Page 926 - Adams and Stashak's Lameness in Horses, 7th Edition

892 Chapter 8

showed decreased lameness with no adverse effects Finally, as previously mentioned, sepsis may be a
within the first 3 weeks of treatment, and this effect complication with any intrasynovial medication, and it
VetBooks.ir Limited information can be taken from this study as fol- ening of lameness following medication of a synovial
is paramount for the clinician to be aware of any wors-
was sustained until the 90‐day follow‐up evaluation.
79
structure. A survey of 241 equine veterinarians revealed
low‐up was not continued beyond 90 days and there
was no control group for comparison. an incidence of 2.1 septic joints per 10,000 IA injec-
Incorporation of PAAG into the synovium after tions, with significantly lower infection rates when vet-
injection into normal and osteoarthritic joints has also erinarians prepared their own injection sites and had
been demonstrated in horses, with evidence of integra- <20 years of practice experience. Strict adherence to
51
tion, proliferation, and invasion of synovial cells into aseptic technique should also be practiced. Clipping the
the gel by day 14. This was followed by the forma- hair is not mandatory, and a survey of veterinarians
59
24
tion of a vascular, sub‐synovial connective tissue layer actually suggested that synovial infection rates were sig-
by day 30 that was covered by a synovial lining. This nificantly higher for veterinarians that routinely removed
histological appearance persisted up to 2 years postin- the hair at the injection site. Nevertheless, clipping the
51
jection in equine joints. Further clinical studies to area of injection is still recommended by the author if
explore potential effects on synovial inflammation winter hair growth precludes the ability to adequately
and pain are warranted. prepare the skin site – due to the devastating conse-
quences of synovial infection.
MISCELLANEOUS
Other modes of therapy that control intrasynovial References
inflammation are currently being investigated. Gene 1. Adequan IA. Polysulfated Glycosaminoglycan. Luitpold
therapy modalities engineered to overproduce benefi- Pharmaceuticals Inc., Shirley, NY, 2007.
cial cytokines such as IGF‐I and IRAP are still being 2. Aggarwal A, Sempowski IP. Hyaluronic acid injections for knee
osteoarthritis. Systematic review of the literature. Can Fam
developed. 44,53 Clinical trials will clarify the utility of Physician 2004;50:249.
these therapies. 3. Akeda K, An HS, Okuma M, et al. Platelet‐rich plasma stimulates
Atropine is an anticholinergic drug that is occasion- porcine articular chondrocyte proliferation and matrix biosynthe-
sis. Osteoarthritis Cartilage 2006;14(12):1272–1280.
ally used intrasynovially to reduce joint effusion. Its 4. Anitua E, Sanchez M, Nurden AT, et al. Platelet‐released growth
efficacy in a mouse model was proven by reducing factors enhance the secretion of hyaluronic acid and induce hepat-
induced joint effusion. It has been used with some ocyte growth factor production by synovial fibroblasts from
81
success in the horse; however, its use for reduction of arthritic patients. Rheumatology 2007;46(12):1769–1772.
joint effusion remains empirical. It is primarily used to 5. Antonacci JM, Schmidt TA, Serventi LA, et al. Effects of equine joint
injury on boundary lubrication of articular cartilage by synovial
reduce effusion in synovial cavities (mostly joints and fluid: role of hyaluronan. Arthritis Rheum 2012;64(9):2917–2926.
tendon sheaths) that have not responded to other forms 6. Asheim A, Lindblad G. Intra‐articular treatment of arthritis in
of therapy. The dose used is 7‐mg IA, and if used for race‐horses with sodium hyaluronate. Acta Vet Scand 1976;17:
treatment of hygroma, it should be combined with 379–394.
bandaging. Horses should also be observed for colic 7. Auer JA, Fackelman GE, Gingerich DA, et al. Effect of hyaluronic
65
acid in naturally occurring and experimentally induced osteoar-
following IA injection. thritis. Am J Vet Res 1980;41:568–574.
8. Aviad AD, Houpt JB. The molecular weight of theraputic hyaluro-
nan (sodium hyaluronate): how significant is it? J Rheumatol
1994;21:297–301.
INTRASYNOVIAL THERAPY: PRACTICAL 9. Axelrod L. Glucocorticoids. In Harris E, Kelley W, Ruddy S, et al.,
CONSIDERATIONS eds. Textbook of Rheumatology. WB Saunder, Philadelphia, PA,
1993;779–796.
Intrasynovial therapies are an integral part of the 10. Balazs E, Darzynkiewicz Z. The effect of hyaluronic acid on fibro-
treatment of lameness in horses. Of course, success of blasts, mononuclear phagocytes, and lymphocytes. In Kulonen E,
Pikkarainen J, eds. Biology of Fibroblasts. Academic Press, New
the therapy depends on the correct synovial structure York, 1973;237.
being medicated, and that decision should be based on 11. Baltzer AWA, Moser C, Jansen SA, et al. Autologous conditioned
an accurate lameness examination and appropriate serum (Orthokine) is an effective treatment for knee osteoarthri-
tis. Osteoarthritis Cartilage 2009;17(2):152–160.
imaging. Furthermore, success of diminishing lameness 12. Baltzer AWA, Ostapczuk MS, Stosch D, et al. A new treatment for
also depends on the severity of the disease in the syno- hip osteoarthritis: clinical evidence for the efficacy of autologous
vial structure being medicated and the efficacy of conditioned serum. Orthop Rev (Pavia) 2013;5(2):59–64.
the medication being injected. For example, a recent 13. Bathe AP. The corticosteroid laminitis story: 3. The clinician’s
viewpoint. Equine Vet J 2007;39(1):12–13.
study found a direct correlation between the success of 14. Behrens F, Shepard N, Mitchell N. Alterations of rabbit articular
intrabursal injections and the severity of the disease seen cartilage by intra‐articular injections of glucocorticoids. J Bone
on MRI, with less severe disease having greater long‐ Joint Surg 1975;57(1):70–76.
term success in treatment. There are no accurate 15. Bell CD, Howard RD, Taylor DS, et al. Outcomes of podotroch-
15
reports of how long a horse should be rested following lear (navicular) bursa injections for signs of foot pain in horses
evaluated via magnetic resonance imaging: 23 cases (2005–2007).
CS injections; however, common practice is to combine J Am Vet Med Assoc 2009;234(7):920.
the intrasynovial injection with at least 4–5 days of rest 16. Bello G, Jackson IT, Keskin M, et al. The use of polyacrylamide gel
because the mechanical integrity of the cartilage has in soft‐tissue augmentation: an experimental assessment. Plast
been shown to be compromised for several days follow- Reconstr Surg 2007;119(4):1326–1336.
29
ing injection. It is recommended that horses be returned 17. Bertone AL, Ishihara A, Zekas L, et al. Evaluation of a single intra‐
articular injection of autologous protein solution for treatment of
to exercise slowly, over 1–2 weeks. osteoarthritis in horses. Am J Vet Res 2014;75(2):141–151.