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VMS4008 - EQUINE > Chronic Lameness > Flashcards

Chronic Lameness Flashcards

1
Q

What are some chronic lameness conditions in the horse?

A
  • Osteoarthritis (Join synovitis)
  • Navicular Dx
  • Chronic Laminits
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2
Q

What is the most common cause of lameness in horses?

A

Osteoarthritis

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3
Q

What factors to consider with OA?

A
  • Use of horse
  • OWner’s expectation
  • Age
  • Severity
  • N° of joint affected
  • Risk of lamainits
  • Other systemic dx
  • Owner’s financial situation
  • Associated soft tisue damage
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4
Q

Consequences of OA?

A
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5
Q

detail what steroids to use when?

A

INTRA-ARTICULAE ADMIN

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6
Q

Side effects of Corticosteroids?

A
  • Laminitis (BEWARE if suspicious of endocrine dx)
  • Iatrogenic Joint infection (low incidence)
  • Periarticular cellulitis (diffuse swelling, hot painful)
  • Joint flare - aseptic synovitis
  • Deleterious effects on cartilage (MPA)
  • SLows healing of joint injury
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7
Q

Describe the use of NSAId for OA ?

A
  • Analgesic - SMOAD
  • Improves joint mobility
  • Inhibition of COX (COX 2 esp inflammation)
  • Side effects due to COX 1 inhibition -> Gi ulceration, RDCn renal but Therapeutic effects due to COX 2
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8
Q

What do we HAVE to keep in mind abotu using NSAIDs?

A
  • Narrow safety margin
  • Not for competition animals
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9
Q

describe Phenylbut use?

A
  • Most commonly used
  • Cost effective –
    86p/sachet
  • Oral or IV
    administration
  • 2.2 mg/kg PO BID
  • NOT COX selective
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10
Q

What is the FEI Detection TIme for Phenylbut?

A

7 days

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11
Q

What other options for NSAIds?

A
  • > Suxibotazone (more palatable)

-> Firocoxib IV or PO
- 3mg/kg SID loading dose then 1 mg/kg SID maintenance
- COX 2 selective!
- FEI detection 14 days

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12
Q

What topical NSAID?

A

Diclofenac Cream - topical application BID
- licensed in UK not US
(equivalent in UK for humans is voltarol)

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13
Q

What other management considerations for OA?

A
  • Weight management → Diet
  • Recommendations: restrict forage to 1.5% bodyweight +
    balancer in feed
  • Housing and environment
  • Nutraceuticals
    -> Weak scientific evidence for in vivo efficacy
    -> Lots of anecdotal evidence
    -> Chondroitin sulphate and glucosamine
    -> Hyaluronic Acid
    -> Green lipped mussel
    -> Boswellia
    -> Devil’s claw – controlled substance under FEI
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14
Q

Biphosphonates - how do they work?

A
  • DMOAD
  • Osteoclast inhibitors – bind to osteoclasts which in turn
    decreases osteoblast activity and bone turnover
  • Reduce rate of bone resorption
  • Reduce bone pain
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15
Q

What evidence for use of Biphosphonates?

A
  • Bone spavin
  • Navicular dx
  • Thoracolumbar pain
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16
Q

Duration fo action for biphosphonates?

A

Approx 6 months

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17
Q

Risks associated with biphosphonates?

A

Colic and renal tox

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18
Q

give examples of biphosphonates

A
  • Tiludronate -> admin via saline infusion intravenously over 30 mins ; licensed for bone spavin
  • Clodronate -> Admin IM over 3 sites; licensed for navicular dx
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19
Q

Describe used of Sodium hyaluronate (HA)

A
  • Glycosaminoglycan
  • Component of articular cartilage and synovial fluid
  • Local anti-inflammatory effect and chondroprotective
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20
Q

How do we admin HA?

A
  • Intravenous(40mg) Repeated weekly for 3 treatments
  • SMOAD + DMOAD [Kawcak et al, 1997]or Intra-articular (20mg/joint)
  • Flare rate of 12%
  • Does not result in a substantial enough reduction in lameness when used alone
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21
Q

Best use of HA?

A

Acute/mild to moderate synovitis

22
Q

describe polysulfated glycosaminoglycans?

A

Increase HA synthesis, stimulate cartilage matrix synthesis, decrease matrix
degradation

23
Q

when are P O L Y S U L F A T E D G L Y C O S A M I N O G L Y C A N S used ?

A
  • Most commonly used intramuscularly →
  • Improves lameness and stride length [White et al, 1996]
  • 7 treatments(500mg) every 4 days for 28 days
  • Can be given intra-articularly
  • Associated with higher incidence of joint sepsis
24
Q

best use for polysulfated glycosaminoglycans?

25
Pentosan Polysulfate used? (Cartrophen)
DMOAD Stimulate synthesis of proteoglycans in extracellular matrix →Healthier cartilage →Stimulates increase production of hyaluronic acid →Lubricates and stabilises the joint →Anti-inflammatory
26
What orthobiologics/regen medicine options?
- Polycrylamide Hydrogel - Interleukin 1 receptor antagonist (IRAP) - Platelet Rich Plasma and alpha 2 macroglobulin - Stem Cells
27
Describe Polyacrymide Hydrogel ?
A promising alternative with a long duration of action - Integrates into joint capsule and tissue via vessel in growth - Creates a cushion like effect in the joint - Preservation of joint cartilage and aid regeneration
28
Describe use of IL-1 Receptor antagonist PRotein (IRAP) ?
- Aim: block action of pro-inflammatory cytokine IL-1 - used in humans for many years to manage OA
29
Protocol for use of IL-1 IRAP
* Protocol: 3 injections 7-10 days apart * Used most often in chronic progressive OA
30
Describe Platelet RIch lasma use?
* Autologous biological product prepared from whole blood * Enrichment of platelets and degranulation to release growth factors * Evidence to support use in younger patients for joint tissue healing → acute traumatic injuryD
31
Describe use of Alpha 2 Macroglobulin -
- Alpha2EQ * Naturally occurring protein in blood * Anti-inflammatory with multimodal mechanism of action * Can be used with other treatments/pre-treatment
32
stem Cells - two types?
- Bone marrow derived Mesenchymal Stem cells - Chondrogenic induced Mesenchymal stem cells
33
Describe Bone marrow derived MEsenchymal Stem clels?
Bone marrow aspirated from sternum Cultured over several weeks Promote repair and regeneration May participate in repair of cartilage May be beneficial in cases with intra-articular soft tissue injuries to promote healing
34
Describe Chondrogenic induced mesenchymal stem cells?
Derived from equine allogenic peripheral blood No need to wait for cultures – comes ready to use Cost – timing/storage
35
If all else fails what surgical options for OA?
- arthrodesis - Neurectomy
36
What different conditions encompass Navicular syndrome ?
o Navicular Bone Pathology o Navicular Bursitis o Navicular suspensory desmitis ( collateral sesamoidean ligament) o Distal Sesamoidean Impar Desmitis o DDFT injury/tear or adhesions of the DDFT
37
What are the mainstays of Navicular syndrome?
1. Rest 2. Anti-inflammatories 3. Bone metabolism medications
38
Describe the 'Rest stage'
* Dependant on degree of soft tissue damage * Box rest with hand walking * If DDFT affected: more prolonged → up to 12 months
39
describe the use of Anti-inflammatories ?
* Most common long term, palliative medical treatment * Intra-articular: Distal interphalangeal joint-> Corticosteroids (TA and MPA) * Intra thecal: Navicular bursa-> More effective clinically?; Corticosteroid +/- hyaluronic acid
40
What can be used for aspect 3 of treatment -> bone metabolism medications?
* Bisphosphonates * Treat bone pain * Inhibit osteoclast activity and bone resorption IM injection OR?→Intravenous regional limb perfusion : no scientific to support this currently
41
How can we use remedial farriery for navicular syndrome
* Dependant on confirmation of the foot * Optimise foot balance * Often have long toe and low, underrun heels, contracted heels
42
Step 1 of Remedial farriery?
1. Correct and maintain dorsopalmar and mediolateral balance * Correct hoof pastern axis * Elevate heel with wedge (2° - 4°)
43
Step 2 of Remedial farriery?
2. Ease of breakover achieved by shortening and/or rolling the toe * Decreases the work of moving the foot
44
Step 3 of Remedial farriery?
3. Maintenance of foot and especially heel mass
45
Step 4 of Remedial Farriery?
4. Protect palmar aspect of foot from concussion Types of shoes → aim to move weight bearing axis * Egg bar shoe * Heart bar shoe – central support shoe * Natural balance * Leverage Reduction Shoe * Frog support * Remove shoes??
46
Other medications for navicular syndrome?
- Isoxuprine - Warfarin - Botulinum Toxins
47
Detail use of Isoxuprine?
Peripheral vasodilator, dec blood viscosity and platelet aggregatiion -> Inc in distal limb circulation
48
Use fo warfarin?
dec blood viscosity HOWEVER ischaemic pathogenesis largery disproved therefore NO LONGER COMMONLY USED
49
detail Botulinum toxins
-> interference with pain pathway reducing lameness - Prelim studies suggest improvement in lameness intra-thecal injection) - More ivestigation required to evaluate dosage and long term efficacy
50
Navicular bursoscopy?
* Fibrillation or tearing of DDFT visible on MRI →Assess and debride lesions → reduce inflammation
51
Palmar digital neurectomy?
* Effective but potential for complications * Horse cannot compete under FEI rules * British Dressage - pre-2023 couldn’t compete - 2024/25 can be signed competition legal by vet

VMS4008 - EQUINE (30 decks)

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