Arthritis

Horses Common Treatments

What is arthritis?

Arthritis literally means inflammation of a joint. It can be traumatic in origin affecting one joint or most commonly develops slowly over time due to wear and tear and affects multiple joints. There is a scale of disease from inflammation of the synovial fluid and joint capsule only known as synovitis, through to involving cartilage damage and then progressing to involving the bone then termed osteoarthritis. Arthritis is most commonly bilateral and symmetrical e.g. involving both hocks. There is a condition in young horses called juvenile arthritis which may have an inherited genetic component, but the most common form is in adult horses and is due to wear and tear. Arthritis is one of the most common conditions seen in equine veterinary practice and is responsible for a large amount of loss of use in ridden horses.

Symptoms

Horses may demonstrate one or more of the following symptoms:

Lameness
Poor performance
Back and/or neck pain
Difficulty in canter – disunited, incorrect strike off
Swollen joints
Fidgety or struggling for the farrier when limbs flexed or when nailing on
Stiff coming out of the stable
Limb filling when stabled
Takes time to warm up when ridden

Diagnosis

A thorough history taking and physical examination is a key starting point. The vet will then observe the horse in walk and trot in a straight line and perform flexion tests to test various joints further. Observing the horse on the lunge on both hard and soft surfaces also reveals more information. If there is a suspicion of joint pain then further diagnostics will likely be indicated. This can involve nerve blocks where different regions of the limb are made numb to localise the source of discomfort and will also include x-rays with or without ultrasound scans. In some circumstances referral for higher level diagnostics is needed such as for MRI scans or nuclear scintigraphy scans.

Treatment Options

There is a wealth of treatment options available for arthritis in horses and the right choice is individual for each owner and horse.

Joint injections

Injecting medication directly into the affected joints provides targeted pain relief and positive effects on the joints themselves and is often the most reliable way of achieving soundness. We have options of what product to inject as follows:

Steroids

Steroids are potent anti-inflammatory drugs which reduce pain and inflammation due to joint disease. When injected directly where they are needed, they have maximum effect and there is minimal systemic absorption reducing side effects around the body. Steroids start acting very quickly (within days) however their duration of action is variable. On average a horse who responds well would remain sound for 3-6 months.

Side effects with steroid joint injections include infection and laminitis. Infection is uncommon and the risk of this is reduced by the strict sterile approach to the procedure and careful aftercare. Laminitis from steroid joint injections is very rare and is usually only seen in high-risk horses. A risk assessment can be made prior to this treatment involving a physical assessment and possibly blood tests for cushings and/or equine metabolic syndrome.

Steroids are prohibited under FEI competition rules therefore please discuss if this is applicable to you and your horse and we can advise on appropriate withdrawal periods prior to future competition.

Hyaluronic acid (HA)

HA can be injected into joints alongside steroid or on its own. It provides anti-inflammatory effects and lubricates the joints whilst topping up the body’s natural HA levels which are used to support healthy synovial fluid, cartilage and joint capsule. There can be a joint flare reaction if used without steroid so it is common for a short course of anti-inflammatories to be given at the time of injection.

Arthramid

Arthramid is a polyacrylamide hydrogel which when injected into a joint adheres to the synovial lining reducing the effects of inflammation and forming a cushion in the joint. It forms its cushion and begins to take its effects over the 14 days following injection and the full effect is seen within 4 weeks after injection in most cases. Due to its nature of action it shows potential as a long-term solution to joint disease and is thought to elicit positive effects for multiple years in the joint.

As with any joint injection there is a risk of infection which is minimised by strict sterile injection technique and careful aftercare. There have been no reports of systemic side effects or allergic reaction however mild self-resolving swelling or joint flare at injection site is occasionally reported.

Stem Cells

A mesenchymal stem cell product made from umbilical cord tissue is now available as a ready to inject preparation making stem cells more readily available. Stem cells elicit positive effects in the joint via a natural anti-inflammatory effect, inhibition of cartilage breakdown and providing a basis for repair of damage. The clinical effect is seen approximately 4 -5 weeks post injection, and it has potential to have longstanding benefits.

Systemic Treatments

Anti-inflammatory Medications

Either a course or long-term use of systemic pain relief medications can be highly effective in managing arthritic horses. The benefits include effective reduction in pain and inflammation, a horse-wide effect which is helpful if multiple joints and multiple limbs are affected, and it is non-invasive as the medication is given in feed. Examples of drugs used for this include phenylbutazone (Equipalazone/Chanazone), suxibuzone (Danilon), meloxicam (Metacam/Inflacam/Rheumocam) and firocoxib (EquiOxx).

Cartrophen/Osteopen

A course of intramuscular injections containing pentosan polysulphate which provides pain relief and supports repair of damaged cartilage.

Tildren/Osphos

A type of medication called bisphosphonate administered via a drip in the case of tildren or intramuscular injection if using osphos. This drug slows down resorption of bone and is particularly useful in the long-term treatment of hock arthritis and navicular disease as bone resorption is a feature of these conditions.

Rehabilitation

A whole horse approach is essential in managing arthritis.

Farriery

Make sure your farrier is always kept updated if a diagnosis of arthritis is made (your vet can do this). Optimal foot balance is essential for ensuring the forces through the joints are kept equal and do not predispose to further joint inflammation and your farrier may choose to alter the shoeing cycle or use a different shoe for supporting certain conditions.

Physiotherapy

Regular physiotherapy will keep the secondary muscular compensation maintained, relieve any muscular discomfort and provide targeted exercises to help support the horse moving forward.

Acupuncture

An additional therapy which can provide pain relief and relieve secondary muscle tension.

Exercise

Arthritic horses often benefit from regular low intensity exercise to keep them supple, improve synovial fluid quality and prevent stiffness. Often after treatment we aim to return horses to their previous level of work although sometimes in more severe cases the workload may need to be altered. For example, a horse may be better to only be jumped on a surface opposed to firm ground or may happily hack for years without medication but would struggle to do more. In the short-term post treatment rehabilitation, there should also be a focus on building muscular strength to support the inflamed joints and reduce recurrence of lameness. This will often involve pole work, hacking, hill work and possibly water treadmill.

Saddle fitting

Optimal saddle fit is essential and regular checks are required to accommodate for any changes through the horse’s body which may be more likely in arthritic horses.

Turnout

Horses with arthritis tend to do better with more turnout opposed to more stabling. Offering as much turnout as possible and considering 24/7 turnout can be helpful in managing these horses.

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Laminitis

Horses Health Problems

Laminitis is a common painful condition affecting the feet of horses, ponies and donkeys. The name describes the disease process well – ‘itis’ meaning ‘inflammation of’ and ‘Lamini’ referring to the laminae. The laminae are a network of intertwining finger-like soft tissue structures inside the hooves which attach the internal and external hoof structures to each other. They are incredibly strong and vitally important. When they become inflamed they swell and tear which causes the internal hoof structures to become separated from the external structures – this manifests as the pedal bone rotating and dropping away from the hoof wall. This process is extremely painful and a significant welfare issue for the affected horses.

Causes

Firstly, it is important to note that any horse can get laminitis, not just a certain type. All horses have a threshold which if it is crossed, they can be triggered into a laminitic state. We see laminitis cases in slim thoroughbreds as well as good-doer ponies.

The largest proportion of laminitis cases are caused by underlying hormonal conditions. These conditions are equine metabolic syndrome (EMS) and cushings disease. For more details on these conditions see their own pages. These conditions cause laminitis because they lower the horse’s laminitis threshold so that factors that would not normally trigger a laminitis episode then does. For example, there can be 10 horses in a field all eating the same grass and then one of them will get laminitis. If it was just the grass causing the laminitis they would all have it but they don’t, there is some dysregulation going on within the affected horse meaning their threshold has been lowered and then they get it. A common real-life example of this would be with an EMS horse – the sugar in the grass is the trigger but a healthy metabolic system would deal with this threat and prevent disease, however in EMS the horse is resistant to the hormone insulin meaning that they cannot manage the sugar threat and end up with clinical disease.

A less common cause of laminitis is traumatic. This can be due to overloading due to a severe injury on the other limb, known as weight-bearing limb laminitis. This should always be considered if a horse is non-weight bearing lame on one limb for a prolonged period – the other foot should be supported by deep bedding or frog support and closely monitored. Traumatic laminitis can also be caused by poor foot balance causing unhealthy forces through the feet or over-working on hard ground.

Another type of laminitis seen rarely is toxin induced laminitis. This is a severe consequence of systemic sepsis from a nasty infection such as colitis or retained foetal membranes and is caused by the endotoxins and reduced blood supply to the feet.

Symptoms

The symptoms can vary and be on quite a spectrum depending on the severity of the episode and how many feet are affected. Laminitis can affect one single foot, all four feet or anything in between. Likewise, it can affect the just the front feet, or just the hind feet or all-round.

The classic laminitic appearance is a horse or pony unwilling to move, in a ‘rocked-back’ stance with the front feet out in front and weight through their heels, bounding digital pulses and hot feet. This is usually if both front feet are affected either in isolation or much worse than the hinds.

If all four feet are affected the horse may not rock back as they can’t overload the hinds because they also hurt. These horses are just unwilling to move, stiff all over from holding themselves, with bounding digital pulses in all four feet. If you can force them to move they are lame on every foot and look like they are walking on hot coals.

If only one foot is affected it will present as a severe lameness in one foot and initially be indistinguishable from a foot abscess or bruised foot.

In more subtle cases the horse may be able to walk well enough in a straight line but show soreness on turns or just look stiff – there is a spectrum and if caught in the early or milder stages then it may not be immediately apparent that it is laminitis. In severe cases the horse may lie down to take the weight off the feet.

Treatment

First aid from you in the first instance involves getting the horse into a stable if possible and starting box rest on a deep bed whilst waiting for a vet. If you cannot move the horse from the field, then leave them there and we can help when we arrive. If you don’t have access to a stable don’t worry, we can wrap the feet with supports or you can put mats and/or bedding in a small area in the field.

The aims of initial veterinary treatment are:

Relieve pain and anti-inflammatory treatment.
Prevent it getting any worse – stabilise the feet to prevent any further laminae separation.

Pain relief is given intravenously and then a course oral medication will be prescribed for at least a few weeks. The pain relief used also has anti-inflammatory effects to treat the inflammation and reduce further damage. A combination of a non-steroidal anti-inflammatory such as phenylbutazone alongside paracetamol is often used.

Providing support to the soles of the feet is essential and is achieved by application of upward pressure in a certain way to the sole to support the pedal bone against the weight of the pony whilst the laminae (i.e. their attachment) is inflamed and at risk of failing. This can be achieved with standing on a very deep shavings bed so the feet sink into it, application of frog supports or whole sole supports such as squish pads. During this acute phase of disease it is essential that the horse stands still. The laminae are injured and are at risk of tearing which will result in pedal bone rotation with too much movement so box rest really is essential. Another element of stopping it getting any worse is reducing any sugar and starch intake as these will trigger further laminae damage – in practical terms this means soaking the hay and ceasing and feed which contains sugar or starch.

The next phase of treatment involves:

Identifying and treating any underlying conditions.
Assessing the level of pedal bone rotation to make a shoeing plan.

Blood tests are indicated to screen for cushings and EMS and then starting treatment as soon as possible to reduce the driving force behind the laminitis.

X-Rays are indicated to visualise where the pedal bone is within the hoof capsule and to see if there has been any gas pocket or seroma formation which would require further treatment. From the x-rays the vet and farrier can formulate a plan to best support the recovery and correct any rotation or sinking. Advanced farriery techniques have transformed the ability to treat severe pedal bone rotation and sinking. Farriery required in treating laminitis will range from a therapeutic trim right through to clogs and casts. A good working relationship between the vet and the farrier is key in laminitis cases.

Regular reassessments will be required to assess when the horse can resume some walking exercise and turn out safely. The time frame for recovery is very individual and depends on so many factors and can range from a few weeks to a few months.

Prognosis

Most horses make a full recovery from a laminitis episode however it can be life-threatening in severe cases where there is too much separation of the laminae to be able to recover. If a horse has laminitis our aim is to prevent it ever happening again. However some horses become prone to recurrent episodes and if this cannot be controlled by treating and managing underlying conditions then the horses welfare should be considered.

Prevention

Maintaining a healthy body weight and exercise level for your horse is something simple which can prevent insulin dysregulation and therefore laminitis. Consider high fibre, low starch/sugar feeds for most horses, prevent over-rugging and monitor grass intake. Hay is just dry grass and can be up to 10% sugar content – soaking can reduce the sugar content dramatically and is a good trick for managing good-doer horses without having to ration the amount they eat. We know that feed intake is responsible for body fat levels and exercise is responsible for insulin regulation. In the wild horses walk many miles every day and eat very low quality forage – if ever we are unsure of how to manage our horses we should consider this. Also keep up with regular farriery to prevent foot imbalances and monitor hoof health.

If you have any suspicion that your horse may have EMS or cushings then a blood test can be taken at any time. It will inevitably be better to treat these conditions before they result in laminitis as another way to prevent this painful condition.

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Choke

Horses Advice

Fortunately choke in horses refers to an obstruction of their food pipe (oeseophagus), as opposed to the windpipe and therefore is very rarely life threatening. It is quite a common condition and occurs when food blocks the oesophagus, which is the pipe that connects the back of the mouth with the stomach.

Causes

Most commonly choke occurs because some food gets stuck in the oesophagus. This can be hay/haylage, hard feed, a solid item like apple or carrot or a foreign body (i.e. not food material). A horse can have a random single choke episode or can be prone to it recurrently. Issues which predispose to choke include dental disease reducing the chewing ability and physical abnormalities of the throat or oesophagus.

Symptoms

Refusing food
Lip curling
Head down, tensing neck muscles, looking as though they are trying to be sick
Possibly making a noise – squeak or grunt
Saliva and food coming from nostrils/mouth
Distress with possible sweating
Gulping and repeated swallowing
Coughing and gagging

These symptoms are the result of the blockage causing a backflow of food and saliva back up the oesophagus, discomfort, panic and the horse trying to clear it themselves.

What to do?

Remove all food and water. Most cases of choke resolve uneventfully when the horse relaxes. This will be associated with the discharge from the nose stopping and the horse will become more settled and relaxed. Massaging the left side of the neck may help to ease the discomfort and help to reduce spasm of the oesophagus. A gentle walk around can help too.

If the symptoms persist for over fifteen minutes then contact the practice on 01562 701334 to arrange a visit.

Treatment

In the first instance we will examine the horse and establish whether the choke has self-resolved prior to our arrival. If it has then the vet may choose to give a muscle relaxant and anti-inflammatory to help resolve the oesophageal spasms and reduce the risk of recurrence. All feed and hay should be soaked for 24 hours so as not to irritate the already inflamed oesophagus. If it sounds as though the horse inhaled any food material and saliva on checking the trachea and chest then antibiotics may be discussed although this is less likely in a self-resolving choke.

If the choke has not self-resolved by the time the vet arrives then initial treatment consists of sedation, muscle relaxants and anti-inflammatories to resolve the spasm and obstruction. If this fails to resolve the obstruction, we will sedate the horse more heavily and a stomach tube will be passed up the nose and down the oesophagus to the level of the obstruction. At this point water will be used to lavage the obstruction clear. Again an examination afterwards will prompt a discussion regarding risk of inhalation in this case and the use of antibiotics.

If this fails to resolve, then often the horse is given some time for its own saliva to continue softening the obstruction and a repeat visit in a couple of hours will be arranged to repeat the tubing process. Sometimes we will use the gastroscope (camera) to visualise the obstruction) to help assist in resolving it.

Following clearance of a larger obstruction we will often recommend starving the horse for a period of up to 12 hours, then continue with sloppy feeds or grass for several days to reduce any stress or pressure on the oesophagus.

Complications

Although the vast majority of cases of choke resolve either without treatment or with some simple help at home a small number of cases can result in complications. The most common complication being inhalation of foodstuff and saliva which can result in a respiratory tract infection or more seriously pneumonia. Much more rare and serious would-be damage to the oesophagus itself from tears up to rupture. In very rare cases the obstruction is not resolved with repeated treatments at home and referral to an equine hospital will be discussed for more intensive management or even surgery to prevent the above-mentioned complications.

Prevention

Ensure that all dried feed is soaked thoroughly as per the manufacturer’s instructions to ensure they are fully swollen before eating.
Regular dental care to ensure chewing is thorough and complete.
The placing of a large brick or rocks in a food bowl may slow rapid, greedy feeders from taking in large mouthfuls of feed.
Ensure continuous access to fresh water.