Evaluating treatment choices for tendon, ligament injury and joint disease in the horse - DVM
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Evaluating treatment choices for tendon, ligament injury and joint disease in the horse


DVM360 MAGAZINE


IRAP

The use of interleukin receptor antagonist protein (IRAP) is increasing, with most clinicians reporting that it is primarily used for those cases of joint arthritis that are chronic and generally non-responsive to standard intra-articular injections.

Equine athletes suffering from chronic joint over-use injury and that have a synovitis or sub-chondral aspect to their joint pain seem to respond well to IRAP, according to various clinicians, though others question the length of action of this therapy. The ease of production of IRAP injections and their autologous nature are proving to be big factors in the acceptance and use of this treatment modality.

Tildren

Tildren acts chiefly through the mechanism of bone production and resorbtion, so conditions such as osseous cyst lesions, navicular bone degeneration and ligament/bone attachment injuries (collaterals, deep digital flexor tendon-coffin bone, cruciate ligaments) are all cases where there should be significant effect.

"In our practice," says Kaneps, "Tildren has been very effective in cases with lameness associated with aggressive bone modeling." Because Tildren has been used in Europe for some time, U.S. veterinarians who now have experience using it have developed a new perspective on past cases.

"A while or so back we would receive mature performance horses with long careers imported from Europe with reasonable radiographs and no lameness issues when they arrived," explains Warsham. "Then, for no reason, after a while, they would develop any number of lameness issues. We started thinking that they (European owners, trainers and veterinarians) must have had something, probably Tildren, that they were using to help keep these 'older soldiers' sound," Warsham concludes.

Tildren does seem to work well in helping reduce osteophyte production and bone remodeling. Many practitioners are finding a reduction in arthritic pain with its use.

Summary

A closer look at the therapies and treatments available for use in the horse for tendon, ligament and joint repair, through the eyes of some of those clinicians utilizing these modalities, does produce some good recommendations and practical guidelines.

Practitioner bias based on familiarity and history is still prevalent, though. The absence of head-to-head studies likely will mean that these regional or personal preferences will continue to affect treatment choices and recommendations.

"The idea of regenerative medicine (stem cells, PRP, IRAP and other treatments) is exciting and holds great promise", adds Dr. Mike Scott of Alberta, Canada, in remarks at the 2009 Canadian Horse Breeders and Owners Conference. "This novelty and excitement has led to the rapid establishment of treatment techniques and commercial products. Veterinarians and horse owners should be aware of these developments and consider these treatments when the need arises," Scott said, "but they should use caution when accepting unrealistic claims and should investigate the facts before expecting miracles."

Hopefully more cases, better follow-up and some comparative studies in the near future will provide veterinarians and owners with more "facts" to investigate in order to make better treatment choices.

Marcella is an equine practitioner in Canton, Ga.


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Source: DVM360 MAGAZINE,
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