DJD 2: Treatment Flashcards
We can minimize joint injury by early recognition of…
Inflammation of the joint
Traumatic Injury
Developmental Orthopedic Disease
Injections
What are the goals when treating DJD?
Decrease inflammation
Alleviate pain
Lubricate the Joint
Restor Normal Environment/Halt Disease
Improve Cartilage Repair
What challenges should be considered when treating DJD?
Specific Joint
Stage of Lesion
Current and intended use of horse
Age of Horse
Treatment Cost
Response to Therapy
Regulations
What are some conservative things that can be done when medically managing DJD?
Exercise modification
weight reduction
antinflammaory drugs
slow acting, disease modifying antioa agents
supportive care
How do you protect the chondrocyte?
Support structures and functions
normalize matrix synthesis
decrease matrix degradation
Disease modifying OA drugs
What are some oral medications that help with OA?
Chonfrotin, glucosamine, MSM and SAU
What are some injectible medications for DJD (IM) ?
Hylauronic acid and polysulfonated glycosaminoglycan
Why are NSAIDS helpful?
Cyclooxygenase inhibitor
-Decrease pain and stiffness, supress inflammation,
What are some side effects of NSAIDs?
Gastric Ulceration, Right Dorsal Colitis, Renal Papillary Necrosis
List some NSAIDs commonly used in horses?
Phenylbutazone, Flunixin Meglumine, Ketoprofen, Fibrocoxib, Diclofenac Sodium, Acetaminophen
What are some Glycosaminoglycans and how do they work?
Chondroitin sulfate, glucosamine - oral supplements, not FDA regulated and dont know how they work
PSGAG - Adequan IM - bovine trachea, stimulates HA production, synthesis of proteoglycan and collagen, inhibit metalloproteases
What are some intraarticular medications?
Corticosteroids, sodium hyaluronate, PSGAG, Regenerative Medicine (PRP, IRAP, ALpha2EQ, Pro-stride, VetStem, BM Stem Cell, Peripheral Blood Stem Cells
What are some benefits and disadvantages of steroids?
Benefit: Decease MMP, Decrease IL-1 and TNF, Decrease fibrin, pain relief, potent, economical
Dis: Pain relief too good, laminitis, MPA (Depo) - damage chondrocyte, articular, matrix, steroid)
What are some commonly used IA steroids?
Betamethasone, Triamcinolone Acetonide, Methyprednisolone Acetate
What are the maximum doses for the main steroids used IA in horses?
Betamethasone <30mg
Triamcinolone <18mg
Methylprednisolone <200mg
Tell me about Triamcinolone Acetonide:
Half-life 1-5 days
6-9mb/joint
18mg total
Brands: Vetalog and Kenalog
Lowers protein and increase HA
Tell me about Bethamethasone:
Potent
Medium duration
6-9mg/joint
18mg total
Tell me about Methylprednisolone Acetate:
Depo-medrol
Long acting
40-60mg/joint
120mg total
Damage proteoglycans
Use low motion joints
What is post injection flare?
Acute inflammatory response (heat, pain, swelling and lameness) in 8-24 hours of injection
-Treat like infection and send to surgeon
Why are infections so bad when they are in a joint injected with steroids or PGA?
Immune suppression makes them get out of hand fast
What are some types of Hyaluronic Acid?
Legend (IV) or Legend IA, Hyvisc, Hyalovet (AI)
What does HA do?
Lubricates, excludes particles and antinflammatory
What is special about Legend?
Streptococcal cell wall
What is Adequan?
Polysulfonated Glycosaminoglycan (PSGAG)
-stimulate HA production, more proteoglycan synthesis and collagen from chondrocytes
-Inhibits metalloproteases
What are some negative effects of PSGAG?
Increased activated throboplastin, prothrombin, thrombocytopenia, MIC increase for antibiotics
What is Polyglycan?
Mix HA, Chondroitin and glucosamine
-Medical device
-Not FDA approved (joint lavage)
Which steroid is the practitioners favorite?
Triamcinolone Acetonide
What is PRP?
Platelet rich plasma
What does IRAP stand for?
Interleukin-1 Receptor Antagonist
-compete with interlukin 1 to decrease joint inflammation
How much sterile blood do you need for IRAP? Should you use a donor?
60ml, no
What is prostride?
Autologous Protein solution
Release growth factor and protein, improve lameness may be better than IRAP
What is beneficial about PRP?
Antinflammatory proteins, neutrophils, good pain and inflammmation
Is alpha2EQ approved?
No - high molecular weight protien in blood
Are stem cell based therapies approved yet?
no
-use fat
-flat
-3D - spheroid
-Periphearl blood - off shelf - europe
