Rick Farr of Farr & Pursey Equine Vets shares his expert advice on arthritis
Q: “Please can you tell me about how you manage any arthritis in horses? My older horse has a touch of arthritis in his near fore fetlock, confirmed by X-rays last summer after very minor lameness. He had done the same the previous summer (2/10 lameness, not on every stride) and both times has had a course of Cartrofen. I just wondered if anyone had any tips on long-term stable and veterinary management and whether this differs in the summer and winter months. How about magnetic boots — are they of any use or just a placebo?”
A: The fundamentals of any treatment plan with regards to arthritis in horses can be divided into two areas:
• Physical management — for example changes in diet, exercise, shoeing, stable/environment
• Pharmacological management — the use of drugs
I have to admit there tends to be far too much focus on the “magic bullet”/drugs to help manage degenerative conditions such as arthritis. However, I feel that, in order to sustain exercise longevity and improve welfare, the physical management of the condition is just as important as pharmacological intervention.
So where do you stand on arthritis of the fetlock? This obviously depends on the horse’s individual case but, as a general rule of thumb, most arthritic conditions (of ‘high motion’ joints such as the fetlock) cope well if you can maintain active movement, with low impact exercise, in addition to reducing the load and internal inflammation within the joint. Sounds like a tall order but this can be done by combining the physical and pharmacological management models:
• Physical — as long as lameness does not increase, keep the horse active. Spend extra time warming-up, avoid working on hard, concussive surfaces at any pace faster than the walk. Keep the horse’s weight under control; similar to human medicine, excess weight causes more pressure on the joints. Talk to your vet and farrier to make sure there is a good hoof-pastern axis in order to equalise weight distribution throughout the lower limb, which is imperative.
• Pharmacological — this is where the options start…
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Management of any degenerative condition such as arthritis can be a challenge and I find it is important to consider three separate components whenever advising clients with regards to pharmacological management:
Let’s start with safety. In my opinion ALL treatments should have some form of proven safety record or, at least, should have “peer-reviewed” critiques of the product used. This is a common component that is lost when it comes to alternative therapies. All pharmacological preparations licensed for horses within the UK have to conform to strict safety requirements and state any potential side effects, which we can discuss with you.
Efficacy — this is where “peer-reviewed”/double-blind studies come into their own, helping to scientifically prove whether a product works. Once again, all UK licensed products have to go through this process. Sadly, most alternative therapies, such as magnetic boots, have an overwhelming amount of anecdotal evidence for their use but very few, if any, have peer-reviewed, double-blinded studies showing their usefulness. I, personally, would not recommend any of these therapies but I am willing to be proven wrong given the evidence. Just remember — it must do no harm… therefore prove it!
Cost — No one has an endless supply of money therefore this is always a critical point. The balance of cost must relate to ease of use and potential benefits.
So what can you give your horse to help with the arthritis? Once again, I cannot emphasise enough the ongoing management and monitoring of the condition. However, several of the following may help improve longevity:
• Oral non-steroidal anti-inflammatories — the use of oral pain killers/anti-inflammatories in the management of any chronic condition is always a realistic option.
• Steroids — There are several types of steroid available to inject into joints to reduce the ongoing inflammation, ranging from basic steroids to anabolic products such as Stanozolol. The individual advantages/disadvantages of all of these need to be discussed with your vet.
• Polysulphated Glycosaminoglycans — these products can help to prevent cartilage degeneration. Most people have heard of the principle component “Chrondroitin Sulphate”. This is a massive topic well beyond the scope of this reply.
• Pentosan Polysulpahte — these products have been shown to help stimulate hyaluronic acid production within joints, which is essential for good joint function. These products include Cartrophen.
• Bisphosphonates — these products are designed to affect the “turn over” of bone, which can be excessive during the arthritic process. Once again, these products have many advantages and disadvantages which need to be individually discussed and evaluated with your vet.
• Autologous products — these are products derived from the patient, quite often by extracting blood/bone marrow or fat and processing it prior to re-implantation back into the patient. This is a very specialised therapeutic avenue, but has very promising results.
As all of this shows, degenerative condition management is multifactorial and should be tailored to every individual patient with you vet, farrier, physiotherapist, nutritionist and trainer. Give your vet a call to discuss your specific options.