Smarter Strategies forEquine Joint Care

Lydia F. Gray, DVM, MAMedical Director/Staff Veterinarian

Jessica NormandSenior Director – SmartSupplements™

April 5, 2012

Your Presenters

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Agenda• Joint Anatomy & Function• What is Osteoarthritis?• Prevention & Therapy• Questions & Answers

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Joint Anatomy & Function

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1. Ligaments2. Joint capsule3. Synovial membrane4. Synovial fluid5. Articular cartilage6. Subchondral bone

Equine Joints Commonly Affected by OA

1. Hock2. Fetlock3. Pastern4. Knee

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What is Osteoarthritis?• Progressive, permanent degeneration of articular cartilage• aka Degenerative Joint Disease (DJD)

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“OA is a by-product of the wear and tear and daily trauma that horses experience during heavy training.”- Dr. Rick Mitchell, Fairfield Equine Associates

Osteoarthritis: Some Statistics• 60% of equine lameness problems are related to osteoarthritis,

making it the most common cause of lameness in the horse.

• Inflammation of the hock joints affects more than 50% of jumpers and grand prix dressage horses, and requires treatment for maintenance of peak performance.

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Osteoarthritis: Effects• OA is a cascading cycle of inflammation that leads to:

1. (Ligaments)2. Joint capsule fibrosis3. Synovial membrane thickening4. Loss of synovial fluid5. Articular cartilage erosion6. Subchondral bone sclerosisand Osteophytes (bone spurs)

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Osteoarthritis: Risk Factors• Acute trauma or sudden injury• Age• Conformation• Foot care• Footing• Workload

– Frequency– Duration– Intensity

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Osteoarthritis: Signs of Lameness• Stiffness• Shortened stride• Uneven gaits• Reluctance to pick up, keep or change canter lead• Reluctance to stop or turn while working at speed

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Prevention & Therapy: Goals• Halt the cascade of inflammation• Stop or limit damage to articular tissue• Promote healing of damaged cartilage• Improve mobility• Alleviate discomfort• Extend the horse’s competitive career

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Methods of Prevention & Therapy• Physical therapy

– Rest or controlled exercise– Ice or other cold therapy– Ceramic or other heat therapy– Compression

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Prevention & Therapy: Methods• Injections

– Intra-articular (joint)• Steroids and/or Hyaluronic Acid • Polysulfated Glycosaminoglycans (Adequan®)

– Intravenous• Hyaluronic Acid (Legend®)

– Intramuscular• Polysulfated Glycosaminoglycans (Adequan®)

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Effects of Oral Glucosamine and Chondroitin Sulfates Supplementation on Frequency of Intra-articular Therapy of the Horse TarsusRodgers MR, Intern J Appl Res Vet Med 2006;4(2):155-162.

Prevention & Therapy: Methods• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

– Aspirin (OTC)– Bute– Equioxx®– Surpass® (topical)

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Prevention & Therapy: Methods• Newer Therapies

– Extracorporeal Shockwave Therapy (ESWT)– Biologics

• IRAP• PRP• Stem Cell

• Complementary & Alternative Therapies– Acupuncture– Chiropractic– Massage– Magnetic

• Corrective shoeing• Oral joint supplements

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Oral Joint Supplements:Key Active Ingredients

• “Mother Nature’s Big Three”– Glucosamine– Chondroitin Sulfate– Hyaluronic Acid (HA)

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Safety of an Oral Chondroprotective Agent in HorsesKirker-Head CA, Kirker-Head RP, Vet Ther. 2001 Fall;2(4):345-53.

Double-Blind Study of the Effects of an Oral Joint Supplement in Horses with Tarsal Degenerative Joint Disease. Clayton HM, Almeida PE, Prades M, et alProceedings. 48th Annu Conv Am Assoc Equine Pract. 2002;48:314-7.

Oral Treatment With a Glucosamine-Chondroitin Sulfate Compound for Degenerative Joint Disease in Horses: 25 CasesHanson RR, Smalley LR, Huff GK, et al, Equine Practice. 1997 Oct;19(9):16-20.

“Mother Nature’s Big Three”Glucosamine is the building block of chondroitin sulfate, a specific type of polysulfated glycosaminoglycan (GAG).

Chondroitin Sulfate is not only the building block of the much larger molecules hyaluronic acid (HA) and proteoglycan (PG) it also inhibits the effects of various enzymes that degrade cartilage.

Hyaluronic Acid (HA) is an integral component of joint cartilage and joint fluid, providing both lubrication and shock absorption.

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Evidence of the Oral Absorption of Chondroitin Sulfate as Determined by Total Disaccharide Content After Oral and Intravenous Administration to HorsesEddington ND, Du J, White N,Proceedings. 47th Annu Conv Am Assoc Equine Pract. 2001;47:326-8.

Oral hyaluronan (HA) gel reduces post operative tarsocrural effusion in the yearling Thoroughbred.Bergin BJ, Pierce SW, Bramlage LR, Stromberg A., Equine Vet J. 2006 Jul;38(4):375-8.

Oral Joint Supplements:Key Active Ingredients

• Other ingredients to look for– MSM– ASU– Omega 3 Fatty Acids– Cetyl Myristoleate– Herbs

• Devil’s Claw, Yucca, Boswellia, Bromelain, Curcumin, more!– Antioxidants

• Vitamin C, Grape Seed Extract, Resveratrol, Superfruits, more!

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The effect of methylsulphonylmethane supplementation on biomarkers of oxidative stress in sport horses following jumping exercise.Marañón G, Muñoz-Escassi B, Manley W, et al, Acta Vet Scand. 2008 Nov 7;50:45.

Markers of Inflammation in Arthritic Horses Fed Omega-3 Fatty AcidsManhart DR, Scott BD , Gibbs PG, et al, The Professional Animal Scientist 2009;25(2):155–160

Horse in Light Work/Young Horse• Workload Definition from NRC:

– 1-3 hours per week– 40% walk, 50% trot, 10% canter

• Goal:– Maintain healthy joint tissue, avoid future problems

• Ingredients to Look For:– Glucosamine – Also consider Chondroitin Sulfate

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Horse in Moderate Work• Workload Definition from NRC:

– 3-5 hours/week – 30% walk, 55% trot, 10% canter, 5% low jumping, cutting/other skill work

• Goal:– Support joints in day to day stress

• Ingredients to Look For:– Glucosamine, Chondroitin Sulfate, MSM

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Horse in Heavy Work• Workload Definition from NRC:

– 4-5 hours per week – 20% walk, 50% trot, 15% canter, 15% gallop, jumping/other skill work

• Goal:– Provide comprehensive support for joint, tendon/ligament health,

avoid discomfort and stiffness

• Ingredients to Look For:– Glucosamine, Chondroitin Sulfate, MSM, HA– Tendon/Ligament Support from Silica & Collagen

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Horse in Very Heavy Work• Workload Definition from NRC:

– 1 hour/week of speed work to 6-12 hours/week of slow work– Includes elite performance horses in intense, strenuous work

• Goal:– Provide aggressive support for joint, tendon and ligament health, minimize

discomfort and stiffness caused by intense training and competition

• Ingredients to Look For:– Glucosamine, Chondroitin Sulfate, MSM, HA– Tendon/Ligament Support from Silica & Collagen– Antioxidants (Resveratrol, Super Fruits, Grape Seed Extract)

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Horse in Recovery• Ingredients to Look For:

– Glucosamine, Chondroitin Sulfate, MSM, Hyaluronic Acid (HA)– Tendon/Ligament Support from Silica & Collagen– Antioxidants– Herbs (Devil’s Claw, Yucca, Boswellia, Bromelain, Curcumin, more)– Omega 3 Fatty Acids– Essential Amino Acids (Lysine, Methionine, Threonine)

• Goal:– Help minimize inflammation, alleviate discomfort and support the

healing process

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Senior Horse• Ingredients to Look For:

– Glucosamine, Chondroitin Sulfate, MSM, Hyaluronic Acid (HA)– Herbs (Devil’s Claw, Yucca, Boswellia, Bromelain)– Antioxidants– Probiotics & prebiotics for digestive Support

• Goal:– Ease stiffness and discomfort, support joint and digestive health,

provide antioxidants

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Active Ingredient Guidelines

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GlucosamineChondroitin

SulfateHyaluronic

Acid MSM Other

Young Horse/Horse in Light Work

4,000 mg 5,000 mg Vitamin C

Horse in Moderate Work

8,000 mg 1,000 mg 10,000 mg Vitamin C

Horse in Heavy Work

10,000 mg 1,000 mg 100 mg 10,000 mg Vitamin C, Silica, Collagen

Horse in Very Heavy Work

10,000 mg 1,000 mg 150 mg 10,000 mg Vitamin C,Silica, Collagen, Antioxidants,Cetylated Fatty Acids

Horse in Recovery

5,000 mg 400 mg 100 mg 12,000 mg Vitamin CSilica, Collagen, Antioxidants,Amino Acids,Herbs

Senior Horse 7,000 mg 500 mg 50 mg 12,000 mg Vitamin CPro/PrebioticsHerbs

Questions & Answers

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Questions1. Should daily joint supplements be combined with Adequan or Legend? If so

how often should Legend or Adequan be used?2. Should all horses be on a joint supplement? Should you be using a joint

supplement all of their life? 3. What is the best supplement for DJD (hocks)? 4. What is best joint supplement option for 25 yr old gelding with Cushings? I

have been told not to use glucosamine. 5. Please comment on Resveratrol products such as EquiThrive in the daily

maintenance of inflammation down regulation. 6. Please address injectables, especially the newer protocol for Adequan, pros &

cons of Adequan vs Legend.7. Please address any research on the absorption of oral HA. 8. I have a new 5 yr old Lusitano , just want to make sure I protect his joints right

from the beginning.

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Questions9. My warmblood has had a knee that pops when she walks since she was 4

years old. She is sound and showing second level dressage, schooling fourth level. What could be the cause of the sound and should I worry?

10. My senior horse (28 yrs old) is arthritic - what care does she require for normal daily exercise of her joints?

11. My horse is a senior horse and I currently do not have her on any joint supplements. She is ulcer prone and I am concerned that the supplements might irritate her stomach. Are there any joint supplements that are recommended for horses with her condition?

12. Any problems with long-term use? Should formulas be switched periodically?13. Is there a difference between feeding a "pure" joint supplement, such as

straight MSM, and feeding a joint supplement with multiple ingredients? 14. Is it ever too early to start a horse on a preventative joint supplement? My

Mustang gelding is 18 and I'd like to keep him happy and healthy as long as possible.

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Questions15. I hear that joint supplement ingredients administered orally are partially or

fully digested, which may reduce or eliminate their effectiveness. Especially glucosamine, chondroitin, MSM, HA, and collagen. Is this true?

16. I give my 15 yr old Fresian Adequan IM and Cosequin ASU. Am I overdoing it? Is there anything else you can suggest as far as exercise amount and duration?

17. I carriage drive, which is a sport of combined driving. What can I do to alleviate some of the stress on my horse's joints?

18. I am interested in the research studies that support/deny using supplements to maintain or improve joint condition. So much is a guessing game when it comes to supplements that I am inclined not to use anything unless there are studies which support their use.

19. How is the efficacy of joint supplements assessed? What clinical evidence is available for improvement in inflammation, cartilage condition, synovial fluid composition, etc. ? How is performance evaluated?

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Questions20. Do you feel there are benefits to feeding a flax seed product daily for joint

health. Along with the other things it brings to your horses health.

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