The horse’s joint is the second most common site of lameness in the horse, after the foot or hoof.  As owners, you often spend a great deal of time at the veterinarian either having a joint lameness diagnosed or managed with various injections or other therapies.  Considering the importance of all the joints in your horse’s body, and how much money is often spent trying to keep them from breaking down, it just makes sense to come at the problem from a preventative point of view.  If you can do this successfully, the approach may reduce the increased wear, tear, cartilage loss, and bone remodeling that comes over time due to the stresses of life, conformation, and competition.  Once that damage begins, with evident bone remodeling and cartilage loss, you often find yourself chasing your own tail.  Promote joint and bone health from the onset, and in the long-term, the benefits can be real and often, dramatic.

The Horse's Joint and Therapy Options

The Horse’s Joint and Therapy Options

There are numerous joints in your horse’s body, but we tend to just associate with the ones in the front and rear legs. Aside from these, there are joints in the jaw, the vertebra that run down the neck and back, and the pelvis.  These joints are also ‘big-hitters’ in the world of horse pain and lameness, associated with TMJ issues, cervical and lumbar pain, kissing spine lesions, and sacroiliac (SI) conditions.  The most commonly affected joints in the limbs include the carpal joints, fetlock, pastern, coffin joint, stifle joint, and tarsal (hock) joints.

The horse’s joint is just as susceptible to injury as our own joints, but potentially on a higher level considering their body size and amount of force applied during some movements and competition.  When you factor in that no horse is perfect in their conformation, this adds additional stress to those joints.

Joint Pain and Lameness in the Horse

Over time, with repetitive forces, your horse’s joints become stressed as does the soft tissue structures surrounding the joint.  This ongoing trauma and stress to the region often first impacts the soft tissue structures, including supporting ligaments and the joint capsule, with resulting discomfort, swelling, and in many cases an increased fluid production, termed an effusion.  This effusion can be seen within the joint, but can also be evident in the tendon sheath on the back of the lower leg in the horse, above the fetlock.

These soft tissue structures become irritated, inflamed and over time, begin to degenerate and change in response to the stress.  In many cases, there is ongoing pain and discomfort, while in others there can be a thickening to the region due to scar tissue deposition.  These are often the early stages of osteoarthritis and joint degeneration in the horse, and more often than not, despite being lame, there are no radiographic changes noted when x-rays are performed.  Injections using corticosteroids with or without hyaluronic acid are usually the first line therapy chosen, along with rest.  Despite these therapies, many horses respond in the short-term, but in the long-term, the lameness becomes a problem once again.

Over time, if the primary joint strain is not controlled or better managed, this inflammatory process will move inwards, and now impacts the joint articular cartilage and bone.  This is where your horse will experience cartilage loss and even bone remodeling.  This is often the stage of no return for many horses, as once this bone degeneration stage sets in, it often cannot be reversed.  Again, the chosen therapy for most horses is joint injections using corticosteroids and hyaluronic acid. Many horses improve clinically in the short-term, but again, the long-term effect is less than optimal.

The Horse’s Joint; Intervening Early for Better Results

It can become a vicious cycle for many horses, especially those that are competing.  They are lame, then inject, rest, become sound, then lame again, and re-inject.  This is often ongoing, repeating the process as often as every 3 months for some horses.  Considering the high cost to joint injections, the risk that comes with them, and the fact that a very high percentage of horses suffer joint degeneration, it begs to wonder if you can do better?  Ideally, as with any disease process, it is far better and easier to try to prevent than it is to ‘cure’, which is rarely done.

As the saying goes, ‘an ounce of prevention is worth a pound of cure.”

For most horse owners, the use of typical joint supplements containing glucosamine or chondroitin are high on their list.  These supplements are often used as part of a therapy route, more than prevention, to be honest.  For some reason, we have the mindset that all is well with our horse, until he becomes lame, then we intervene.  I understand this philosophy, but in reality, it puts us back into the defensive mode, trying to play catch-up with a joint condition that is now much harder to manage.

In either case, whether if you are being ‘reactive’ or ‘proactive’, there are many things to consider.

Glucosamine and chondroitin supplements can and do improve joint health, based on horse research, but there are two things to consider.  First, in most cases, the doses or volumes used of the two ingredients do not equate to those provided in traditional supplements.  This would imply that failure for some horses to respond may be simply due to under-dosing, as compared to research.   Second, there is the question of bioavailability in the horse and impact on clinical results.  In one study, using 10 grams of glucosamine (20 mg/kg) in adult horses, there was a failure to achieve clinically relevant serum and synovial fluid levels to modify chondrocyte (cartilage) health and activities.  It was theorized that if improvements were noted, likely these were due to the glucosamine impact on the intestinal lining, liver, or kidney health. (1)  Many horses do appear to benefit from Glucosamine supplements, but if you choose this route, keep in mind that in research, the average supplemented daily dose is between 10-15 grams, and bioavailability is questioned.  I, personally, have not received great results with glucosamine usage in my equine patients, either as a preventative therapy or treatment in joint conditions.

Polysulfated Glycosaminoglycans (PSGAGs) are another route chosen for joint health and preventative health in the horse.   These supplements generally come in the form of injections, usually given intra-muscularly in the horse at set intervals.  These therapy options can benefit many horses, but the timing of the injections, and the stage of joint degeneration present at the time, can dictate the results.  In one study, the use of 500 mg of PSGAG injected every 4 days for 7 treatments was determined to be more efficacious at reducing carpal pain and lameness, as compared to the control group.(2)  In my personal veterinary experience, PSGAGs do offer hope in regards to joint health from a preventive point of view, but are rarely used for that purpose.  More so, this therapy option is often chosen once joint degeneration is present, and thus the clinical outcomes are highly variable and often at a very high price for the owner.

Collagen is becoming a high priority ingredient for myself, not just for maintaining joint health in the horse, but also helping to control conditions once they are evident.  Type I collagen has been shown to be chondroprotective and demonstrate anti-inflammatory properties in a clinical study of post-traumatic osteoarthritis.(3)  In another study using Standardbred horses, administration of 90 grams of hydrolyzed collagen demonstrated marked improvements in inflammatory markers in a synovitis-induced model.(4)  Most research in the horse, using collagen, has an average dose of around 50 grams for most models.  Again, dosing is critical for some horses, while depending on the circumstances and synergism with other supplements, the dose possibly could be lowered.  I, personally, have found great value in the use of Type-I collagen (Cur-OST® EQ Collamend) in our equine patients, both as a proactive approach, and one to help support joint health once it has begun to decline.

Joint Support in the Horse; My Personal Approach

Poor joint health and lameness is a very common condition seen in my equine patients.  For many, the joints have already begun to show signs of deterioration on radiographs, while for a small percentage, the problem is still in the soft-tissue stage.  When I personally look at these cases, the affected joint is high on my priority list, but I make sure there are not other contributors such as foot imbalance, saddle fit, or rider imbalance which may be playing a role.  If these factors are present, I try my best to address them, as any improvement in those areas can help lessen the strain on the impacted joint.

Inflammation: The first area that I address in all joint cases is the inflammatory process, which is not just relating to pain or discomfort for the horse, but is really what is behind the bone and cartilage degenerative process.  I do not use joint injections any longer in my patients, as for most, they had become an expensive ‘bad’ habit, providing short-term benefits but often leading to more problems down the road. Some horses simply could not be injected any longer due to scar tissue fibrosis of the joint capsule or significantly reduced joint space due to the condition progression.  So, joint injections are not my friend, and thus, I have to seek other options.

As a result of seeking solutions many years ago for my equine patients with joint pain and degeneration, we began to implement herbal options adapted from human research.  In our first research paper, using a curcumin blend (Cur-OST® EQ Pure), not only did the horses in the study clinically improve in the 30-day period, but joint inflammatory cytokines (PGE-2 and MMP’s) were also reduced.  What was interesting in this study, was the fact that several of these horses had relied on intra-articular injections or daily usage of NSAIDs to maintain comfort.  These therapies were discontinued during the course of the study and the owners did not have a need to resume them after the study.

In my equine patients with joint pain and degeneration, I opt to use specific herbs to target and manage those inflammatory processes.  In the short and long-term, I often obtain better results than prior therapies including injections and oral medications.  The herbal approaches impact the entire horse, not just the joint, so they feel better overall.  Proper dosage is critical, as with all herbs, but my general impressions are that the combination of herbs which we utilize appear to impact the joint and the entire body on a different level, than seen with traditional injections or medications. The main formulas that I will utilize in cases of ongoing joint discomfort in the horse include either:

While those herbal approaches do assist me with managing inflammation in the equine patient with joint conditions, there are new options that we have explored that add further support, not just in assisting to balance the inflammatory response, but to provide help on another level.

Joint Bone and Cartilage Health: The second area of focus for myself in all of my horses with joint ailments is to target the health of that tissue.  Through modification of the inflammatory response, I can reduce or slow the process potentially, but it is always beneficial to ‘feed’ that cartilage and bone to reach higher levels of success.  Diet is extremely important, but in many cases, additional support can be of real value for the horse.

In many of our equine patients, especially if they have concurrent tendon, ligament, or hoof ailments, type-1 collagen has become a very valuable asset.  The Cur-OST® EQ Collamend has become very popular in many of our competitive equine athletes to assist in support of the joint, tendons, ligaments, and aid in building a solid hoof.  Type-1 collagen is very prominent in the body, and supplementation on a daily basis can greatly assist us in helping that horse. Given the high bioavailability of the Naticol Type-1 collagen in this formula and the high prevalence of collagen in an around the equine joint, the EQ Collamend can potentially provide higher levels of benefit than traditional glucosamine supplements.

In many of those horses, another avenue or approach I will take is to ‘nourish’ those cells through specific herbs that provide a heavy mineral base but also appear to modify gene translation on the level of the bone and muscle.  In reality, if we can modify gene translation, potentially turning off active genes that are contributing to joint degeneration and turn on more protective genes, this could be a real asset.  This is one area of promising research with the heavy mineral herb, Shijait.  Most of our horses with joint conditions are on the Cur-OST® EQ Bone Support formula, which contains the patented 50% fulvic acid Shilajit called Primavie®.  I have had some very interesting results using this blend in horses as a part of an ongoing support measure.  These findings were noted in my article on Equine Arthritis.

When you assist these horses with joint conditions over a period of time, what you begin to realize is that it is all about the diet and modification of the internal inflammatory process.  If you can manage these two things, most horses actually do quite well, even in some advanced cases.  However, many of the approaches, as mentioned above, that I take with the horse all address the inflammatory process.  Over time, there is an additive type of effect.  Initially, we may need a heavier 3-tiered type of approach, but once that horse begins to stabilize and recover, often we can back down, either reducing doses or in some cases, relying on just 1 or 2 of those formulas.  I have several joint ailment conditions in horses that are being managed currently with the EQ Bone Support and the EQ Collamend, as an example, after an initial 60-day induction period using all 3 formulas.  This is pretty neat to see and witness, but takes into consideration that other factors are also managed all along, including hoof balance and diet. This opens the discussion on inflammation, realizing what we are doing with each patient, and when to cut back. This is an important topic because the inflammatory process is not something you wish to completely abolish or terminate.  It is a vital part to health and soundness, and sometimes too much of a ‘good’ thing can create potential problems for the patient.

Joint Dysfunction in the Horse; Proactive or Reactive?

In the end, it is far better to make attempts to prevent something than it is to try to manage it after the fact.  Joints are extremely important to every horse, especially those that are competing or performing. Considering the high degree of joint ailments in the horse, and the high level of stress that these joints are under on an almost daily basis, it just makes sense to put forth some sound efforts to keep those areas as healthy as possible.

There are many options available to you, as the owner, to keep your horse sound and moving with as little discomfort as possible.  The ultimate question is what you are seeking and on what level?  To me, as a veterinarian, it is far cheaper to put some measures in place now and into the future to help maintain health and soundness, than it is to chase the problems once they become evident with a needle.  Often, once that needle is implemented, it can become an expensive and bad habit that often leaves the horse debilitated on a different level ‘after the fact’, with repetitive usage.

Seek a higher level of soundness and joint support for your horse and he will thank you for it!

 

Further Articles:

 

Author:  Tom Schell, D.V.M., CVCH, CHN

 

 

 

References:

  1. Laverty, S et al. Synovial fluid levels and serum pharmacokinetics in a large animal model following treatment with oral glucosamine at clinically relevant doses. Arthritis Rheum. 2005, Jan;52(1):181-91
  2. Verde, C et al. Efficacy of intramuscular polysulfated glycosaminoglycan in a controlled study of equine carpitis. J Vet Pharm Ther. 2010. Aug;33(4):357-62
  3. Qurratul-Ain D et al. Daily consumption of hydrolyzed type-1 collagen is chondroprotective and anti-inflammatory in murine post-traumatic osteoarthritis. PLoS One, April 2017.
  4. Van de Water, E et al. The preventative effects of two nutraceuticals on experimentally induced synovitis. EVJ. 49(2017) 532-538.

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