Hey everybody, Whinny here! This week I’m going to tackle part 2 of my blog on arthritis. I learned that there is a lot to this topic! Last time we talked about what causes arthritis and what it does to your horse. Now this week let’s find out how to deal with it if your horse has been diagnosed.

To start with, arthritis unfortunately can’t be cured. The damage is already there, so the goal is to manage the pain and inflammation so your horse can live comfortably. Interrupting the cycle of inflammation is important to slow the progression of damage as much as possible. Each case is different, depending on what joint is involved and how advanced the arthritis is, but in many circumstances, horses can live normal lives and continue being ridden. Your vet will help you decide on the right treatment for your horse based on his individual case.

What Can You Do at Home?

• Turnout and exercise
  • Horses with arthritis benefit from as much turnout as possible to reduce stiffness. They tend to feel creakier when they’re kept in a stall for long periods of time and aren’t able to move their joints. Moving around helps to keep the joints lubricated. You’ll want to make sure your horse can easily get to his food and water source in the pasture. Also watch out for herd dynamics, as an older arthritic horse might be picked on by his companions. He might be better off in a smaller pasture with quiet herd mates. If your vet thinks it’s ok, riding work can help to strengthen the muscles that help support the joints. Light, consistent work is best, as long as your horse is comfortable with it. Retirement is not always the best thing for an arthritic horse! Consider the footing you’re riding on. Hard, rocky, or uneven footing can be tough on the joints.
• Hoof trims
  • Make sure your horse’s hooves are trimmed regularly, about every 5-6 weeks. If the hooves grow too long, or aren’t well balanced, it can put extra stress on the joints. This goes for every horse, not just those with arthritis, but since an arthritic horse is already dealing with an abnormal joint, he’ll feel the effects of a long toe or inappropriate angles even more.
• Balance his weight
  • You’ll want to keep your horse in good body condition – not too fat and not too thin. If he’s too heavy, it puts excess strain on his joints. You may have to adjust his diet if he’s not doing as much physical work as he used to, since he may not need the same number of calories. On the other hand, some horses have trouble keeping weight on as they age, and if your horse doesn’t have the muscle mass to support his joints, that’s also problematic. Your vet will help you evaluate his nutritional needs to keep him in balance.

Medical Treatment

Direct medication of the affected joint

The most effective treatment for arthritis is usually a direct injection of a medication into the arthritic joint. The benefit is to the specific joint that is treated, but it can really decrease the pain and inflammation coming from that area and make your horse much more comfortable. There are several different types of joint injections nowadays.

• Corticosteroids
  • These are the most common anti-inflammatory medications used for joint injections. They’ve been around the longest and are quite effective at reducing pain. They help to slow the deterioration of the cartilage by interrupting the damaging cycle of inflammation. Steroid injections are often combined with hyaluronic acid, a joint lubricant. Typically, the treatment is repeated every 6-12 months. Horses with Cushing’s disease or metabolic syndrome may not be candidates for steroid injections, so be sure to talk to your vet about it.
• Polyacrylamide gel products
  • Arthramid and Noltrex are examples of these products. When injected into the joint, they work by integrating into the synovial lining and provide shock absorption, lubrication, and joint capsule elasticity. Polyacrylamide gels can benefit even some cases of advanced arthritis where steroid injection is no longer effective. They’re a bit more expensive than steroids, but the effect can last longer. They’re safe for horses with Cushing’s or metabolic disease.
• Regenerative therapies
  • These injections are derived from your horse’s own blood and harness the power of molecules that naturally occur in his system to decrease inflammation and promote healing. The most common types of regenerative therapies used for arthritis are Platelet-rich Plasma (PRP) and Interleukin Receptor Antagonist Protein (IRAP). Blood is drawn from your horse (don’t worry, it’s not a scary amount!) and processed in a way that concentrates the beneficial molecules to be injected back into the arthritic joint. These injections can be very effective and are my Springhill vet’s first choice for younger horses or less severely affected joints.

Non-steroidal anti-inflammatory medications

Commonly used, “NSAIDs” such as phenylbutazone (bute), are effective at reducing pain and swelling. Remember though, that these medications are like a band-aid – they’re making your horse feel better while they’re in his system, but not really treating the arthritis. They can also be hard on the GI tract and kidneys if used long term. So, while bute is inexpensive and commonly available, and can be helpful for occasional flare-ups, you probably don’t want to rely on it for long-term treatment. Some horses do benefit from a daily medication for overall comfort, especially if they have severe arthritis or multiple joints affected. In that case, your vet may choose firocoxib (Equioxx), which is the same medication type as bute, but less irritating to the GI tract and safer for long term use. A topical medication called Surpass is also available, which is applied directly to the skin over the affected joint.

Oral joint supplements

It’s important to understand that supplements aren’t required to meet the same standards for effectiveness as medications are. There are many, many supplement products being sold out there, and unfortunately few have any research behind their claims to support joint health. Oral joint supplements often contain ingredients such as glucosamine and chondroitin – substances found in joint cartilage. Unfortunately, horses don’t absorb these materials well in the oral form, that’s why these products work better in dogs and humans than they do in horses.  

There are a few products that have shown some protective effect, but in general you won’t see anything like the improvement a joint injection can provide. Oral supplements aren’t inexpensive either, so you may be better off saving your money for a more effective treatment. If you’re going to use a joint supplement, it’s probably better as a preventative in a young horse, rather than as a treatment for existing arthritis. I wish I had better things to say about joint supplements – it would be nice if they really worked well.

Other injectable medications

There are several treatments that are injected by the intravenous or intramuscular route. These are similar to supplements in that they provide some of the building blocks for cartilage, but there is more evidence for their effectiveness. They work best in mild to moderate arthritis and can be useful if the horse has multiple arthritic joints. The most frequently used is Adequan, an intramuscular injection that contains polysulfated glycosaminoglycans to reduce joint inflammation and stimulate the production of joint fluid. Another product, Legend, is an intravenous form of hyaluronic acid that decreases inflammation in the joint. These products can be useful, but if your horse is significantly lame, think about these as helper medications to be used along with another type of arthritis treatment.

Joint Fusion Procedures

In cases of severe arthritis, where medical treatment is no longer effective to reduce pain, a procedure to fuse the joint may be considered. What this means is that the veterinarian destroys the remaining cartilage in the joint so that the bone ends can grow together and fuse into one structure. Once the joint is essentially removed, it no longer causes pain. There are several ways to accomplish this, depending on the joint involved and the amount of arthritis. Facilitated ankylosis is where a chemical is injected into the joint to kill the cartilage cells. Arthrodesis is a surgical procedure where cartilage is physically removed, and screws are placed to hold the joint immobile. Joint fusion isn’t a shortcut treatment, and definitely isn’t appropriate for every case, but can provide a solution in certain situations.

Complementary Medicine for the Arthritic Horse

Chiropractic treatment can help to maintain your horse’s overall comfort. Reduced joint mobility causes negative effects on the joint itself, the nervous system, and the muscles and tendons surrounding the joint. These things lead to your horse having pain, abnormal posture, or poorly coordinated movement. As he compensates for his arthritic joint, your horse may become sore elsewhere, very commonly in his back. Chiropractic care can help to improve his overall physical function.

Acupuncture stimulates the nervous system, releasing chemicals into the muscles, spinal cord, and brain. These biochemical effects stimulate the body’s natural healing abilities. They can increase blood circulation, relieve muscle spasm, and release pain-controlling endorphins. The National Institute of Health consensus statement concluded that there was compelling evidence of acupuncture’s ability to control multiple ailments in people, including osteoarthritis and musculoskeletal pain. We think it’s a great treatment to help control arthritis pain in horses as well.

We’re lucky nowadays to have so many options available to keep our horses comfortable. My Springhill vets are happy to talk with you about which of these treatments would be best for you and your horse!

Until next week,

~Whinny

P.S. Are you watching the videos over on my YouTube Channel? There’s some really good stuff there! From How To’s to seminars to funny stuff like the Horse Girl Goes to the Vet series, there’s something there for every horse owner. Don’t miss out!

Hey everybody, Whinny here. As the Clinic Mouse and a brand-new blog-writer, I’ve been learning tons about what goes on at Springhill Equine! From my mouse-house on the side of the field, I can watch the Springhill vets evaluating horses as they trot up and down. Then If I scurry over by the clinic, I can hear what they talk about with the horses’ owners. One of the things that gets talked about a lot is arthritis. I’d never heard of that before, so one night I found this giant book someone left out and I read up on it. Wowzers, that was a looong chapter, and really complicated, so I couldn’t possibly tell you everything in it. I’m actually going to write two separate blogs on arthritis because there is so much stuff I thought was interesting! Today I’m going to go over what it is and what it does to your horse. In a few weeks, I’ll tell you what I learned about how to treat it!

What is Arthritis?

Well, first of all, a horse has joints. Hocks, stifles, pasterns, fetlocks – those are all joints. Mostly we think about the legs, but there are tons of joints in the neck and the back, too. The joints have to move constantly and also support the horse’s weight. That’s a hard job and they have to do it for the horse’s whole life!

A healthy joint has cartilage in it that provides a smooth surface over the bone for movement and shock absorption. There’s fluid in the joint, called synovial fluid, that lubricates the joint and helps to nourish the cartilage. That’s how it’s supposed to work.

Arthritis means inflammation in the joint and all the bad stuff it can cause. I’ll talk about why it happens in a minute, but basically, when you have arthritis, the cartilage becomes damaged and that causes pain, stiffness, and swelling of the joint. That results in lameness and all the ways it can affect your horse. Arthritis is usually progressive and results in permanent damage to the joint. If you’ve heard of degenerative joint disease, that’s another name for the same thing.

Arthritis is suuuper common. Lots of riding and show horses get it, but even wild horses do, too. I read that arthritis is responsible for up to 60% of all lameness. Considering how many lameness exams I see the Springhill vets doing, that’s a lot! I also read that 50% of horses older than 15 have some arthritis. So I’m glad I looked it up, since it must be really important. 

How Does Arthritis Start?

There are a couple different types of arthritis. I’m going to talk about the most common kind, osteoarthritis (aka degenerative joint disease). There’s another kind called septic arthritis, caused by an infection in the joint, but that’s different so I’ll save it for another blog. Osteoarthritis is most often caused by “wear-and-tear” of the cartilage over time. It starts with low-level inflammation in the joint caused by exercise or aging. The inflammation can overwhelm the body’s ability to contain it, and a vicious cycle begins. Destructive enzymes are produced in the joint, breaking down the lubricating synovial fluid and causing it to become thinner and less protective. The cartilage molecules (proteoglycans and collages) are damaged and lose integrity.

Because of that, the cartilage’s ability to retain water and provide shock absorption is decreased. The damage stimulates even more inflammation, more destructive enzymes, and more cartilage damage, and so the cycle continues. If left untreated, the inflammation will lead to long-term deterioration of the joint. Eventually, the cartilage can erode away entirely, leaving exposed bone without its protective cartilage cap. This is very painful, advanced arthritis.

Osteoarthritis can also be caused by a sudden, direct injury to the cartilage or bone such as a chip fracture in the joint, a developmental joint disease like an OCD lesion (see Tony’s previous blog on OCD), or instability of the tissues that support the joint. Those things will jump-start the progression of arthritis, but it ends up the same as the wear-and-tear type, with permanent degradation of the joint cartilage.

What Does Arthritis Look Like?

So if your horse has arthritis, how will you know? One important thing I learned is that you won’t always see obvious limping. While there definitely can be clear lameness, especially if the arthritis is already severe, there are also more subtle signs that your horse may have a painful joint. He may just feel stiff with a shortened stride. A horse with arthritis sometimes warms up out of his stiffness after riding for a little while, or the stride may stay short and choppy the whole time. He might have trouble picking up or keeping a canter lead, or he might cross-canter with the front end on one lead and the hind end on the other. He might lack power while jumping or have difficulty stopping or turning.

You may notice that a horse with arthritis in his hind end drags his toes and wears the toe of his hind hooves or shoes excessively. Your farrier may tell you that your horse has trouble holding up a leg for hoof trims. Horses with more advanced arthritis may have an obviously enlarged joint, difficulty getting up after laying down, or not move around the pasture as much. Sometimes chronic soreness can cause a horse to become sour or look like he has a bad attitude. It’s not his fault though, he just hurts. Hopefully you guys understand that a lot of the time, horses aren’t just being naughty, and if you can treat the pain, he’ll be a lot happier to keep working.

Diagnosing Arthritis

Remember that vicious cycle of inflammation I told you about? It’s super important to get it under control so you can slow the progression of arthritis as much as possible. The key is to catch it early, since the longer you wait, the more damage will occur. Have one of my Springhill vets check out your horse for even mild stiffness or a change in behavior under saddle.

She’ll begin by talking with you about what you’ve noticed in your horse. Then, she’ll do a physical exam to feel for swelling and other joint abnormalities. She’ll watch your horse move and may flex his joints to help identify which area is bothering him. Depending on what she finds, she may need to perform “diagnostic analgesia” – temporary numbing of a joint to determine whether it’s the source of pain. Then, she may recommend an x-ray to look at what’s happening to the bone inside the joint.

X-rays are the most common type of imaging used to diagnose arthritis since they can be done either at your farm or here at the clinic. Occasionally, other types of imaging are needed, such as nuclear scintigraphy or arthroscopic surgery, but those cases aren’t very common. Getting an accurate diagnosis is the best way to manage your horse’s comfort.

Once the diagnosis is made, it’s time to make a treatment plan. But there are more options nowadays than there used to be, so I’m going to save that for my next blog on treating arthritis!

That’s it for this week!

~Whinny

P.S. If you want to really get to expert status on this, and you can’t wait for Part 2 of this blog, go check out our Podcast Episode on Equine Arthritis. You can listen to it right from that link, or from the Podcast Page on my website, or from whatever podcast app you use, like Spotify, Apple Podcasts, and all those. If you’re searching for it, the name of the show is Straight from the Horse Doctor’s Mouth. Listening to that is the fastest way to become a horse health guru! Well, in combination with reading my blog, of course.