Therapeutics for Joint Disease

Question 1

What clinical presentations of joint disease would require specific management?

Answer 1

Osteoarthritis
Sepsis
Autoimmune disease

Question 2

Considerations when treating joint disease

Answer 2

• Prescribing cascade
  ○ Don’t have many licensed products available
• Competition withdrawal in horses
  ○ Governing bodies will have rules on withdrawal
• Efficacy and evidence
  ○ Are they going to work?

Question 3

Types of treatment for osteoarthritis

Answer 3

Systemic options
* Easier/simpler
* Have side effects
Intra-articular options
* Common in equine practice

Question 4

Systemic Osteoarthritis Treatments

Answer 4

○ NSAIDs - all species
And paracetamol
Significant GI side effects in small animals
○ Bisphosphonates
Equine
○ Glycosaminoglycan derivatives
Regenerative therapy

Question 5

Intra-articular Osteoarthritis Treatments

Answer 5

○ Corticosteroids - most common
Multiple equine products licensed
No small animal products licensed
○ Glycosaminoglycan derivatives
Hyaluronic acid
Weak evidence
○ Synthetic hydrogels
○ Biological products

Question 6

Biological products for treatment of osteoarthritis

Answer 6

Stem cells
IRAP (Interleukin-1 Receptor Antagonist Protein therapy)
□ From patients own blood
□ Will bring in growth factors and cytokines which improve inflammatory response
PRP (Platelet rich plasma)
□ Works similarly to IRAP

Question 7

Types of treatment for joint sepsis

Answer 7

• Start with lavage of joint - surgical
• Systemic options
• Intra-articular options
• Intraregional Limb Perfusion

Question 8

Systemic options for joint sepsis

Answer 8

Antibiotics
NSAIDs

Question 9

Intra-articular options for joint sepsis

Answer 9

Antibiotics
Opioids - analgesia

Question 10

Regional options for joint sepsis

Answer 10

Antibiotics

Question 11

How is intra-articular and regional options better than systemic for joint sepsis?

Answer 11

Increases concentration of product where we want it to work
Overcomes issues with dosing
Overcomes issues with sensitivity to antibiotics

Question 12

What is Intraregional Limb Perfusion?

Answer 12

Apply tourniquet to limb above region you want to perfuse
Venous distension distally
Inject product into one of the distended veins
Hold tourniquet on for period of time (30-45 minutes)

Question 13

Treatment options for immune mediated disease

Answer 13

Systemic options only
* Corticosteroids
* Immunomodulators
Cyclosporin
Azathioprine - NOT CATS
Intra-articular isn’t going to be as efficacious because it can affect different limbs at different times

Question 14

How do NSAIDs work?

Answer 14

Inhibit action of COX enzymes
* Leads to inhibition of prostanoid synthesis in inflammatory cells
* Therefore reduces vasodilation, pyrexia and provides analgesia