Integrative options for preventing and treating arthritis.
We’ve all heard the saying, “It is often easier to beg for forgiveness than ask for permission.” While this might be true in some areas of life, joint health is not one of them. Striving to prevent arthritis in our horses should be the main goal.
In Part 1 of this series (Oct-Nov 2014), we looked at some of the causes of arthritis and how it’s diagnosed. This time, we will cover preventative strategies and treatments.
Given their druthers, most horses would probably rather spend their days in the field eating grass than working for us. Therefore, it is our responsibility as owners and riders to make sure they are prepared for the tasks we ask them to do.
Many horses, especially those destined for future competitions, are started and asked to compete at high levels years before they are mature. The level of stress and repetitive motion applied to their young joints can set them up for osteoarthritis as they age.
In many countries, young horses are started under saddle and then turned back out into pasture for a year to mature and grow before really being started in a work program. Starting horses gently, then slowly increasing the amount of work they are asked to do, in accordance with their individual stages of maturity, will go a long way in preventing future joint disease.
Five tips for maintaining soundness
When a horse is mature and in a steady work program, there are many things we as owners can do to help them stay sound. Here are the most important:
- One of the biggest issues facing many horses today is their weight. As opposed to working equines of old, horses today are often overfed for the amount of work they are asked to do. Extra weight adds extra stress and strain to joints. I prefer to be able to easily palpate a horse’s ribs. Keeping your horse free of extra weight will reduce wear and tear on joints.
- We must all strive to ride our horses in the most biomechanically correct way we are able. Horses are masters at not using their bodies in the healthiest ways when being ridden. Poor posture in people can lead to chronic back pain, and the same is true of horses. Back pain can then lead to undue stress on joints.
We must also evaluate our riding programs. Remember from the last article that consistent, repetitive motion is an insidious cause of arthritis. Our horses need to have their workouts varied. Circle after circle is not healthy. There should be some “cross-training” out and about on trails and in fields. The variation in footing between the indoor arena and outdoor areas will allow the joints to flex and extend in their full range of motion, keeping them healthy. It is our responsibility as owners and riders to make sure our riding does not contribute to undue joint stress.
- Improper hoof care is a huge cause of joint instability and stress. The hoof is the only part of the horse that impacts the ground. It is the weight bearer and part of the shock absorber. Hoof care is beyond the scope of this article, but please work with a qualified hoof professional and your veterinarian to make sure your horse’s hooves are as healthy as possible.
- Whole body inflammation contributes to joint inflammation. Inflammation not only causes pain, but inflammatory chemicals in the joints contribute to joint damage. Many times, inflammation begins in the gastrointestinal tract. While this may seem surprising, we are what we eat. Unless your horse is an upper level athlete, working at maximum capacity every day, he likely doesn’t need supplemental carbohydrates from grains.
Too often, horses are fed sweet feed with whole grains or a pelleted feed made from grain products. These are not natural to the horse. Horses are grazers and do best on a forage-based diet. There are many available supplements to balance a forage-based ration. Supplemental Omega-3 fatty acids have been shown to decrease inflammation in the joints, thereby decreasing the amount of damage the inflammation might cause. Adjusting the diet is a very simple way to help prevent arthritis.
- Veterinary Spinal Manipulation Therapy (VSMT) or animal chiropractic will help maintain joint stability. Instability can be so slight that it is missed by the rider, but it causes normal activities to transfer abnormal stress onto the joints. VSMT addresses not only the spine, but all the joints of the limbs. Regular VSMT can keep your horse in the best functional ability possible. so that normal joint stress is dealt with and accidents may not be as traumatic.
In the case of acute trauma and synovitis (see last issue), treatment is aimed at decreasing inflammation and swelling as quickly as possible. Synovitis should be treated as a soundness emergency, and prompt treatment will most likely allow full recovery.
The initial treatment will include ice alternated with bandaging the joint. Cold will help decrease the inflammation quickly, and bandaging will keep the joint from swelling. Veterinary treatment may include non-steroidal anti-inflammatory drugs such as phenylbutazone or Equiox (firoxib). Equiox has a much lower likelihood of causing stomach ulcers. Many owners do not like to use NSAIDs in their horses, but as an emergency treatment for a short time, they can help preserve the affected joint’s health.
If the ice, bandaging and NSAIDs do not reduce the inflammation fast enough, your veterinarian may suggest injecting the joint with a hyaluronic acid, a corticosteroid, or both. While long-term use of intra-articular corticosteroids is not ideal, a dose in the inflamed joint is one of the fastest ways to take the inflammatory chemicals out of the area, thereby preventing further damage.
Acupuncture can be used to help reduce swelling associated with synovitis and can be used to help control pain. All concerns owners have with NSAIDs and corticosteroids should be discussed with the treating veterinarian. Each case is an individual and individual treatment plans need to be determined.
Integrative therapy options
When it comes to keeping horses with chronic osteoarthritis comfortable, nothing beats VSMT, acupuncture and Chinese herbal therapy.
- VSMT will help keep the joints functioning; the veterinarian who treats your horse should provide you with physical therapy and bodywork “homework”.
- Acupuncture will help maintain a balanced flow of energy in the body and provide pain relief.
- Chinese herbs, tailored to the patient, will help balance the whole body, allowing it to begin to heal itself.
- Massage therapy can provide comfort to a body that is compensating for an arthritic joint.
- Horses with chronic OA will benefit tremendously from the addition of Omega-3 fatty acids to the diet, along with oral PSGAGs and HAs. Using Adequan and/or Legend may also provide relief.
All the preventative measures listed above should be implemented for horses with OA. It can be frustrating to own a horse with arthritis, and sometimes the treatment choices can seem overwhelming. Taking a multi-faceted approach will pay off in long-term comfort for your equine friend.
Starting horses gently, then slowly increasing the amount of work they are asked to do, in conjunction with their individual stages of maturity, will go a long way in preventing arthritis.
Keeping the horse free of extra weight will reduce wear and tear on joints.
PSGAGs and HAs
Two classes of injectable drugs are used systemically for both acute synovitis and osteoarthritis. Legend is an intravenously-administered hyaluronic acid. Adequan is an intramuscularly-administered polysulfated glucosaminioglycan. Pentosan is another PSGAG that is not yet approved by the FDA in the US. To simplify — hyaluronic acids are used more for synoviocyte health, while PSGAGs are used for cartilage health. Both HA and PSGAGs are available in oral form from a number of supplement companies. While there is no definitive research saying they help or don’t, it is my experience that many horses benefit from oral supplementation of these compounds, especially when the diet is adjusted.
The future of treating both synovitis and osteoarthritis most likely lies in the field of regenerative medicine. Using substances collected from the affected horse, stem cell therapy, IRAP and PRP are all being used to treat affected joints. These therapies are still considered experimental and research is ongoing. They are often offered only in larger practices that treat many sports medicine patients. However, they are worth investigating if your horse is diagnosed with arthritis.