Evaluating treatment options for equine tendon, ligament and joint disease - DVM
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Evaluating treatment options for equine tendon, ligament and joint disease


DVM360 MAGAZINE


Platelet-rich plasma

Platelets contain many growth factors that can be released upon activation.

Transforming growth factor from platelets helps promote new blood-vessel growth, formation of new connective tissue (fibroplasia) and the re-growth of skin.

Platelet-rich plasma (PRP) therefore has been used to improve healing and help regenerate damaged tissue.

It has been shown to enhance early bone healing.

This blood component is a potent activator of collagenase, which promotes tissue strength and of TGF-b, which stimulates the deposition of collagen within the wound as a step toward tissue repair.

PRP is prepared by drawing the horse's blood into a specially prepared bag. The blood is processed and eventually a syringe of PRP is produced.

This preparation can then be injected into the tendon or ligament injury.

Research results are encouraging, but there are no head-to-head comparative studies involving these products. Clients and DVMs need more information to evaluate and choose these therapies properly.

"Evaluation of clinical cases is ongoing," according to Dr. Andris Kaneps of the New England Medical and Surgical Center in Dover, N.H., "but our initial results indicate that PRP treatment of tendon and ligament injuries is a tremendous improvement over other current techniques."

IRAP

Research shows that one of the main substances responsible for cartilage destruction is interleukin-1 (IL-1). Antibodies against this destructive substance are known to have a beneficial effect in arresting cartilage damage.

IRAP, or interleukin receptor antagonist protein, is the term for this technology that requires that blood be drawn in a special tube.

The blood tube is then incubated, resulting in a high level of interleukin antibodies. The syringe is centrifuged and the serum harvested and later injected into the joint in question.

This technique is only minimally invasive. The risks are the same as for any type of joint injection, with infection and scar formation topping the list.

IRAP is relatively expensive but has no negative effect on cartilage. Because no prohibited substances are administered, there is no withdrawal time for competition.

Dr. Andrew McDiarmid of Clyde Vet Group in the U.K. say, "Although use of this treatment is still in its early stages, preliminary results are encouraging and IRAP represents an exciting addition to our therapeutic range in the management of equine lameness." He adds that most veterinarians in England currently use IRAP on refractory cases that have not responded to conventional therapy.

Tildren

Tildren is another newer drug that is being used for equine joint problems. It is licensed in Europe but not currently in England or the United States.

Tildren works by regulating bone destruction as it reduces the activity of osteoclasts (bone destroyers) and activates osteoblasts (bone producers).

Competition horses often have sufficient bone stress to force remodeling into an activated state as the body attempts to thicken and protect some areas and to lighten and thin others. Tildren slows this overactive process and leads to better overall joint health. Some horses may experience a mild to more severe colic while receiving Tildren, so caution is warranted and appropriate treatment should be started if needed.

Tildren is shown to be effective for treating navicular disease but there is some debate about its use in hock arthritis relief.

Confusing array

Overall, it is easy to see why clients and clinicians become overwhelmed and confused as to treatment choices for tendon, ligament and joint disease in the horse.

Many good practitioners have used PRP, developed a certain comfort level with it and are likely to recommend it to their clients over other modalities.

An equal number facing similar cases will recommend Acell, Tildren or stem cells.

The follow-up article will feature discussions with surgeons and clinicians.

They will share their clinical experiences with these drugs, techniques and modalities.

And some will discuss the process they use in making their treatment choices.

Marcella is an equine practitioner in Canton, Ga.


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Source: DVM360 MAGAZINE,
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