Joint problems: not only for older horses
Your 4-year-old mare was getting ready for her first dressage competition at the training level, when suddenly she became lame with a swollen fetlock.
Or maybe it is your 20-year-old stallion who still jumps in shows—but only after a long warm-up and without his usual enthusiasm.
These two very different horses may have one common problem: joint problems.
Charlotte Barton, BVetMed, MS, Dipl.
ACVS-LA, a postdoctoral researcher in clinical sciences at Colorado State University, says: The reality is that in up to 60 percent of lameness examinations, the joints are identified as the primary cause.
It is no surprise that these problems are more common in older horses, because years of use and wear take their toll, just like in older humans.
But younger horses are not immune either, and in fact, athletic activities can put them at risk for all kinds of joint problems, says Kayla Ortved, DVM, PhD, Dipl.
ACVS, ACVSMR, professor of large animal surgery at the New Bolton Center of the University of Pennsylvania.
However, while joint problems can affect horses of any age, there are important differences in how they affect younger and older horses—and in how their problems are managed for the best results.
We asked Barton and Ortved to give us a detailed explanation.
First points Before getting into the differences, let's set a baseline.
First, we consider young horses to be between 3 and 6 years old, either in initial training or actively competing.
We define older horses as 15 years old and up, whether they are still working or retired.
We also note that the problem can affect almost any joint, regardless of the horse's age, from more common joints like hocks, stifles, pasterns, fetlocks, coffin joints, and cervical joints to less common joints like shoulders and elbows.
And we know that the process of identifying a joint problem is largely the same, regardless of the horse's age—although older horses with more advanced problems may have more noticeable signs that make assessment easier, say Barton and Ortved.
With that baseline, let's compare!
Diagnosing joint problems Identifying the problem starts by observing any changes in your horse.
This may include joint swelling, heat, pain, reduced range of motion, or changes in stride, performance, or behavior.
For example, your horse may be unwilling to move forward, refuse jumps unusually, or show overall stiffness.
When should you call the veterinarian?
Ortved says: “It is always better sooner than later.
” “Addressing early joint problems is much easier and hopefully allows us to achieve a very good prognosis and outcome.
” A veterinarian's examination begins with a physical exam, including a specific lameness evaluation in which the veterinarian observes your horse's movement and may perform flexion tests.
The examination may then proceed to joint or nerve blocks to narrow down the affected area.
Your veterinarian will help determine the best treatment option for your horse.
©Amy K.
Dragoo Your veterinarian may use imaging to identify the specific cause.
This usually means using radiography.
In some cases, ultrasound or even MRI, CT, or PET scan may be recommended.
Joint problems in young horses
Ortved says: Like human athletes, young sport horses use their musculoskeletal system in ways that can increase joint injuries.
This may mean a single traumatic injury or wear and stress caused by repetitive use.
Barton adds that developmental diseases can also be an underlying cause of joint problems in young horses.
The following joint problems are commonly more frequent in young horses.
Synovitis.
Barton says: “This is inflammation of the joint lining and can be a precursor to the development of arthritis.
” Unfortunately, it can be difficult to diagnose because it is not always accompanied by lameness or fluid accumulation around the joint.
However, as it progresses, joint fluid accumulation with varying degrees of lameness may be observed.
(Remember that four-year-old mare with the swollen ankle?
This could be the underlying cause.
) Barton says: “Synovitis can gradually worsen until clinical signs such as lameness appear, at which time there may be joint changes associated with early arthritis.
” On the other hand, if you notice inflammation around a joint—perhaps after a hard training day—that can be a good sign, Ortved says: “If we recognize this...
[and] if we treat those horses, we can hope to prevent its development into more widespread arthritis.
” Osteochondrosis (OCD).
This is a developmental orthopedic disease.
In other words, it affects developing bones and joints and disrupts the growth of articular cartilage, and may cause changes such as cartilage flaps, osteochondral fragments, and subchondral cystic lesions.
(Osteochondral defects affect both cartilage and the underlying bone.
Subchondral defects affect the bone beneath the articular cartilage.
In general, lesions in bone and joints are abnormal or damaged areas.
) OCD can cause fluid accumulation but may not initially cause lameness, so Ortved suggests screening for OCD in pre-purchase examinations.
In some cases of OCD, surgery may be necessary to remove the defect, which should preserve joint health.
While the full process of this disorder is not completely understood, Ortved notes that rapid growth, abnormal biomechanical forces, and genetics can all play a role.
Barton notes that mineral imbalances and high-carbohydrate diets may also play a role.
Arthritis in young horses.
Although arthritis is more common in older horses, it can also occur in young horses.
Barton says: “In many cases there may be no specific triggering factor, but in some cases, if orthopedic problems were present when the horse was a foal, we may see problems earlier.
For example, severe angular limb deformities may lead to early arthritis.
” Bone fragments and intra-articular fractures.
Although these problems are common in young horses, they are seen more often in racehorses than in sport horses.
Ortved and Barton say: “For this reason, it may make sense to check for these things in the pre-purchase examination when buying a Thoroughbred horse that has retired from racing.
» Joint problems in older horses, Barton says: «In older horses, we begin to see more degenerative orthopedic diseases, and the prevalence of arthritis increases.
» In short, Orton says: «Things have progressed.
» In advanced joint problems, damage to the cartilage may be seen, which can lead to permanent loss of cartilage.
In addition, older horses may have changes in the bone around the joint and a reduced range of motion.
Orton adds: «Many older horses have arthritis in many of their joints, simply because of their athletic history as well as years of loading on the joint.
» The goal of treating joint problems is to keep the horse comfortable, whether it is competing or not.
©Amy K.
Dragoo Treating joint problems in young horses Joint problems can affect the quality of life and the performance ability of horses at any age.
Orton says: «Any kind of joint inflammation can cause some degree of lameness or reduced performance.
We can treat these young horses.
When we get to moderate to severe arthritis, it is more difficult to treat and can create serious problems in quality of life.
» This stage is much more common in older horses and often includes lameness, pain, and even changes in weight bearing, for example, overloading the healthy limb.
However, regardless of age, the treatment and management of joint problems largely depend on what you expect from the horse, how advanced the problem is, and whether the joint is in a high-motion or low-motion joint.
Barton says: «In all cases, we must ensure that the horse is comfortable with a good quality of life.
» However, in the case of young equine athletes, Barton says: «We think about longevity, try to slow the progression, and keep the horse in the best possible condition for as long as possible.
» Orton says: «This means focusing on treatments that reduce inflammation, restore and maintain joint health, to prevent the problem from progressing as the horse ages.
» There are multiple treatment options, the most common of which include the following: intra-articular injections of corticosteroids, polyacrylamide gels, and hyaluronic acid orthobiologic treatments such as platelet-rich plasma, autologous protein solution, interleukin-1 receptor antagonist, and stem cells are now as common as steroids, Orton said.
Intramuscular injections of polysulfated glycosaminoglycans, with Adequan ® being the only FDA-approved drug for treating equine osteoarthritis intravenous injections of sodium hyaluronate, with Legend ® being an FDA-approved brand for treating osteoarthritis of the knee or fetlock joint nonsteroidal anti-inflammatory drugs (NSAIDs), such as phenylbutazone (commonly known as bute), firocoxib (under the brand name EQUIOXX ® ) and the topical cream Surpass ® based on sodium diclofenac At present, joint orthobiologic treatments are carried out by collecting and culturing blood or stem cells from the affected horse.
This can mean waiting a few days to several weeks until the treatment can be injected, Barton said.
But he added: «There are many exciting treatments on the horizon that are being tested and developed.
» This includes off-the-shelf biologics that do not require collecting and processing blood or cells from the horse.
Barton said: “Things like gene therapies are progressing toward clinical trials in humans, and there is also research in horses showing good results.
” He added: “So I think that as research advances, more treatment options will be available to us.
” In addition, Urtod said: “Shockwave therapy, high-intensity laser therapy around the joint, and icing the joint after work can be helpful.
” And in some cases, surgery may be necessary.
There is still debate about the effectiveness of oral supplements.
Urtod noted that high-quality products that provide key ingredients such as glucosamine, chondroitin sulfate, and hyaluronic acid may offer daily support for healthy joint fluid and tissues.
Barton recommended: “It is also important not to overlook things like strengthening and conditioning exercises, maintaining a proper weight with a good diet, and ensuring proper balance and hoof angles.
” In addition, horse owners should consider their budget and the horse’s response to any previous treatment when determining a course of treatment.
Joint treatment for older horses For older horses with more advanced joint problems, owners may face a choice: continue an intensive treatment regimen to maintain a certain level of performance, or reduce the horse’s workload and treatment protocol.
But even the second option does not mean complete rest.
Urtod said: “If you think about yourself with arthritis, sitting on the couch won’t help.
” These horses may need a change in training, but they still need movement.
Urtod said of a treatment warning that relates to corticosteroids, which can affect insulin and glucose levels.
This can be dangerous for horses with underlying metabolic conditions, such as insulin dysregulation or pituitary pars intermedia dysfunction (PPID, formerly known as equine Cushing’s disease), which is usually more common in older horses.
If your horse has one of these disorders, speak with your veterinarian about blood tests that can determine whether injections are safe.
Preventing joint problems If joint problems are so common, is there a way to prevent them?
Yes and no.
Generally, sport horses are at inherent risk of joint injury and cumulative wear and tear due to intense athletic activity.
However, you can take steps to reduce this risk, and starting when your horse is young gives you the best chance of maintaining a long performance career.
Urtod said: “Proper nutrition is definitely key to maintaining overall health as well as joint health.
” Barton agrees and notes that this is “especially important for young, growing horses to prevent future problems as well as reduce the risk of developmental orthopedic disease.
” Barton adds that feeding foals large amounts of grain can affect bone development and increase the risk of OCD.
He says that imbalances in copper, zinc, cadmium, and the calcium-to-phosphorus ratio can also affect bone health.
Joint problems can affect both young and old horses.
©Adobe Stock A proper training program is also helpful.
Autod believes that this program should include cross-training rather than focusing on one specific type of work that may place extra strain on certain joints.
Also, practice moderation; for example, a jumper does not need to train over big jumps every day.
He said: "Make sure your horse also has rest days.
Low-impact exercises can be a good choice for preventing joint stress while building the muscles that support the entire skeletal system.
For example, work on an aqua treadmill to strengthen the core muscles or work on hills to strengthen the quadriceps muscles," Autod said.
As the horse gets older, rest days may become more important.
Autod said: "Including other physical methods, such as massage and acupuncture, can probably support the horse's musculoskeletal system.
Barton said: "Ultimately, good overall care of the horse means smart care of the joints.
This includes close attention to the horse while grooming or riding, ensuring proper fit of equipment, correct hoof care, and regular veterinary examinations.
" If you are lucky enough to have an older horse that does not suffer from joint disorders or whose problems are mild, these same strategies are used to maintain that condition.
Planning for the long term While joint problems are one of the most common ailments in horses, they do not necessarily have to change your horse's life, performance plans, or competitive dreams.
Smart management of young horses can greatly reduce problems now and in the future.
Early diagnosis and treatment, along with strategic management to stop or slow the progression of joint disorders and optimize your horse's chance for a long working life and a happy life, are very important.
Source: Practical Horseman – Health