Page 91 - Barrel Stallion Register 2023

EQUINE HEALTH
“The most commonly used treatment for joint problems today is probably hyaluronic acid (HA) in combination with a corticosteroid of some kind. These are generally mixed together and injected into the joint. – Dr. Duncan Peters
betamethasone, triamcinalone and those types of steroids. These are very potent anti-inflammatories and can quiet down the inflammatory process in the joint,” Carpenter says.
“We can also use things like hyaluronic acid, which is really good from a lubrication perspective, to put back what we consider the normal building blocks of joint fluid to restore joint health,” Carpenter explains. These are often used as an initial approach and from a cost aspect they may be the most cost-effective.
“The most commonly used treatment for joint problems today is probably hyaluronic acid (HA) in combination with a corticosteroid of some kind,” says Peters. “These are generally mixed together and injected into the joint. The next most commonly used treatment would be HA alone, or a corticosteroid alone.
“For things like sprains and strains, the horse needs rest from work,” Peters continued. “We may also give injections like HA, and sometimes steroids. We may try some of the regenerative medicine strategies, which might involve something like IRAP (interleuken receptor antagonist protein) or PRP (platelet-rich plasma). Those are the main ones we’d use for a sprain or strain to help it heal more quickly. This would help quiet down and minimize the inflammation and help the healing by adding growth factors.”
There is a tremendous shift today in the performance horse and racing industries toward using biological, natural regenerative therapies like IRAP, PRP or stem cells. “I think these types of treatment will be the wave of the future, with people using something the horse’s own body can utilize in a repair process—or something that will stimulate the body to take care of a problem,” says Peters.
Biologics are very popular now and include things like Pro-Stride (autologous conditioned plasma), which is made from your horse’s own blood that is processed in a 2-step system
that produces a concentrated solution of anti- inflammatory and healing factors. This super-
charged solution is then injected directly into the affected joint.
Other biologics include IRAP, which is a natural anti-inflammatory product that can be used to treat a variety of joint injuries. It is also produced from the horse’s own blood and can be injected into joints to treat inflammation and lameness and to encourage joint healing. Alpha 2 is another therapy for equine joint disease as it can slow the progression of osteoarthritis by inhibiting factors that lead to cartilage breakdown. A2M is a molecule that is found naturally in the blood and has been found to help prevent cartilage breakdown.
Carpenter says other biologic treatments include PRP and stem cells. “These are all a
bit more expensive, but the benefit is that there are not as many negative effects. With steroids you are knocking out the entire inflammatory process which can have some detrimental effects, but something like IRAP is very specific to the inflammatory mediator that is very common and prevalent in joint disease,” he explains.
“We don’t entirely know how those things work because we haven’t done a lot of cases,” says Peters. “With IRAP, we know this will block the inflammatory cascade, but with the PRP or the stem cells we are not quite sure how those are working in the joints. We don’t know if they are actively doing the repair themselves or stimulating other aspects of the process.
“Cytokines, chemical reactors and chemical mediators, growth factors and individual cells within the joint may be stimulated or what we call up-regulated to produce other growth factors or other positive compounds. We don’t know if these therapies have an effect to down-regulate or do other things to result in reduced inflammation or reduce the activity of some of the cells. There is a lot of research being done in this area, and these therapies may be used more in the future because of their ability to heal joints and maintain joints,” Peters says.
The “maintenance” injections many people were using with HA and steroids has fallen out of favor a little because of the potentially detrimental effects of steroids. “Now, more people are trying to treat a specific joint for a specific problem. This is probably where the biological regenerative therapies will be most helpful,” says Peters.
“You can get the benefit of quieting
down inflammation or maintaining the joint without the risks associated with steroids— such as cartilage breakdown over time, or the possibility of laminitis,” he says. “I think there will be more push for joint therapies that allow specific joints to be treated, without some of the potential problems that can occur from treating joints time and time again or too close together with other medications.
“We are still learning, with some of the
newer therapies. We have a much better handle
on the HA or Adequan in the joints, and the cortiocosteroids, and it will just take some time as we use the newer treatments to get a better feel for when they work best, or what types of things they work the best on. There is a lot of basic science being done, as well as clinical-use science going on right now involving these treatments, and I foresee more use of these in the future,” Peters says.
“There is a tremendous shift today in the performance horse and racing industries toward using biological, natural regenerative therapies like IRAP, PRP or
PRP (platelet-rich plasma) is a biologic treatment used for sprains or strains that can help quiet down and minimize inflammation and help healing by adding growth factors without the risks associated with steroids.
stem cells.” – Dr. Duncan Peters
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