JOINT THERAPIES IN THE FIELD: WHAT TO USE AND HOW
however as it has been found to be detrimental to carti- lage.4 Thechoiceof HA or polysulfatedglycosaminogly- cans (PSGAGs) in combination with corticosteroids is a common practice. There are multiple options available including but not limited to HA and PSGAGs.a-d The dose for HA commonly used is 10–22mg per joint and PSGAGs is 250mg per joint. Choices ofwhichHA to use is often based on clinical preference, cost, and availabil- ity.Highmotion joints are often treatedwith highermo- lecular weight options to improve viscosity and reduce friction5,6 Intra-articular injections performed in the field setting
have special considerations that differ from those that existwhen the patientistreated in a hospital. Attention to sterility should be closelymonitored when performing IA injections in the field. Due to these field conditions, many clinicians will often add antibiotics to injections. Additionally, when in the field, availability and accessi- bilitywithout preparation of the product is an important
factor.Many of the specialized or biologicals require spe- cial processing or temperature constraints that make it impractical for the field use. For this reason, the ease of off the shelf products such as corticosteroids andHA are appealing for IA treatments in the field. Even though these drugs have been used routinely for decades in horses, inherent risks remain. These include but are not limited to joint sepsis, laminitis, and overall joint impact. Literature will support that septic arthritis is uncommon following IA therapies.7–9 It has also been found that IA corticosteroids have not been shown to increase the risk of joint infection.5,6 TCA is one of the most commonly used IA therapies, concerns with its use have been discussed relating to its association with laminitis. Historically, clinicians have stayed below the total body dose of 18mg due to this association. However, TCA does not appear to increase the risk of laminitis in healthy horses,10–12, and a safe total body dose has not yet been established.3 Doses up to total body dose of 40mg have been usedwith no effects of laminits.10MPA has been a long-standing joint treatment; however, recent surveys haveshown thesinglejoint dosedecreas- ing from40–80mg to 20–40mg per joint.3 This is largely associated with evidence of harmful effects on cartilage metabolism.14,15
4. Discussion
With the growing interest in athletic and pleasure use of horses, the need for management of soreness will con- tinue in the equine patient. Corticosteroids used by themselves or combined with HA or PSGAGs have pro- ven for decades to be successful inmanaging osteoarthri- tis aswell as synovitis in the equine patient.Overall, the use of corticosteroids is very economical. Even with the combination ofHAor PSGAGs, the costs arewithinmost client’s budgets to treat their horses. When guidelines are followed, traditional joint therapies are very economi- cal, readily available, and successful for themanagement of joint conditions in the field.
2 2022 / Vol. 68 / AAEP PROCEEDINGS Acknowledgments
Declaration of Ethics The Author and the paper have adhered to the Principles ofVeterinaryMedicalEthics of theAVMA.
Conflict of Interest
The Author has no conflicts of interest and there are no conflicts or financial interests associatedwith this paper.
References and Footnotes 1. Mcllwraith CW. Licensed medication, “generic” medications, compounding, and nutraceuticals-What has been scientifically validated, where do we encounter scientific mistruth, and where are we legally? in Proceedings. Am Assoc Equine Prac 2004;50:459–475.
2. Frisbie DD. Principles of treatment of joint diseases. In: Auer JA, Stick JA, editors. Equine Surgery, St. Louis, MO: Saunders, Elsevier 2006 p. 1055-1072.
3. Zanotto GM, Frisbie DD. Current joint therapy usage in equine practice:Changes in the last 10 years. EquineVet J 2021;00:1–7.
4. Pezzanite LM, Hendrickson DA, Dow S, et al. Intra-articular administration of antibiotics in horses: Justifications, risks, recon- sideration of use and outcomes.EquineVet J 2022;54:24–38.
5. Gustafson SB, Mcllwraith CW, Jones RL, et al. Comparison of the effect of polysulfated glycosaminoglycan, corticoste- roid, and sodium hyaluronate in the potentiation of a sub in- fective dose of Staphylococcus aureus in the midcarpal joint of
horses.Am J Vet Res 1989;50:2014–2017.
6. Antonacci JM, Schmidt TA, Serventi LA, et al. Effects of equine joint injury on boundary lubrication of articular car- tilage by synovial fluid: Role of hyaluronan. Arthritis Rheum 2012;64:2917–2926.
7. SteelCM, PannirselvamRR, AndersonGA. Risk of septic arthri- tis after intra-articular medication: A study of 16,624 injections in Thoroughbred racehorses. Aust Vet J 2013;91:268–273.
8. Smith LCR, Wylie CE, Palmer L, et al. Synovial sepsis is rare following intrasynovial medication in equine ambula- tory practice. Equine Vet J 2019;51:595–599.
9. Krause DM,Pezzanite LM,GriffenhagenGM,et
al.Comparison of equine synovial sepsis rate following intrasynovial injection in ambulatory versus hospital settings. Equine Vet J 2022;54: 523–530.
10. McCluskey MJ, Kavenagh PB. Clinical use of triamcinolone acetonide in the horse (205 cases) and the incidence of gluco- corticoid induced laminitis associated with its use. Equine Vet Educ 2010;16:86–89.
11. Bathe AP. The corticosteroid laminitis story: 3. The clini- cian's viewpoint. Equine Vet J 2007;39:12–13.
12. Haseler CJ, Jarvis GE, McGovern KF. Intrasynovial triam- cinolone treatment is not associated with incidence of acute laminitis. Equine Vet J 2021;53:895–901.
13. Hammersley E, Duz M, Marshall J. Clinical Research Abstracts of the British Equine Veterinary Association Congress 2015. Equine Vet J 2015;47:24–24.
14. Chunekamrai S, Krook LP, Lust G, et al. Changes in articu- lar cartilage after intra-articular injections of methylpredni- solone acetate in
horses.Am J Vet Res 1989;50:1733–1741.
15. Frisbie DD, Kawcak CE, Baxter GM, et al. Effects of 6a- methylprednisolone acetate on an equine osteochondral fragment exercise model. Am J Vet Res 1998;59:1619–1628.
aHyvisc,Boehringer-IngelheimVetmedica, St. Joseph,MO64506. bLegend,Merial Inc.,Duluth,GA30096-4640. cPolyglycan,Bimeda, Inc.,Oakbrook Terrace, IL 60181. dAdequan, Luitpold Pharmaceutical, Shirley,NY11967.
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