Adiagnosis of arthritis does not have to mean the end of a horse’s competitive life. Joint nutraceuticals and prescription joint treatments can halt the progression of arthritis and, in some cases, possibly even heal it to a degree. The advances in alternative therapies — combined with effective herbal analgesics and/or anti-inflammatories and substances like DMSO and MSM — have lessened the arthritic horse’s dependence on those sometimes harmful corticosteroids and NSAIDs and opened the door for a healthier battle against this disease.
Once the arthritic horse is again comfortable, a regular, formal exercise program can avoid stiffness and even improve the health of the joint cartilage. If you are willing to invest the time and effort, odds are good your arthritic horse may continue to perform for a long time.
Arthritis involves inflammation, and cold is the greatest inflammation-buster out there. The trick is to apply it as soon as possible and keep the area cold for as long as you can.
Cold numbs pain, squelches local inflammatory responses and can prevent or eliminate swelling. For acute problems, use continuous cold until the area is completely cool. Keep the horse iced for as many hours a day as possible and continue until heat is gone.
Ice also works in the ongoing management of chronic joint problems. Applying cold for 20 minutes to an hour after every hard work or competition greatly decreases both the frequency and severity of flare-ups in chronic problem joints.
We found the MacKinnon Corp. Ice Horse machine (see September 1997) the ultimate for long-term (up to eight hours), mess-free and effective cooling, although it is a costly device.
A less expensive alternative is the Dura-Kold ice boot, which get daily use in our test barn (see September 1998). These boots are the only ones we’ve found that stay cold where it counts — on the inside, against the leg — for an hour or even longer. Our first pair has been in continuous use (over 1,000 applications) for almost three years, and we haven’t replaced the ice cell inserts yet (although we’re counting ourselves lucky there).
We also recommend keeping a liberal supply of the Tempra Technology’s Instant Cold Therapy Packs (see August 1999) in your trailer for emergency situations away from home. These gel packs are activated by squeezing and mixing the contents together, mold extremely well to any area, are lightweight and stay cold up to 30 minutes.
Heat is an extremely effective method for easing the pain and stiffness associated with arthritis, especially when a soft tissue strain/sprain or just plain overuse is involved.
Used before work, heat can also cut warm-up times needed when dealing with chronically stiff and arthritic joints. It’s your horse’s equivalent to soaking in a hot tub. Warm the still joint for about 20 minutes then immediately do some gentle flexion and extension of the joint with the leg held off the ground to produce good tissue relaxation and stretching.
Simply keeping problem areas wrapped overnight before work will trap some heat. The effect is improved by use of liniments before wrapping or sweating the leg. Absorbine and Bigeloil are tops in our experience for creating the heat you need inside those wraps.
You can also put the horse’s own body heat to use with either Neoprene sweat wraps (for knees and hocks) or Thermoflow leg wraps. Although the Thermoflow wraps look like standard stall wraps, a special panel is impregnated with an insulating ceramic. It reflects the radiated heat back onto the leg. We found these helped maintain comfort and range of motion in stiff ankles and were also good for old tendon/ligament injuries.
Heating gel packs, like Tempra Technology’s Instant Heat Therapy Pack (see cold therapy) or any of the micro-waveable hot/cold gel packs available at drug stores, provide more intense heat and are most useful pre-competition.
The only precautions with heat are to avoid it if the area is swollen or warmer than normal to the touch and to discontinue it if swelling increases after its use.
“Rubbing” or “bracing” legs is a lost art that needs resurrection. A brisk but gentle five to 10 minutes massage/rubbing, using the palms of your hands, encourages circulation, breaks up collections of fluid, helps relax tendons and ligaments and interrupts pain messages. You can intensify this effect by also using traditional liniments (Absorbine, Bigeloil) on the leg when you rub. For control of pain, heat and swelling, we recommend the herbal liniment Sore No-More (see December 1999) or Sore No-More mixed with DMSO.
To wrap or not to wrap is a question that often perplexes even the more experienced horsemen. Strained, painful joints are usually more comfortable when kept wrapped, and wrapping usually controls swelling better. If the horse obviously stands more comfortably (leg squarely under the body and bearing full weight) when wrapped, by all means use them. You will not “weaken” the leg by using wraps.
Complementary Therapy Devices
Magnetic therapy and TENS (September 1998, March 1999), lasers (April 2000), LEDs (brilliant, monochromatic light sources that are not lasers) and ultrasound are all effective therapies.
We have had especially good success with pulsed electromagnetic field therapy (see September 1998). Pain relief is excellent. It can be used at the same time as ice (eliminating any possible activation of inflammatory cells) and has the potential to improve healing. Static magnetic wraps (we prefer Equine Magnetic Therapy) can also give pain relief.
The LED light wraps help alleviate the swelling and pain in joints. We like lights embedded in a Neoprene wrap, which offers the double benefit of the light therapy and heat. (See upcoming article.)
Diagnostic acupuncture exams are usually accurate in pinpointing sources of pain, which is useful when nerve-block results are equivocal and the horse seems to have pain from more than one location. Some early cases of arthritis/joint pain respond well to acupuncture as a part of the overall treatment plan.
Acupuncture may also relieve much of the pain that is coming from secondary sources related to an abnormal way of moving the horse is using to protect the area of the primary problem. However, every reputable acupuncturist will tell you that once changes have occurred in a joint, acupuncture alone is not the therapy of choice.
Chiropractic examinations can help identify structural problems that may be contributing to, or caused by, a problem joint. Correcting these through specific exercises enables the horse to move normally again once pain is relieved.
Arguably the biggest breakthrough in the treatment of joint problems, especially cartilage lesions, is the use of glycosaminoglycans — GAGs (purified chondroitin sulfate or powdered high chondroitin sources such as bovine or shark cartilage, Perna) and glucosamine. Both research and our own extensive trials confirm this (see November 1997, May 1999).
Joint nutraceuticals should be an integral part of treatment for any horse with joint problems. The least effect will be noted in horses whose problem involves actual tearing/rupture of a soft tissue structure involved in stabilizing the joint. Horses whose arthritis has resulted in extensive bone formation around the joint (spurs), as may be seen with advanced disease in the hocks and with ringbone, may also see little benefit.
Our favorites are Equine America’s Corta-Flx (chondroitin), Grand Meadows’s Grand Flex (glucosamine) and Nutramax’s Cosequin (chondroitin and glucosamine). However, our field testing has proven there are many other effective, high-quality products available.
Herbals And MSM
We’ve found devil’s claw and yucca (see January 2000), at appropriate dosages, to be quite effective for arthritis. We also have found combination products with the anti-arthritis/anti-inflammatory herb Boswellia effective (ArthriSoothe-P by The Garmon Corp. and Engage by EquiHealth/Global Health).
Overall, herbals do not have as rapid an onset as phenylbutazone, and the peak effect may be less than what you can achieve with phenylbutazone, but it is enough to make a significant difference without bute’s side effects. In some horses, it’s a very big difference.
MSM’s popularity comes and goes, but it remains an effective-enough product to have stood the test of time. MSM is anti-inflammatory because it is a potent anti-oxidant. Don’t expect overnight results, however.
Nutritional anti-oxidants are not effective against already established inflammation, although they will help modify the severity of the inflammatory responses if already present in effective concentrations when the reaction begins. This effect is most beneficial in joints with soft tissue problems, such as synovitis.
MSM can also help by supplying the body with a useable form of sulfur that must otherwise be obtained from the sulfur-containing amino acids methionine, cystine and cysteine, which are often in short supply. Sulfur helps form reinforcing cross-bridges in all types of connective tissue and is therefore important to the repair of joints. The usual recommended dose is five to 10 grams per day, although higher amounts can be used for short time periods.
Your veterinarian may suggest any one of a number of potent, but expensive, approaches to controlling arthritis. These include intra-articular hyaluronic acid (called “HA,” available as many brand names), Legend (the only intravenous brand of HA), and Adequan (intra-articular intramuscular polysulfated glycosaminoglycans or “PSGAG”).
Hyaluronic acid is both anti-inflammatory and lubricating, restores a more normal chemistry to the joint fluid and thereby creates a more favorable environment for healing. Pain relief is often rapid (within 24 hours) and dramatic.
PSGAGs take a little longer to work but are felt by many to be even better at promoting healing. They bind specifically to damaged areas on the cartilage, protecting them from further enzymatic destruction and encouraging healing. Both drugs are most effective when used in early arthritis. When used early and coupled with adequate rest/turnout, healing is possible in many horses.
Veterinarians differ in which agent they prefer. Some use both (e.g. hyaluronic acid directly injected to the joint used with a six-week course of intramuscular PSGAG).
A small percentage of horses will develop increased heat, swelling and pain following intra-articular injections, but these usually subside in 24 to 48 hours (more quickly if you use aggressive anti-inflammatory measures like cold therapy and icing).
With the advent of ever-improving joint nutraceuticals, the need for and use of injectable medications is waning. A commonly recommended approach is to use the injectables in the initial phase of treatment but to also begin joint nutraceuticals. Most horses will then need injectable treatments far less often, if at all.
Corticosteroids And NSAIDs
As little as 15 years ago, corticosteroids were the only option for injecting joints. Their use waned with the introduction of HA and PSGAG and the discovery that long-term, heavy use of steroids will eventually contribute to cartilage breakdown.
Intramuscular, intravenous or oral steroids also come with a risk of laminitis. Intra-articular steroids may increase the risk of joint infections if the skin is not correctly prepared. However, fear of corticosteroids is exaggerated to some extent. They are still useful drugs in the control of severe, acute inflammation.
In specific cases, the benefits from a conservative dose of corticosteroids in treating “hot” injuries may outweigh any risks, particularly for a single treatment. A good compromise for some horses may be DMSO mixed with a very small dose of steroid, applied locally to the horse’s skin.
Phenylbutazone, aspirin and other NSAIDs come with a risk of intestinal ulceration, possible intestinal bleeding and, with long-term use, kidney damage. However, even the best anti-inflammatory/analgesic herbals can’t compete with their rapid onset, pain relief and control of swelling.
Like corticosteroids, the benefits can sometimes outweigh risks, especially for a single treatment to obtain rapid control of a very angry joint. Use of any drug in this class, or corticosteroids, is a judgment call best discussed carefully with your own veterinarian.
The most underestimated and misunderstood part of arthritis therapy is regular exercise. Acutely hot, painful joints obviously must be protected and rested, but beyond this, exercise is beneficial, even essential, in maintaining joints.
Exercise prevents the shortening and tightening of soft tissues that contributes to the formation of stiff or even “frozen” joints. Even more importantly, exercise is needed to nourish the cartilage. Cartilage has no direct blood supply. It obtains its nutrients and removes waste via the synovial/joint fluid.
The structure of cartilage allows it to function similar to a sponge. When the horse is exercised, the cartilage is alternately compressed and released, forcing fluid out of the cartilage matrix and then allowing fresh fluid to flow in.
Studies show that cartilage lesions heal better when the test animals are lightly exercised. Even the degenerative effects of corticosteroids can be prevented by exercise when moderate dosages are used. Both hyaluronic acid and PSGAG have much better results when animals are exercised instead of rested.
Obviously, a good dose of common sense is necessary here. Avoid hard surfaces, speed work or jumping until joints have stabilized and the horse is comfortable, then build slowly. Steady walking and trotting over a surface that has good cushion is the best exercise for arthritic joints. Once the horse is handling this comfortably, you can attempt to increase the pace or specialized work.
Also With This Article
Click here to view "Not Sure What Arthritis Is'"
Click here to view "X-Rays And Diagnosis."
Click here to view "Sample Arthritis Management Program."
Click here to view "Phenylbutazone Use."
Contacts: MacKinnon Corporation Ice Horse 800/786-6633; Dura-Kold 800/541-7199; Tempra Tech 800/867-9189; Sore No-More Equilite 800/942-5483; Absorbine 800/628-9653; Bigeloil 800/628-9653; ThermoFlow 800/903-6888; Equine Magnetic Therapy 800/731-8463; Corta-Flx 803/649-1100; Grand Flex 800/255-2962; Cosequin 800/925-5187; The Garmon Corp. 888/628-8783; EquiHealth/Global Health 877/434-3258; MVP/United Vet Equine 800/328-6652.