Smarter Strategies forEquine Joint Care

Lydia F. Gray, DVM, MAMedical Director/Staff Veterinarian

Jessica NormandDirector of Supplement Marketing

September 20, 2011

Your Presenters

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Agenda

1. The anatomy and function of joints2. What is osteoarthritis?3. What are the goals of prevention and

therapy?4. Prevention & Therapy5. Questions & Answers

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Joint Anatomy & Function

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1. Ligaments2. Joint capsule3. Synovial membrane4. Synovial fluid5. Articular cartilage6. Subchondral bone

What is Osteoarthritis (OA)?• Progressive, permanent degeneration of articular cartilage• aka Degenerative Joint Disease (DJD)

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“OA is a by-product of the wear and tear and daily trauma that horses experience during heavy training.”- Dr. Rick Mitchell, Fairfield Equine Associates

Osteoarthritis: Some Statistics• 60% of equine lameness problems are related to osteoarthritis,

making it the most common cause of lameness in the horse.

• Inflammation of the hock joints affects more than 50% of jumpers and grand prix dressage horses, and requires treatment for maintenance of peak performance.

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Equine Joints Commonly Affected by OA

• Hock• Knee• Fetlock• Pastern

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Effects of Osteoarthritis• OA is a cascading cycle of inflammation that

leads to:– Articular cartilage erosion (5)– Synovial membrane thickening (3)– Joint capsule fibrosis (2)– Osteophytes (bone spurs) – Subchondral bone sclerosis (6)

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Risk Factors for Osteoarthritis• Acute trauma or sudden injury• Age• Conformation• Foot care• Footing• Workload

– Frequency– Duration– Intensity

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Osteoarthritis: Signs of Lameness• Stiffness• Shortened stride• Uneven gaits• Reluctance to pick up, keep or change canter lead• Reluctance to stop or turn while working at speed

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Signs of Lameness in the Dressage Horse• Reluctance to accept or go on the bit, shortening the neck, stiffness• Not taking contact evenly left vs. right• Irregular rhythm in specific lateral movements• Irregular rhythm in medium or extended trot• Short steps behind in walk• Uneven height of steps or lack of rhythm in piaffe or passage• Inability to collect, stiffening of the back, not sitting down behind• Late behind in flying lead changes or difficulties changing leads• Loss of freedom/elasticity of movement (less bouncy, flatter stride)

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Signs of Lameness in the Jumper• Not pushing evenly off both hind limbs, with the hind limbs drifting

to one side therefore not jumping squarely across a fence• Reluctance to turn• Refusing to land with one forelimb leading• Difficulty in making the distances in a combination• Difficulties in altering stride length• Reluctance to get deep to a fence, or tendency to have rails down in

such circumstances• Changing legs behind in canter or swapping leads• Rushing fences• Stopping (refusing)

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What are the Goals of Prevention and Therapy?

• Halt the cascade of inflammation• Stop or limit damage to articular tissue• Promote healing of damaged cartilage• Improve mobility• Alleviate discomfort• Extend the horse’s competitive career

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Methods of Prevention & Therapy• Physical therapy

– Rest or controlled exercise– Ice or other cold therapy (or hot)– Compression (wraps)

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Methods of Prevention & Therapy• Injections

– Intra-articular (joint)• Steroids and/or Hyaluronic Acid • Polysulfated Glycosaminoglycans (Adequan®)

– Intravenous• Hyaluronic Acid (Legend®)

– Intramuscular• Polysulfated Glycosaminoglycans (Adequan®)

Research: Effects of Oral Glucosamine and Chondroitin Sulfates Supplementation on Frequency of Intra-articular Therapy of the Horse Tarsus– Rodgers MR, Intern J Appl Res Vet Med 2006;4(2):155-162.

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Methods of Prevention & Therapy

• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)– Aspirin (OTC)– Bute– Equioxx®– Surpass® (topical)

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Methods of Prevention & Therapy• Newer Therapies

– Extracorporeal Shockwave Therapy (ESWT)– Biologics

• IRAP• PRP• Stem Cell

• Complementary & Alternative Therapies– Acupuncture– Chiropractic– Massage– Magnetic

• Corrective shoeing• Oral joint supplements

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Oral Joint Supplements:Key Active Ingredients

• “Mother Nature’s Big Three”– Glucosamine– Chondroitin Sulfate– Hyaluronic Acid (HA)

Research: • Safety of an Oral Chondroprotective Agent in Horses

– Kirker-Head CA, Kirker-Head RP, Vet Ther. 2001 Fall;2(4):345-53.• Double-Blind Study of the Effects of an Oral Joint Supplement in Horses with Tarsal Degenerative Joint Disease.

– Clayton HM, Almeida PE, Prades M, et al– Proceedings. 48th Annu Conv Am Assoc Equine Pract. 2002;48:314-7.

• Oral Treatment With a Glucosamine-Chondroitin Sulfate Compound for Degenerative Joint Disease in Horses: 25 Cases

– Hanson RR, Smalley LR, Huff GK, et al, Equine Practice. 1997 Oct;19(9):16-20.

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“Mother Nature’s Big Three”: DefinitionsGlucosamine is the building block of chondroitin sulfate, a specific type of polysulfated glycosaminoglycan

(GAG).

Chondroitin Sulfate is not only the building block of the much larger molecules hyaluronic acid (HA) and proteoglycan (PG) it also inhibits the effects of various enzymes that degrade cartilage.

Hyaluronic Acid (HA) is an integral component of joint cartilage and joint fluid, providing both lubrication and shock absorption.

Research:• Evidence of the Oral Absorption of Chondroitin Sulfate as Determined by Total Disaccharide Content After Oral and Intravenous Administration to Horses

– Eddington ND, Du J, White N,– Proceedings. 47th Annu Conv Am Assoc Equine Pract. 2001;47:326-8.

• Oral hyaluronan (HA) gel reduces post operative tarsocrural effusion in the yearling Thoroughbred.– Bergin BJ, Pierce SW, Bramlage LR, Stromberg A., Equine Vet J. 2006 Jul;38(4):375-8.

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Oral Joint Supplements:Key Active Ingredients

• Other ingredients to look for– MSM– ASU– Omega 3 Fatty Acids– Cetyl Myristoleate– Herbs

• Devil’s Claw, Yucca, Boswellia, Bromelain, Curcumin, more!– Antioxidants

• Vitamin C, Grape Seed Extract, Resveratrol, Superfruits, more!Research:• The effect of methylsulphonylmethane supplementation on biomarkers of oxidative stress in sport horses following jumping exercise.

– Marañón G, Muñoz-Escassi B, Manley W, et al, Acta Vet Scand. 2008 Nov 7;50:45.• Markers of Inflammation in Arthritic Horses Fed Omega-3 Fatty Acids

– Manhart DR, Scott BD , Gibbs PG, et al, The Professional Animal Scientist 2009;25(2):155–160

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Young Horse or Horse in Light Work• Workload Definition from NRC:

– 1-3 hours per week– 40% walk, 50% trot, 10% canter

• Goal:– Maintain healthy joint tissue, avoid future problems

• Ingredients to Look For:– Glucosamine– Also consider Chondroitin Sulfate

• Products to Look For:– SmartFlex® I Maintenance– Cosequin® Equine Powder– Grand Flex

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Horse in Moderate Work

• Workload Definition from NRC:– 3-5 hours/week – 30% walk, 55% trot, 10% canter, 5% low jumping, cutting/other skill work

• Goal:– Support joints in day to day stress

• Ingredients to Look For:– Glucosamine, Chondroitin Sulfate, MSM

• Products to Look For:– SmartFlex® II Support– Cosequin® SP (exclusive to SmartPak)

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Horse in Heavy Work• Workload Definition from NRC:

– 4-5 hours per week – 20% walk, 50% trot, 15% canter, 15% gallop, jumping/other skill work

• Goal:– Provide comprehensive support for joint, tendon/ligament health,

avoid discomfort and stiffness• Ingredients to Look For:

– Glucosamine, Chondroitin Sulfate, MSM, Hyaluronic Acid (HA)– Tendon/Ligament Support from Silica & Collagen

• Products to Look For:– SmartFlex® III Resilience– Grand HA Synergy– Steadfast Equine

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Horse in Very Heavy Work• Workload Definition from NRC:

– 1 hour/week of speed work to 6-12 hours/week of slow work– Includes elite performance horses in intense, strenuous work

• Goal:– Provide aggressive support for joint, tendon and ligament health, minimize

discomfort and stiffness caused by intense training and competition

• Ingredients to Look For:– Glucosamine, Chondroitin Sulfate, MSM, Hyaluronic Acid (HA)– Tendon/Ligament Support from Silica & Collagen– Antioxidants (e.g. Resveratrol , Superfruits)

• Products to Look For:– SmartFlex® IV Ultimate– Cosequin ASU

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Horse in Recovery• Ingredients to Look For:

– Glucosamine, Chondroitin Sulfate, MSM, Hyaluronic Acid (HA)– Tendon/Ligament Support from Silica & Collagen– Antioxidants– Herbs (Devil’s Claw, Yucca, Boswellia, Bromelain, Curcumin, more)– Omega 3 Fatty Acids– Essential Amino Acids (Lysine, Methionine, Threonine)

• Goal:– Help minimize inflammation, alleviate discomfort and support the

healing process

• Products to Look For:– SmartFlex® Rehab– Recovery EQ Extra Strength

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Senior Horse• Ingredients to Look For:

– Glucosamine, Chondroitin Sulfate, MSM, Hyaluronic Acid (HA)– Herbs (Devil’s Claw, Yucca, Boswellia, Bromelain)– Antioxidants– Probiotics & prebiotics for digestive Support

• Goal:– Ease stiffness and discomfort, support joint and digestive health, provide

antioxidants

• Products to Look For:– SmartFlex® Senior– SmartFlex® Senior Herb-Free– Senior Flex– Senior Flex H/A Pellets– Grand Flex Senior

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Resources Available on SmartPak.com

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• Supplement Wizard • Comparison Charts• Horse Health Articles• Ingredient Glossary• Ask the Vet Blog• Personalized Supplement Consultations

Questions & Answers

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Questions

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1. What should I look for in a "starter" supplement to maintain healthy joints, before there are serious injuries or problems? ~ What can I do proactively to keep my horse's joints healthy? ~Is there any reason to feed a joint supplement to a young horse (2-3yrs of age) as a prophylactic? 2. My horse is 24 years old and has degenerative joint disease in his hocks.  I have been managing it with monthly injections of Adequan, applications of ice after work for 20 minutes and exercising 40 minutes four times a week.   Anything else I can do? ~ I am going to start using Adequan and back off my heavy joint supplement (since it has more solid research behind it).  Do you feel it's better to do the loading series then a monthly maintenance dose going forward or the loading series twice a year?  3. How soon if at all, should you have your performance horses' hocks injected for maintenance purposes only?4. My horse is 13 yrs old, is that too early to start him on a joint supplement? We do second level dressage and hunter paces in the fall. And which joint supplement Would be the best? Thanks! 5. My 10 yr old POA is used for Combined Driving.  This spring he developed what look like windpuffs on both hocks (no lameness). My vet injected the hocks with cortisone & hyaluronic acid. Besides SmartFlex III what other supplement would be beneficial?

Questions

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6. Is there proof that joint supplements actually get to the joint, and when it gets there is it effective? ~ Is HA in oral joint supplements effective?  7. We have a rescue with a number of elders ranging in age from 26 to 35. I would like to know what products produce the best results for moderate arthritis in former performance horses.  We see a lot of arthritis in the neck as well as knees/hocks/ankles. 8. When one buys a horse at age 12 years or older and its previous work history is unknown, what indicators of joint damage or discomfort should the owners be on the lookout for?9.Our 19 yr Icelandic gelding has spavin & bone spurs in front feet (now on Cosequin ASU & Previcoxx ). What activity could we provide & level of riding encouraged? We have hilly terrain; responding well to treatment; 24/7 turnout. Please advise.10. Once you start your horse on the SmartPak Joint Supplements, how long does it take to see an effect. 11. My horse refuses to eat his food with the powder supplement. What should I do?12. My 17 year old bay Qtr Horse had upper ring bone that has fused 100%. Would you recommend putting him on joint supplements? 13. Is it true that different glucosamine form/molecule types are not equal to each other, and that some forms are more easily absorbed by the body than others?14. Is a multi ingredient supplement as effective as using each ingredient separate?15. Can you discuss the impact of Omega-6 on joint inflammation?

Questions

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16. I have a 10 yr old overweight brood mare - any suggestions on keeping her joints healthy while reducing her weight? She is on SmartPak supplements now.17. Currently have 20 yr old qtr horse on Smart Flex Sr, seems to be doing better, but I think he may have arthritis issues in his shoulders (or knees) not sure. Would like to know what other supplements he may benefit from to prevent soreness after riding.18. What supplements can I give to my IR horse(s)? My farrier has suggested I stop using glucosamine and/or chondroitin. That leaves MSM and other herbals. They are on MSM now but do I need to add others?  19. Do joint supplements actually get to the joints? Does Hyluronic acid get to joints through supplements, and even through injectable? 

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