fibrillation and an increase in chon- droitin sulfate 846 epitope (a synthetic biomarker) in the synovial fluid of both osteoarthritic and non- osteoarthritic joints. This indicated that NaPPS has some beneficial disease-modifying effects.35 The product is available in a 12-mL vialo (which is the approximate dose for a 1000-lb horse), but cau- tion must be exercised in the United States because the product is not licensed and is only available as an intra-articular lavage.
Intravenous HA
The use of intravenous HA (40 mg IV) after surgery is used by some clinicians, and there is scientific evidence that would support its use. With a study in the equine osteochondral fragment–OA model, three treatments of 40 mg were given intravenously 13, 20, and 27 days after osteochondral fragment creation. There was a significant decrease in lame- ness, synovial fluid protein and PGE2 levels, syno- vial membrane vascularity, and synovial membrane cellular infiltration at day 72 compared with the
control group given 4 mL of saline intravenously at those same times.36
Oral HA
A number of oral nutraceuticals are used after ar- throscopic surgery. All these products are unli- censed, and, with the exception of oral HA,p no scientific evidence has been produced to support their use. However, one oral HA productp has been shown to benefit postoperative effusion after ar- throscopic surgery for tarsocrural osteochondritis dissecans (OCD).37 Oral HA (100 mg) was given daily for 30 days after surgery in 24 yearlings (with 27 joints operated), and another 24 yearlings (30 joints operated) were treated with placebo daily for 30 days. An examiner blinded to the treatment groups scored the effusion at 30 days on a scale of 0 to 5. The mean 30-day effusion score in the treated group was 0.67 as compared with 2.05 in the placebo group (P 0.0001).
References and Footnotes
1. McIlwraith CW. The use of intra-articular corticosteroids in the horse: what is known on a scientific basis? Equine Vet J 2010;42:563–571.
2. Ferris DJ, Frisbie DD, McIlwraith CW, et al. Current joint therapy usage in equine practice: a survey of veterinarians 2009. Equine Vet J 2011;43:530–535.
3. Frisbie DD, Kawcak CE, McIlwraith CW, et al. Evaluation of polysulfated glycosaminoglycan or sodium hyaluronan ad- ministered intra-articularly for treatment of horses with ex- perimentally induced osteoarthritis. Am J Vet Res 2009;70: 203–209.
4. Kawcak CE, Frisbie DD, McIlwraith CW. Effects of extra- corporeal shockwave therapy and polysulfated glycosamino- glycan therapy on subchondral bone and serum and synovial fluid biomarkers in an equine osteoarthritis model. Am J Vet Res 2011;72:772–779.
5. Frisbie DD, Kawcak CE, McIlwraith CW. Evaluation of the effect of extracorporeal shockwave treatment on experimen- tally induced osteoarthritis in middle carpal joints of horses. Am J Vet Res 2009;70:449–454.
6. McClure SR, Weinberger T. Extracorporeal shockwave therapy: clinical applications and regulation. Clin Tech Equine Pract 2003;2:358–367.
7. Revenaugh MS. Extracorporeal shockwave therapy for treatment of osteoarthritis in the horse: clinical application. Vet Clin North Am Equine Pract 2005;21:609–625.
8. King MR, Haussler KK, Kawcak CE, et al. Mechanisms of aquatic therapy and its potential use in managing equine osteoarthritis. Equine Vet Edu 2013;25:204–209.
9. Templeton MS, Booth DL, O’Kelly WD. Effects of aquatic therapy on joint flexibility and functional ability in subjects with rheumatic disease. J Orthop Sports Phys Ther 1996; 23:376–381.
10. Hurley MV. The effects of joint damage on muscle function, proprioception and rehabilitation. Man Ther 1997;2:11–17.
11. Johansson H, Sjolander P, Sojka P. A sensory role for the cruciate ligaments. Clin Orthop 1991;268:161–178.
12. Iles J, Stokes M, Young A. Reflex actions of knee joint afferents during contraction of the human quadriceps. Clin Physiol 1990;10:489–500.
13. Hopkins J, Ingersoll C, Drause B, et al. Effect of knee joint effusion on quadriceps and soleus motoneuron pool excitabil- ity. Med Sports Sci Sports Exerc 2001;33:123–126.
14. Palmieri R, Tom J, Edwards J, et al. Arthrogenic muscle response induced by an experimental knee joint effusion is mediated by pre- and post-synaptic spinal mechanism. J Electromyogr Kinesiol 2004;14:631–640.
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