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EQUINE HEALTH
Dr. Thomas Koch
“Steroid treatments help some horses, but may not be ideal, and there are some issues regarding their use, and concerns related to the long-term health of the joint.”
whether or not the treatment you provide matches that particular underlying condi- tion. There are obviously a lot of issues, with some horses responding to treatment and some not. We realize that OA is a dis- ease complex--more than just one disease,” Koch says.
Often these horses are being managed with daily medication to try to ease their pain, if they are not participating in a sport that prohibits drug use while competing. Pain management can be a challenge for horses that must be drug-free during competitions. A retired horse or a recreational horse might get by with a little “bute” every day, but a sport horse or race horse cannot be medicated in that manner.
“Another drawback is that NSAIDs like bute have a narrow therapeutic index (a small window of effectiveness that is not very far from toxic levels). A little too much, and they cause problems or gut issues. It’s a fine line. In an older, geriatric horse, for instance, those drugs may not be metabolized the same as in a younger horse, and the therapeutic index is even smaller.” A person must be careful to not overdose the horse.
Every time you rely on daily medication, there can also be issues with consistency and compliance. “In human medicine, 60% of treatment failures are due to people not tak- ing the medications prescribed, because it’s a hassle or they forget. They take their medica- tion for a while in the beginning and feel better, and then stop taking it because they either forget about it or feel they don’t need
it anymore, and then the arthritis flares up again. You don’t have consistent management of the condition when taking the medication sporadically,” he explains.
“It’s the same for many horses. People put them on certain drugs, and they get better, then the owner stops the medication, and
the horse gets painful again. The pain is not always managed consistently.” Also, these drugs merely aid pain management and don’t facilitate healing or resolution of the condi- tion. The underlying process is still progress- ing, and joint damage continues.
There are a number of biologic products that can be injected into joints, like PRP (platelet rich plasma) or IRAP (interleukin receptor antagonist protein). Interleukins are mediators of inflammation like histamine and other cytokines that cause bad things to happen in injured tissue.
– Dr. Thomas Koch
“The advantage with these biologic treat- ments is that there have been fewer regula- tions regarding their use (as opposed to stem cells). But again, it can be hit or miss in whether they work, depending on the individ- ual horse and how well it responds. IRAP is a very targeted treatment against interleukin-1 but if the pain is not driven by an underlying interleukin-1 inflammation, it will be less successful,” says Koch.
Steroids have also been used for treating OA, but there is controversy about using those in joints; some people feel that these can damage the cartilage, so they try to avoid steroids. There are also different types of steroids that influence the joint in different ways. “Steroid treatments help some horses, but may not be ideal, and there are some issues regarding their use, and concerns related to the long-term health of the joint.”
104 SPEEDHORSE March 2022
Placement of culture vessel containing equine mesenchymal stomal cells into incubator for laboratory cell expansion.