June 2019 Equus Extra - Joint Health supplemental sponsored by Lami-Cell

i s t o c k . c o m / P e t e r L l e w e lly n

Volume 3

JOINT HEALTH Brought to you by:

n Tips for preventing arthritis n Balancing work and rest n Protecting against trauma

FIGHT ARTHRITIS AT EVERYAGE Signs of arthritis typically appear when a horse has passed middle age, but the destructive processes behind the soreness were set in motion years before. Here are steps you can take to protect your horse’s joints throughout his life.

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rthritis is often thought of as a condition of aging, mainly because its first outward signs tend to show up later in a horse’s life. But in many cases, the factors that lead to the condition are at work---in the way a horse is managed, fed and ridden---for years before. In fact, decisions made about a horse’s care at every phase of his life ultimately affect if, when and to what extent he develops arthritis.

This means that regardless of your horse’s age, you can take steps now to protect the health of his joints. These measures aren’t particularly difficult or expensive, but they do

require vigilance, consistency and, oftentimes, restraint on your part. Although a horse’s genetics and the sheer wear and tear of an active life may make arthritis unavoidable, you may be able to minimize the impact of the condition on his soundness, activity level and, ultimately, his enjoyment of life.

“Every horse who has led an active, useful life is going to get some degree of arthritis if he lives long enough,” says David Trachtenberg, DVM, owner of Trachtenberg Veterinary Associates in Penfield, New York. “But I do think that thoughtful care throughout his life can really pay off by keeping that arthritis at a very manageable level. If you’re lucky enough to get a horse young enough that you can make these changes, it’s definitely worth the effort you’ll put into it.”

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By Christine Barakat

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Age: 4 to 24 months

“The owners feel they are doing the right thing by giving their horses the • Feed a balanced ration very best nutrition, but really they are giving them way too much. You’ve also • Turn out as much as possible got to remember that if they are still with their dam, they are getting nutri• Avoid forced exercise tion through her milk, so if she is being fed a high-protein diet then Years before a horse is ready to the foal is, too.” be ridden, you can influence his joint Instead, says Trachtenberg, it’s bethealth. A growing youngster’s feed ration plays a crucial role in determining ter to offer a ration that provides just the basic nutrition a youngster needs his vulnerability to developmental orand nothing more: “I like young horses thopedic disease (DOD), a collection of to have a body condition bone and joint abnormalities that arise when the conversion of cartilage is dis- score of about 4.

That may look a turbed, usually by overly rapid growth.

In the case of osteochondritis dissecans little thin to some (OCD), the cartilage is too thick to be sufficiently penetrated by blood vessels, and the bone beneath develops weak and empty spots known as lesions. In epiphysitis, areas of actively growing cartilage at the ends of bone cannot support the horse’s weight, leading to inflammation in the areas under stress.

“Not every DOD will lead to arthritis later on in life,” says Richard Markell, DVM, owner of Ranch and Coast Equine Practice in Encinitas, California. “But there have been studies that suggest that small osteochondral fragments can cause scoring that leads to arthritis later on.”

Diets that contribute to DOD tend to provide excessive nutrients and calories, leading to very rapid growth and obesity. “The youngsters who develop DOD are the ones who are being fed high-protein diets, such as a high percentage of grain and/or alfalfa hay and lots of vitamin supplements,” says Robin Dabareiner, DVM, PhD, of Texas A&M University.

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people, but it’s analogous to a growing teenager---they often go through lanky stages before they are physically mature.

It’s not what our eye is accustomed to, but it’s healthy.”

Don’t overlook hoof care for foals and weanlings. Unbalanced hooves can exacerbate existing problems or create new ones. Schedule regular farrier visits for youngsters, just as you would a mature horse.

If a young horse develops swelling at the joints, call your veterinarian immediately to get a proper diagnosis and make dietary adjustments. “The first thing we do is cut the grain back as much as possible, with only coastal Bermuda hay---no alfalfa---and no supplements,” says Dabareiner.

“You can turn these cases around if you don’t ignore them.”

In addition to careful feeding, young horses need plenty of turnout. “Studies have shown that young horses who get regular, but unforced, exercise have greater bone density than those kept in stalls,” says Trachtenberg. “The bone density and improved strength of muscles, tendons and ligaments will protect them from injury and arthritis down the road.”

Keep in mind that forced exercise, such as ponying or longeing, is not the same as turnout. Forced exercise can be detrimental to joints, so resist the urge to devise any formal conditioning program for a horse who is not yet ready to be ridden. If your current situation doesn’t allow a youngster to be turned out full-time or for a majority of the day, look into a boarding or lay-up facility that can accommodate his needs.

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Foals and weanlings

youth Age: 2 to 5 years • Don’t start work until physical maturity • Start out with slow and easy exercise

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• Don’t push too hard even as fitness improves The first stages of a young horse’s training offer the opportunity to lay a good foundation for a lifetime of joint health or to set in motion a chain of destructive events culminating in debilitating arthritis. At this point in your horse’s life, the best thing you can do to protect his joints is to move him along slowly and conservatively.

“One of the biggest mistakes you can make is pushing young horses too fast, before their bones are mature,” says Dabareiner. “Excessive training on immature bones is a perfect prescription for arthritis later on.”

A young, immature horse’s cartilage is still forming and not able to withstand intense or repetitive work.

“The cartilage in these young horses is ‘soft,’” says Markell. “That isn’t a great medical term, but it’s the best description I can give people when cautioning them about starting a horse too early or overtraining a young horse.” Immature cartilage is more likely to be damaged, possibly never healing properly, and leaving bone underneath it at risk.

At what age a horse is physically mature enough to handle regular work depends greatly on his breed. “My practice is show jumpers and dressage horses, so we see lots of warmbloods, and they mature much slower than 3

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Supplementingredients The choices of nutritional supplements to support joint health may seem overwhelming, but knowing a bit about the most common ingredients can help you sort through the options.

Glucosamine: A naturally occurring sugar, this is one of the building blocks used in the production and repair of cartilage.

Hyaluronan (hyaluronic acid, HA): a key structural component of connective tissue, cartilage and synovial fluid.

Chondroitin sulfate: a large protein molecule used in the formation of connective tissues and cartilage.

MSM (methylsulfonylmethane): an organic compound that contains sulfur, a macromineral necessary for the production of collagen.

Avocado soybean unsaponifiables (ASU): These extracts from soybeans and avocados prevent the destruction of existing cartilage while stimulating the repair of cell tissues.

Resveratrol: a compound derived from the skin of red grapes that is believed to have antioxidant properties. Antioxidants protect cells against the effects of free radicals, helping to reduce the body’s inflammatory response. Research suggests that resveratrol dietary supplements can be beneficial to joint heath when used by themselves or in conjunction with joint injections.

Thoroughbreds. A 4-year-old warmblood isn’t done growing; his bones aren’t ready for intense work.”

On the other hand, a Quarter Horse may be ready for work sooner. “Quarter Horses mature faster than warmbloods, that’s for sure,” says Dabareiner, “so generally we can start them earlier.”

But even within breeds, individuals mature at different rates, so there is no set formula for when to start a horse under saddle. “The bottom line is that if your horse doesn’t look mature---if he’s still got any of the gangly look to him---he’s probably not ready for work yet,” says Trachtenberg.

If you’re not sure, you can ask your veterinarian his or her opinion on your horse’s physical maturity.

Waiting to ride a young horse can feel like wasted time, but there are plenty of ways to begin training without ever mounting up. “You can be teaching a young horse without riding him,” says Trachtenberg. “Through groundwork, you can have him

responding to basic commands and understanding how to yield to pressure.”

Not only will such groundwork spare his young joints, but the lessons will

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transfer to work under saddle.

When you do begin to work a young horse, take things slowly to protect his joints. “One problem we see in the Western performance horse industry is people who have paid high-dollar fees to enter horses in 3-year-old futurities, so they must train them hard,” says Dabareiner. “They’ll have maybe 60 days under saddle and are then put to cows and worked hard, every day until the event. It’s a fact of the business, but as a result, I’ve seen some 4-year-old horses that have joints that you’d expect on a 15-year-old.”

Condition a young horse just as carefully as---or perhaps even more than--you would a mature horse coming back from an injury. That means short, easy workouts to begin with, slowly building up to longer or more intensive sessions, with regular days of rest and turnout.

Also be mindful of the pressures you put on a young horse. The torque associated with tight turns can be particularly hard on joints, so keep circles large and avoid longeing for more than a few minutes at a time. Repetition can also take a toll on young bones. Teach the horse a skill, but resist the urge to drill it over and over.

Showing restraint with a young horse can be difficult, especially if he is promising. “You have to be really careful,” says Markell. “The better quality the horse, the more he’s going to be able to do and the more you’ll want to do it. I see this all time: Someone has a great prospect and they’ll say to me, ‘Just look how spectacular his trot is!’

My response is always, ‘Yeah, just don’t do it too much.’”

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middle age Age: 5 to 15 years • Maintain good condition • Insist on good farriery • Provide periods of rest as needed Once your horse is mature and trained, protecting his joints from arthritis is all about consistency. For starters, it’s important to keep him in good physical condition, without lapses in fitness, if possible. “When we are talking about protecting a joint, it’s

important to understand that the rest of the horse’s body is a support system for that joint,” says Markell. “The muscles and tendons and ligaments that surround a joint all work together to keep the structure stable. Without fitness, which brings strength and stability, it will move abnormally, and that leads to arthritis. So think of keeping the entire body in shape when you’re thinking of joints.”

Of course, active horses need periods of rest every now and again. A day of rest after a longerthan-usual trail ride or weekend of heavy showing will give your horse’s body a chance to repair any minor damage and quell the inflammatory process.

“You certainly need to rest a horse who is fatigued or injured,” says Markell. “And a week or two off isn’t going to be a problem, particularly if the horse has regular turnout. But what you want to avoid is really prolonged periods of inactivity.”

The older a horse is, the harder a comeback from long periods of inactivity can be on his joints. “If you give an older, fit horse time off, it may take too many miles to get him fit again afterward,” says Dabareiner. “In those cases, it’s better to keep him in work all the time. I’ve seen many horses dealing with low levels of arthritis very well, to the point you almost don’t notice it clinically, until they were given six months off, then it becomes something they can’t overcome to get back in shape.”

Regular, consistent exercise will also help keep your horse at a healthy weight. Laminitis is an immediate and real concern in obese horses, but J o i n t

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Arthritis explained old age Degenerative arthritis is the end result of a cascade of events, involving multiple structures in and around your horse’s joints, over a long period of time.

Articular cartilage covers the ends of long bones, cushioning the space where two meet.

This cartilage is made up of collagen fibers, which—aided by molecules called proteoglycans—trap moisture to produce a shock-absorbing effect: Each time the joint

flexes, synovial fluid (the lubricating fluid of joints) is forced in and out of spaces within the cartilage.

Repetitive flexing of the joint, however, causes minute damage to the joint structures, triggering an inflammatory response by the body. As enzymes flood the area to repair the damage, they also thin the synovial fluid, reducing levels of proteoglycans, which means less protection for the cartilage and more potential damage.

loading of those extra pounds on joints will also take a toll over time. The inactivity that is typically associated with obesity also contributes to the development of arthritis.

Whatever your horse’s activity level, you may want to talk to your veterinarian about the preventive use of supplements that contain such ingredients as glucosamine, chondroitin or avocado soybean unsaponifiables (ASU).

The other place you’ll want consistency is in your horse’s hoof care.

Hooves that are long, out of balance or otherwise badly cared for can alter the movement of all the joints above it, potentially leading to arthritis.

“Farriership is super important to a horse’s long-term soundness,” says Markell. “You can take all the precautions in the world with his workload and conditioning, but if his feet aren’t done right, it doesn’t really matter. Study after study has shown that every degree of 5

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If the horse isn’t given time off to heal, this cycle of inflammation continues, and enough fluid will fill the joint space to lead to painful swelling and stiffness that we recognize as the signs of arthritis.

Eventually the cartilage may tear or erode away entirely, leading to bone-on-bone contact within the joint, a very painful condition known as osteoarthritis or degenerative joint disease.

hoof angle significantly affects joint loading. And repetitive strain on a joint from an imbalanced hoof is going to cause arthritis.”

Recognizing an unbalanced hoof can be difficult, however, because horses learn to compensate and cope. “Horses with poorly trimmed feet may still appear sound,” says Trachtenberg. “The damage being done is all subclinical.

You may never know their joints were under stress until arthritis appears years later.”

Markell recommends using word of mouth to find a farrier who specializes in and is successful at shoeing horses with the same job description as yours: “If you have a dressage horse, ask around to find out who shoes the best, soundest dressage horses in the area. If your horse is a reiner, though, you’ll want to get in touch with the guy who takes care of the top reiners.”

Age: 15 or more years • Be alert for the first signs of trouble • Start treatments early • Allow as much activity as possible Signs of arthritis are very common in horses over age 15. After a lifetime of work, even one that didn’t involve strenuous exercise, it’s almost inevitable that a horse’s joints will develop some degree of stiffness. Arthritis in an older horse can be managed most effectively when it is identified and addressed early.

“Don’t wait for outright lameness to start looking for arthritis,” says Trachtenberg. “Most of the time, the first sign is a decline in performance or a change in behavior. If he suddenly won’t swap leads behind or seems ‘crabby,’ it’s probably because his joints hurt.” Trachtenberg recommends a lameness examination for any horse who suddenly develops performance or attitude problems.

And, of course, a thorough exam is needed when an older horse develops actual lameness. “Mistaking arthritis for another issue can lead to some bad decisions that make the situation worse,” says Trachtenberg. “You need to restrict exercise in horses with soft-tissue injuries, but with arthritis you need to keep them moving [see “Staying Active to Stay Sound,” page 6]. So if you assume an older horse has a suspensory injury, but really he’s got arthritis, you’ll put him on stall rest and only aggravate the real problem.”

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Ask enough veteri­nar­ ians and you’ll get a wide range of opinions on the best way to manage a horse with arthritis. You’ll also find something that is universally recommended: movement.

“Keeping a horse with arthritis active is probably the best thing you can do for him,” says Richard Markell, DVM, of Ranch and Coast Equine Practice.

“Your instinct may be to put him away in a stall, but that’s only going to make it worse.” Moderate exercise stimulates the production of synovial fluid within a joint, slowing the

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progression of arthritis. It also helps strengthen the muscles and ligaments that stabilize the joint.

Of course, too much exercise can be detrimental for an arthritic horse. The challenge is finding the fine line between too much activity and not enough.

A good place to start is with continual turnout in a large field with an active herd. Horses kept in this situation will typically get enough natural exercise to support their joints without overdoing things.

When it comes to riding, don’t “retire” a horse with arthritis outright. Instead,

scale his work back slowly to keep him as active as possible while still being comfortable. This may mean adjusting your own goals. “I’ve had clients with arthritic horses who could no longer handle jumping 3'6",” says David Trachtenberg, DVM, of Trachtenberg Veterinary Associates. “And when I tell them this, they’ll think for a minute and say ‘Well, I’m happy doing the three-foot division.’

If the horse is comfortable there, they can enjoy another couple of years of showing. It’s a great solution for everyone.”

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Staying active to stay sound

Trachtenberg adds that the footsoreness of chronic laminitis can also be mistaken for arthritis.

When an older horse is diagnosed with arthritis, it’s not too late to address the underlying cause. “Try to figure out why it’s happening,” says Markell.

“You might uncover some problems you hadn’t noticed before. Maybe he’s not being shod the way you’d like, or the footing in your arena is bad. You can still change those things and help slow the progression of the disease. Or maybe you’ve got a friend with a full brother to your horse that also has arthritis, and genetics is the cause.”

Once those factors are addressed, you can focus on preserving your horse’s soundness. Fortunately, there are many early treatment options for arthritic horses. “Most people start with a supplement at the first signs of arthritis,” says Dabareiner, “and there are certainly a lot to choose from” (see “Supplement Ingredients,” page 3).

Trachtenberg directs his clients toward supplements containing glucosamine or hyaluronic acid: “Those are the ones I’ve had the most luck with over the years. You have to do your research, though, and buy a product that has some good quality controls in place and is likely to have an accurate label. Looking for one with the NASC [National Animal Supplement Council] seal is a good place to start.”

Some medications (see “Injection Options,” page 7) to treat arthritis can be injected directly into a joint. The decision on when to start such treatments will depend on the individual horse and your veterinarian’s experiences.

“A decade ago, we would line up a

Injection

options

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When you hear someone mention “injecting” a horse to manage arthritis, they are referring to medication delivered directly into the joint or sometimes intravenously. Here are the most common choices for that treatment: Hyaluronic acid: This molecule gives synovial fluid its sticky texture and helps build cartilage. HA injections are also thought to have anti-inflammatory effects and stimulate the body to produce natural hyaluronan. These injections are typically given directly into the joint, although one product (Legend) is also licensed for intravenous use as well.

PSGAGs (polysulfated glycosaminoglycans): These complex sugars are naturally found in articular cartilage. They are injected to stimulate production of hyaluronic acid as well as to inhibit the degeneration of cartilage.

The most common PSGAG (Adequan) is licensed for intramuscular injections as well as injections directly into the joint.

Corticosteroid injections: With powerful anti-inflammatory action, any corticosteroid injected into a joint will immediately halt the destructive processes while relieving the horse’s pain.

Veterinarians tend to be very judicious with their use because of concerns over potential side effects, including laminitis and an adverse impact on cartilage.

about injections. I’m going to be proactive and aggressive in looking for that sign, but I’m still going to wait to find it before I start injections.”

And don’t overlook nonsteroidal anti-inflammatory drugs (NSAIDs) such as phenylbutazone and firocoxib as options for managing early arthritis.

Not only will they make a horse feel better, but they will stop the destructive chain of events that can lead to further damage. “You can certainly manage

a horse with bute and Equioxx,” says Dabareiner, “particularly if they’ve got arthritis in multiple joints. Instead of injecting them all over the place, put them on a low dose of medication and keep an eye out for ulcers and colic.”

“There are hundreds of thousands of people who take a couple of ibuprofen so they can play tennis,” says Markell.

“And there are just as many horses out there who might benefit from an Equioxx a day so they can have a great life. If used reasonably and cautiously, NSAIDs are a great thing for horses with arthritis.”

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iven how common equine arthritis is, it’s wise to assume that your horse will one day develop the condition. In fact, the smartest horse owners begin to take steps to minimize damage to joints years, and even decades, before the first signs of stiffness appear. And the early efforts pay off when a few simple changes and conscientious choices in management add years of soundness to your horse’s life.

barn full of horses prior to a big show and inject their hocks as a preventive measure,” says Markell. “We don’t do that anymore. I don’t think it’s helpful, and anytime you inject a horse’s joints there are risks involved. Now we wait for a sign of arthritis to start thinking 7

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The breakdown of cartilage in your horse’s joints may be a natural consequence of hard work, but it’s not necessarily inevitable. Here’s how to protect your horse from arthritis.

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ny horse who enjoys a long and active life is probably going to develop some degree of arthritis eventually. In fact, it’s a rare horse over the age of 20 who doesn’t have at least a touch of the degenerative joint disease, which is characterized by the breakdown of articular cartilage at the end of long bones.

In addition, arthritis can occur in

By Christine Barakat with Melinda Freckleton, DVM

a horse of any age after injury to joint structures, cartilage and/or stabilizing tissues, such as tendons and ligaments.

What is somewhat preventable, however, is early onset arthritis in younger animals, which can result from chronic overuse. If the minute injuries to the cartilage or other joint structures that result from exertion are not given sufficient time to heal, a destructive cycle can begin. Inflammatory enzymes sent

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7 Ways to protect your horse’s joints

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to repair cartilage defects also break down the synovial fluid, making it thinner and less protective. At the same time, collagen and proteoglycans are lost, reducing the cartilage’s ability to stay hydrated and flexible. And if the horse continues to work as his joint is attempting to repair itself, more damage occurs.

Here are some steps you can take to prevent these destructive processes from damaging your horse’s joints:

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Don’t overtrain. If your horse is jumping well or nailing his sliding stops, continuing to drill him may lead to arthritis, not to mention mental burnout. The horseman’s adage that “there are only so many jumps in a horse” isn’t superstition, it’s a physiological reality. If you find yourself needing more practice than your horse does, look into taking lessons with a qualified trainer on a borrowed horse. This will minimize the work you do with any one animal but allow you to get in the repetitions you need.

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Schedule “easy” days for hardworking horses. Any horse on

a rigorous competition or work schedule needs downtime to allow his body to heal. Exact planning of days off will depend on his level of fitness and your schedule, but as a rule of thumb, never work a horse hard more than three days in a row without throwing in an easy trail ride or just a day to wander a large 9

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paddock on his own. (Note: Confining a horse to his stall on his day off may actually lead to stiffness in his joints.)

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Ask your veterinarian about joint support supplements or injections. While oral supplements

and injectable products such as hyaluronic acid (HA) and polysulfated glycosaminoglycans (PSGAGs) are commonly used in the management of active arthritis, their role as preventive measures is still being investigated.

Your veterinarian will have real-world experience in which products may be most beneficial for your horse given his circumstances.

4.

Keep your horse’s hooves trimmed and balanced.

Use the best farrier you can find and have him out regularly to tend to your horse’s feet. Maintaining feet at the proper angles and length will keep a horse moving optimally, reducing joint strain and inflammation.

5.

Protect joints from potential traumas. Obviously you won’t

be able to prevent all acute injuries to joints---horses are always thinking up new ways to hurt themselves---but do take steps to minimize any risks you can anticipate. For instance, a horse who aggressively paws his stall door at feeding time could rap a knee or fetlock hard enough to cause inflammation.

Rearrange your schedule so you can deliver feed to his bucket when he’s still turned out, or open the door and let him paw under a stall guard to protect his joints.

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Take any skin wound near a joint very seriously. Wound in-

fections that extend into joint spaces can aggressively eat away at cartilage, leaving a horse in arthritic pain so crippling that euthanasia is the only humane solution. If your horse has a skin wound over or near a joint, call your veterinarian for advice. She may decide the safest bet is a farm call to investigate the depth of the defect and a prescription for a course of antibiotics to prevent infection. Small puncture wounds, in particular, need to be examined. The skin defect on the surface can heal quickly, lulling you into thinking everything is fine as infection develops unseen.

7.

Maintain appropriate footing.

A surface that makes a horse work too hard or subjects him to excessive concussive forces puts him at greater risk of strain or injury.

Even for light casual rides, make sure the footing isn’t too hard or too deep. If you’re not sure about your arena surface, ask your trainer or veterinarian for advice. For more serious training, one of the hightech footing options now available would be a good investment.

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