Aching Equine Joints: A PAIN FOR BOTH HORSES & OWNERS

Transcription

1 ynopsis Aching Equine Joints: A PAIN FOR BOTH HORE & OWNER This seminar will touch on joint disease development, diagnosis and management strategies including the types of medications currently used and their effects. Ryan Wolker DVM, MVetc, DACV Outline HITORY OF EQUINE TREATMENT History of treatment Recognizing & diagnosing lameness What causes joint pain? Therapeutic options 1

2 Recognizing Lameness Recognizing Lameness Lameness can be recognized by the following: hortened stride or arc of foot flight Drifting Postural changes or reduced flexion of joints Head nod Hip hike / pelvic excursion Once the lame limb(s) are identified, the lameness is localized Hoof tester examination Limb / joint palpation Flexion tests Peripheral nerve blocks Intraarticular / Intrathecal blocks 2

3 Once the lameness has been localized to a specific area, an imaging modality must be selected Radiographs (x-ray) Great for bone imaging 3

4 What Causes Joint Pain? 4

5 What Causes Joint Pain? What Causes Joint Pain? 5

6 Once the lameness has been localized to a specific area, an imaging modality must be selected Ultrasound Great for soft tissue imaging 6

7 What Causes Joint Pain? What Causes Joint Pain? Wear and tear over the years results in traumatic injury to joints Wear and tear over the years results in traumatic injury to joints prain/strain injuries to ligaments / joint capsule Cartilage damage Release of inflammatory mediators and destructive enzymes Inflammation causes pain and increased pressure in the joint FACT: The articular (hyaline) cartilage that you are born with is the best that will ever be present! What Causes Joint Pain? What Causes Joint Pain? 7

8 Therapeutic Options Management trategies Management strategies Corticosteroids Polysulfated glycosaminoglycans Hyaluronic acid Medical devices Nutraceuticals Ensuring adequate conditioning of your horse Try not to be a weekend warrior Allowing for rest / time-off Appropriate BC (5/9) Appropriate warm-up / cool-down, stretching exercises Regular farrier attention to feet** Non-steroidal anti-inflammatory drugs teroids Function to block the enzyme cyclooxegnase (COX) May be non-specific (COX1/COX2) or specific (COX2) Non-specific pecific 8

9 Phenylbutazone Phenylbutazone ( Bute ) Firocoxib (Equioxx) Diclofenac (urpass) Acetylsalicylic acid (Aspirin) Phenylbutazone ( Bute ) Non COX specific Excellent analgesic 1-2g / 24hr period (1000lb horse) May contribute to gastric ulcer development when used at high doses for prolonged periods of time 9

10 Firocoxib Firocoxib COX-2 specific Per day $ generally more Very easy on the stomach Not quite as effective of an analgesic as phenylbutazone Firocoxib Diclofenac Non COX specific Formulated as a liposomal cream which you apply to the affected area Useful for sprain / strain injuries of specific joints or soft tissue injuries 10

11 Flunixin meglumine ( Banamine ) Great for colic pain and eye injuries Never ever give Banamine IM 11

12 Corticosteroids Aspirin Poor analgesic Good anti-clotting effects Function to block the enzyme phospholipase A2 For the purposes of treatment of joint pain, we typically are using corticosteroids directly in the affected joint Methylprednisolone acetate (Depomedrol) Triamcinolone Betamethasone Corticosteroids teroids Non-specific pecific 12

13 Corticosteroids Polysulfated glycosaminoglycan Excellent inhibitors of inflammation teroids have been abused by overuse teroid arthropathy Adequan -- heparinoid Known functions include inhibition of a variety of degradative enzymes 500mg IM q4d x 7 treatments Maintain with treatment once every 4-8 weeks Polysulfated glycosaminoglycan Hyaluronic Acid Constituent of joint fluid & articular cartilage Forms a backbone to which smaller molecules (chondroitan, keratan) are attached Main molecule involved with joint lubrication Has direct antiinflammatory properties also 13

14 Hyaluronic Acid Medical Devices Not FDA approved Often combination products Early results in clinical trials are demonstrating beneficial effects Medical Devices Neutraceuticals Glucosamine Chondroitan MM (methylsulfonylmethane) AU Omega 3 FA 14

15 Neutraceuticals Thank you!! 15