July 22, 2018
2014 Tennessee Equine Hospital Lecture Series
Article by Allison Armstrong Rehnborg; Photos by Ryan Ryan Rehnborg
With nearly as many causes as it has cures, equine lameness is a complex, multi-faceted issue, encompassing injuries and conditions as simple as stone bruises and as complicated as joint disease and osteoarthritis. In addition to its immediate impact on horses and horse owners, lameness places a tremendous financial strain on the horse industry, to the tune of millions of dollars each year. But while lameness is a universal and often mysterious affliction, the Tennessee Equine Hospital’s Sports Medicine Team is devoted to providing relief for lame horses and answers for troubled horse owners. The team, which consists of Dr. Monty McInturff, Dr. Matthew Povlovich, and Dr. Liberty Getman, routinely uses state-of-the-art diagnostic equipment, including the hospital’s Lameness Center and a brand-new equine MRI, to identify different diseases and conditions of the hooves and limbs.
The hospital’s hard-working veterinary staff members also educate the public about some of the industry’s most important topics in equine medicine – including lameness – through the hospital’s quarterly educational lectures. On May 20, 2014, Monty McInturff presented “Diagnosing and Treating Equine Joint Disease” as the second installment in the hospital’s 2014 Lecture Series. Provided free of charge to the public, the lecture drew a considerable crowd and also featured a guest presentation on synovitis – a form of equine arthritis – by Jim Little, DVM, a health field specialist for Bayer HealthCare.
Dr. McInturff kick-started his lecture by handing out several preserved and articulated examples of equine bones and joints to the crowd, explaining that he planned to educate them on the nature of the equine joint and its role in the sound – and lame – horse.
“This lecture isn’t just about lameness,” McInturff said as he held a cross-section of a horse’s hoof and lower limb aloft. “I want to teach you about the normal joint, and I want to teach you about the abnormal joint. I want to teach you about the things we do to protect these joints, and to understand why those things are so important.”
The veterinarian then launched into a discussion of the signs of equine joint disease. Some symptoms, such as pain on palpation, heat, and swelling, are obvious, while others, such as a decreased willingness to work or even just “coming in second place,” are more subtle.
“Maybe you touch the joint and you feel the tenderness, and the horse responds to it,” McInturff said. “Maybe there’s heat or swelling. Maybe you’re riding the horse, and you’re noticing that he just doesn’t take the hills the same way he used to. But all of these things are signs of joint disease, and they all happen before lameness occurs. How can we notice these signs before lameness occurs? How can we prevent lameness, rather than just treat it?”
He then explained that joint disease is the painful inflammation or stiffness of joints – otherwise known as arthritis, a common plight for horses and humans alike. In order to illustrate how arthritis occurs, McInturff gave a simplified description of how equine joints work. Joints exist in the horse wherever two bones meet, and bones are attached to one another by ligaments. Cartilage caps the ends of the bones and serves as a protective barrier, ideally allowing the joints to flex and bend with ease. But when the protective cartilage on the ends of a horse’s bones is chipped, worn, or damaged, arthritis and pain can develop.
“Healthy cartilage is the key to healthy joints,” McInturff explained, likening healthy joint cartilage to a sponge. When a sponge is full of water, it is resilient and very hard to tear or damage. But a dry, compressed sponge is brittle and easily damaged. Healthy cartilage is filled with fluid and “springs” back into place easily after a joint bends and flexes. Damaged cartilage, on the other hand, will be dry and worn, sometimes allowing the bones to scrape against each other and cause pain.
“All the medicines we give a horse for his joints are geared towards making those joints happier and ‘spongier,’” McInturff said, noting that there are many forms of treatment for arthritis. Some treatments are traditional and involve corrective shoeing and surgeries. One traditional treatment that he addressed involved the use of neutraceuticals, a category of non-prescription foods or supplements intended to improve health or have medicinal benefit.
“Neutraceuticals can be effective, if they are digested by the horse and actually enter the bloodstream, where they can reach the joints,” McInturff said. “Some horses may digest them and the neutraceuticals never reach the bloodstream. But here’s my advice – if a neutraceutical is working for you, keep using it! If not, find something else.”
The hospital veterinarians frequently use regenerative therapies, such as interleukin-1 receptor antagonist protein (IRAP), platelet-rich-plasma (PRP), and stem cells, to treat joint disease. These treatments involve using the horse’s own blood and stem cells to aid the body in repairing itself more quickly. More common treatments include administering phenylbutazone (an anti-inflammatory drug commonly known as bute), and, of course, giving joint injections of hyaluronic acid or steroids. Common joint injection products for horses include Adequan or Legend. But no matter how successful a given form treatment may be, McInturff stressed that the best way to ensure the health of your horse’s joints is prevention.
“Prevention is ultimately the best medicine,” McInturff said. “Joints are only as healthy as the cartilage inside them, so don’t be afraid to work proactively to prevent joint disease. For example, administer bute after a hard ride, feed neutraceuticals, or use Legend. Healthy joints keep us in the saddle longer. I was taught in vet school that the more you treat a joint, the faster it breaks down, but really, I’ve found that the opposite is true. The more you treat a joint, the longer it lasts.”
After McInturff stepped down, Dr. Jim Little of Bayer HealthCare took the podium, delivering a presentation on how Bayer’s product, Legend, can treat joint dysfunction and osteoarthritis in the horse. Little described how traumatic synovitis (inflammation of joint lining) develops in the horse, indicating that it is an ongoing process, exacerbated in high-motion joints by repeated episodes of trauma from everyday use and training. Synovitis involves the release of inflammatory mediators and cytokines, which initiate further inflammation in the joint and can erode cartilage. Legend, which is an injectable medicine, works by blocking further release of those mediators and decreasing the effects of existing mediators.
Little also presented research on the effectiveness of Legend, revealing that it has been shown to improve lameness in test horses up to 45 days past the last injection. He also presented the results of a study which compared intravenous injections of Legend to intra-articular injections, and concluded that there is no statistical difference between the two forms of treatment and that intravenous injections ultimately pose less risk to the horse’s joints.
The Tennessee Equine Hospital’s third lecture, discussing internal medicine, will be presented on August 19 by Dr. Christine Cocquyt and Dr. Rena Chang. For more information or to RSVP, visit: www.tnequinehospital.com.
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