With Horses It’s Never Just the Joint

For orthopedic pain, step back and look at the whole horse.

An equine veterinarian examining a patient with orthopedic pain – a common condition among competitive horses – will of course check the joint. But the seasoned veterinarian knows it’s never just about the joint. “Every joint needs to be thought of in terms of the whole horse,” said Christopher Elliott, BVSc (hons), MANZCVS, DACVSMR, a board-certified specialist in equine sports medicine and rehabilitation at Palm Beach Equine Clinic in Wellington, Florida.

Wellington may be a small town geographically, but it is considered an international hub of equestrian competition. Originally from Australia, Dr. Elliott serves as veterinary services manager at the Wellington International Show Grounds and manages veterinarians on behalf of FEI – the governing body for eight equestrian disciplines – for the winter season at the Show Grounds. He has practiced equine sports medicine for 17 years and sees private clients on a daily basis.

“Managing the whole horse is the most important thing, not just the joint that’s currently ailing the horse,” he said. “It’s never ‘just the hock’ or ‘just the coffin joint.’ We have to work out why we’re starting to see wear and tear or overuse in a particular part of the body. Maybe the horse is overloading in front, which may cause degenerative joint change in the coffin joint, or maybe shoeing isn’t quite perfect, or core strength needs to be improved, or the neck and back aren’t as strong or supple as they could be. Maybe there’s some soreness behind and that’s why overloading is occurring in front. The point is, if we focus too much on one joint, we might be missing the reason why.”

Follow the science

Paying attention to joint health should commence early in the horse’s life, before the onset of symptoms, he said. “The best way to slow or stall repetitive wear and tear in joints is appropriate training, promoting core strength, a strong topline, strong muscles, strong neck and hind quarters. Obviously, the old adage ‘no hoof no horse’ is vital. All these factors, including adequate rest and nutrition, are part of a multifactorial process.”

As far as steroids and supplements are concerned, Dr. Elliott cautions horse owners, trainers and veterinarians to follow the science.

Degenerative joint disease is an inflammatory process, with inflammation in the synovium, the synovial fluid, the cartilage and subchondral bone, he said. “We’ve moved away from the concept of just supplying more substrate to the joint, such as more glucosamine or chondroitin. They are components of joint health, but the notion was, ‘If you’ve got a leaky bucket, the key is to just keep putting more liquid on top.’

“Today we’re moving more toward joint support and health, and to natural, often plant-based anti-inflammatories or antioxidants. We’re trying to control the inflammatory process, which is the driver of degenerative change.”

For the treatment of degenerative joint disease, arthritis or joint pain, “the cornerstone of orthopedics has been steroids for longer than I’ve been alive, and I’ll hazard a guess they’ll remain that way for some time.” And, so will misconceptions about steroid use, with the common belief that once you start injecting steroids inside the joint, you’ll need to keep doing so, with less efficacy every time, forcing more frequent injections, he said.

“Many people don’t understand the concept of degenerative joint disease.” Joint disease is almost always inevitable among competitive horses. The steroids are about reducing inflammation, which leads to less pain and allows the athlete to train the horse, run the horse and jump the horse. “All that activity will continue to degrade the joint. It has nothing to do with the fact that the steroids are in there. The steroids just allow you to continue riding longer.”

“A common misconception is that joint support should begin when the horse is older and already stiff and showing signs of degenerative joint disease. Instead, it should begin earlier in order to delay its onset and lessen the severity of the degenerative joint changes, which are inevitable with every horse in every sport.”

Options

All that said, veterinarians have many non-steroid options to promote joint health, including natural, biological-type products, like blood-derived autologous products such as platelet-rich plasma or conditioned autologous serum, said Dr. Elliott. “These have their place and they are very useful, and they have definitely become more mainstream in the last 10 years.

“In general, you get what you pay for. If something is really cheap and doesn’t quite make sense, you’re probably not getting what you paid for. The FDA is there for a reason – to protect the consumer as well as the animal. That product is guaranteed to have exactly what it says each and every time. Each batch is repeatable, and the company is held accountable for its product. It has gone through a registration process, which includes safety and efficacy.

“It is important to ask yourself, ‘What does science say about these products that supports their use?’” he advised. “Some products are rushed to market without FDA approval based on flimsy scientific evidence. Other products may have been tried in the human market but failed, so they get thrown into the equine market with flashy marketing. This is a particular problem in the U.S., where companies are allowed to market directly to consumers. That’s forbidden in the rest of the English-speaking world.”

And it’s a good idea to look at what’s occurring in human orthopedic medicine, he continued. If a product has been found to be of little or no value in human medicine, question why it should be marketed in the equine market. “It’s vital to seek out the literature and look at the trends in human medicine. After all, a joint is a joint, regardless of species.”

Clients may have difficulty ferreting out the truth amidst all the published data out there, said Dr. Elliott. “But a veterinarian – particularly a veterinary specialist – can be of vital importance. It’s our job to search through the weeds, carefully read the scientific articles and compare what products are available and what the science says about them. It’s important to find someone who can look past the colorful brochures and get to a true understanding of a product – its pros and cons, cost/benefit and what the science really says.

“For too long, joint health support has fallen to non-veterinarians, like the person at the tack store telling you what they give their horse, or online forums or online pharmacies. It’s important we bring this back to the realm of the equine veterinarian, who is a source of knowledge and understanding of the evidence.”

Key Points

In a recent presentation on joint support medication, Dr. Elliott offered the following things to keep in mind:

• Joint support medications aim to delay onset of OA, reduce severity of OA and prolong athletic careers, said Dr. Elliott.
• Clients want to help their horse.
• “As vets we should strive to be the primary source of information (not the feed store and tack shop),” Dr. Elliott said.
• By using evidence-based medicine, veterinarians can help clients make informed decisions.

Image credit: Iryna Inshyna/fotoedu