Joint Disease in the Equine Athlete

Athletes come in many different sizes, shapes and species.  The human athlete makes tremendous demands on their cardiovascular system, pulmonary system, muscles as well as joints.  The equine athlete is no exception and in many instances, places more demands on their bodies than the human.  No matter what discipline we are discussing from barrel racing to the elite dressage athlete, the wear and tear on the body can be tremendous. The number one area that takes the most pressure are the joints and there are many!  A joint is essentially the region where two bones come together and were motion is present in order to facilitate movement.  On the end or surface of each bone involved in the joint is cartilage that essentially acts like a cushion and surrounding the joint is a capsule that helps to contain joint fluid which lubricates the two bony ends, in simple terms. In terms of joints, we generally have two types; high motion and low motion joints.  The fetlock, for instance, is a high motion joint and has a high range of overall motion.  Other regions, such as the hock or tarsus, are more complex and actually consists of 4 joints in that region.  Of these 4 joints, we have high motion joints on the upper part and low motion joints on the lower part.   With increased use, comes increased strain to the joint, resulting in subsequent inflammation.  When we couple increased use wear and tear with other issues such as poor conformation, we can have double the damage.  There is no perfect horse, in my opinion, in terms of conformation, but alignment of bones is crucial for even distribution of weight and pressures to minimize strain.  A club footed horse or one with straight hocks can still perform as a jumper, but one has to be aware that the affected joints will be more prone to inflammation and damage. The inflammation that is normally created as a consequence of competition or exercise starts at a low level and is often not detected.  Usually, the first signs of excessive inflammation may be a mild lameness due to pain.  Often times, the horse is rested and recovers fully in the short term.  As the inflammation progresses, it is often then seen in the joint capsule with increased fluid production in the joint, called effusion.  If the condition continues, the next area of attack is the joint cartilage, which is often manifested as cartilage erosion and destruction.  If the cartilage erodes too much, then we have what is termed 'bone on bone' contact within the joint, which then causes tremendous irritation or inflammation within the joint and leads to bone remodeling, resulting in bone spur development in many cases. So, as you can see, degenerative joint disease is a continuous and progressive condition.  It isn't something that should persuade you not to compete, but it is something that should raise the question as to how to prevent or at least slow the progress?

Joint Therapy Options Joint protection is crucial for every horse, but especially for those in active competition or training.  Once the damage is done, there is no reversing it but there are options to slow the progress.  It is always best to act in a preventative fashion, more so than chase treatments. One of the most commonly used supplements consist of glucosamines, chondoitin sulfate and possibly other additives.  In my eyes, these supplements are termed chondroprotective agents and are mainly trying to replace what is being lost as a result of inflammation.  Human and animal research has raised the question of the value of these ingredients, including absorption, but it does appear that they help in some instances. Aside from oral joint supplements, we have many prescription routes of therapy including injectable chondroprotective agents as well as medications injected directly into the joints.  The most common mode of therapy are joint injections and include the use of corticosteroids as well as medications that encourage joint fluid production, which include hyaluronic acid.  These routes of therapy are often times very effective in the short term and useful for acute flare ups, in my opinion, but not ideal for the chronic joint condition.  They can be effective in resolving pain and stiffness, but some research has actually indicated that long term use of steroids in the joint could lead to increased joint cartilage loss. As a veterinarian, I have seen all forms of joint disease from the early joint effusions to the joints that are so ridden with bone remodeling that they are almost fused.  I think the thing we have to address with these horses is the process of inflammation, which is the underlying cause of all of the pathology.  I have never been 'okay' with repetitive joint injections in the equine athlete, because I feel that the joint is a sacred place and one not to be violated repetitively.  The joint is sterile and each time a needle is placed, infection is a real risk that can cause tremendous damage.  With each joint injection, there is actually an incitement of inflammation, which results in damage over time and increased injections. Of course, we also have non-steroidal anti-inflammatory medications, which there are two commonly used in the equine field.  The medications essentially target pain production and combat inflammation from a single entity standpoint which is prostaglandin inhibition.  Side effects from long term use of these medications can be very high and include gastric ulcers, large colon ulcers as well as potential kidney damage.  They are very valuable for short term and acute conditions, but again are not ideal for long term use. If we tackle the inflammatory component of the condition, it is very possible to really slow the progress of the destruction.  Ideally, we want to control the inflammation from a preventative aspect in the horse with no active joint pathology.  In many horses, the damage is done and lameness is persistent....but yet can still be managed if we control the inflammation.  Many current therapies attempt to control the inflammatory process, but do so by addressing one aspect of the cascade of events.  We often times see mixed results with these therapies because of this reason.  Inflammation is a complicated process and requires an approach from multiple angles.  In my opinion, herbs are the solution when used properly and can yield phenomenal results. One also has to keep in mind that multiple joints are often affected in these patients and the inflammatory process can also be affecting other aspects of their performance and health.  It is not wise to inject multiple joints repetitively, and these therapies do not impact the systemic inflammation...so what is one to do?? Our Cur-OST line of products tackle inflammation at the cellular level, resulting in the multi-angle approach as well as combat oxidative stress.  Take the logical step to joint protection and combat it from the standpoint of inflammation prevention.  Why just replace what is being lost in the joint as a result of inflammation, when you can potentially control the process at a higher level? Joint pathology is a very common problem in the equine athlete as well as backyard animal.  There can be many questions, but very few answers.  I think it is important that every horse owner understand what is happening as well as what options are available.  One of the biggest joys I have is opening my email and reading stories of recovery from horse owners, companion pet owner as well as people.  Our Cur-OST products can produce fantastic results and often times very quickly!  Thank you all for sharing your stories! Check out our video section to view some results in real patients!  Also visit us on our YouTube channel. I hope this information is useful! Tom Schell, D.V.M., DABVP tschelldvm@nouvelleresearch.com www.curost.com