The Wrangler Horse and Rodeo News

28 • The WRANGLER • October, 2024 As the demands placed upon our equine partners have increased, so has the availability of products for specific needs. While some medications can be administered by owners at home, intra-articular joint injections are only done by veterinarians. Intra-articular injections must be performed under sterile conditions, as a needle is placed directly into the joint. This route allows for the most effective and efficient placement of medications and is common in performance equine medicine. Most veterinarians utilize several different products regularly, depending on the conditions they are treating. While this is not a comprehensive list of every product on the market, we will cover some of the most commonly used. For educational purposes only, you will find this is written in layman's terms and certainly not medical advice. Your veterinarian can answer any and all questions about what is appropriate for your horse and your specific case. Why Injections? Degenerative Joint Disease and Osteoarthritis are some of the most common issues affecting performance horses. For many horses, certain joints need more care than others and the direct treatment through an intra-articular injection is necessary at some point. Any degeneration within the joint causes pain and inflammation, which of course impacts performance and soundness. Intravenous or intramuscular products, such as Legend or Adequan, are FDA approved and have been proven to maintain joint function. Due to the method of administration, they will treat the whole body, rather than focusing on a specific joint. They do not have to be administered by a veterinarian, but are prescription medications. For many years in both human and equine practice, cortisone was the only product injected into joints. Veterinarians still utilize steroids when necessary and sometimes in combination with some of the products listed below. In 2024, we are fortunate to have many great options that can be tailored to more specific or challenging cases. Hyaluronate Sodium and Polyacrylamide A product such as Hyvisc, a hyaluronate (HA) sodium injection, can help replenish the body's natural HA fluid. Ideally, HA is clear and thick, providing cushion to the joint. With repeated stress, the body continues to produce HA and it can become more watery, which limits its ability to lubricate and protect the joint. Hyvisc is a high-molecular weight HA that effectively treats the non-infectious joint inflammation associated with equine osteoarthritis. Over time, Hyvisc will break down and be absorbed similarly to the body's own joint fluid. Noltrex Vet is a synthetic joint lubricant with similar physical properties to healthy synovial fluid. Noltrex Vet improves lubrication and provides physical protection of articular cartilage. Noltrex Vet has a longer "residence time" in the joint, which allows it to reduce friction for a longer period of time. Studies have shown that Noltrex Vet even works with the cartilage, helping to fill in damaged areas. The focus of this product is to lubricate and protect the cartilage surface. It can be used in any high (eg stifle, fetlock) or low (lower hock) motion joint. ArthramidVet is similar to Noltrex, but it affects the synovial membrane more than the cartilage surface. By integrating itself into the membrane, stabilizing the joint capsule, and increasing elasticity, ArthramidVet is able to reduce to the onset and development of joint inflammation. ArthramidVet is used in synovial or athrodial and high motion joints. It is recommended that horses rest for 48 hours and then exercise lightly for two weeks after treatment. It takes two to four weeks for the product to become fully integrated into the joint. Regenerative Medicine Some products are considered "regenerative medicine." Platelet Rich Plasma (PRP), Interleukin-1 Receptor Antagonist Protein (IRAP), Pro-Stride and Stem Cell fall into this category. IRAP II is obtained by culturing the horse's own blood with borosilicate glass beads and harvesting the serum. IRAP is a protein that can be used to target chronic, progressive osteoarthritis. The IRAP attaches to the joint capsule and helps to prevent inflammation, allowing healing to occur. It can also be used as a post-surgical treatment. IRAP requires 24 hours to culture and is then centrifuged to obtain the serum. IRAP aims to inhibit the inflammatory cascade, but does not aim to directly repair or regenerate cartilage damage. Pro-Stride is an APS (autologous protein solution) which contains a high concentration of cells, platelets, growth factors, and anti-inflammatory proteins. Requiring only 20- 30 minutes to process, the product is created from a sample of the horse's own blood. Pro-Stride works by blocking two major pro-inflammatory proteins (cytokines) from binding to the cartilage surface. Pro-Stride has a high concentration of IRAP (5.8 times more concentrated than blood). Pro- Stride is specifically targeting the inflammatory cascade, but does not aim to directly repair or regenerate tissue. PRP (platelet-rich plasma) is often used for tendon, ligament, and joint injuries. PRP can decrease the pain threshold via opioid pathways and the growth factors in platelets play a role in enhanced healing. PRP accelerates and improves the quality of healing, as well as supporting and enhancing tissue healing as an anabolic agent. Stem cells are used to regenerate new tissue, increasing the ability to heal. Originally obtained from bone marrow By Teal Stoll Under The Needle: Under The Needle:

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