1
|
Ramírez-Noguera P, Zetina Marín I, Gómez Chavarin BM, Valderrama ME, López-Barrera LD, Díaz-Torres R. Study of the Early Effects of Chitosan Nanoparticles with Glutathione in Rats with Osteoarthrosis. Pharmaceutics 2023; 15:2172. [PMID: 37631386 PMCID: PMC10459352 DOI: 10.3390/pharmaceutics15082172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Due to cartilage's limited capacity for regeneration, numerous studies have been conducted to find new drugs that modify osteoarthrosis's progression. Some evidence showed the capability of chitosan nanoparticles with glutathione (Np-GSH) to regulate the oxide-redox status in vitro in human chondrocytes. This work aimed to evaluate the capacity of Np-GSH in vivo, using Wistar rats with induced surgical osteoarthritis. Radiographic, biochemical (GSH and TBARS quantification), histopathological, and immunohistochemical (Col-2 and MMP-13) analyses were performed to evaluate the progress of the osteoarthritic lesions after the administration of a single dose of Np-GSH. According to the results obtained, the GSH contained in the NPs could be vectored to chondrocytes and used by the cell to modulate the oxidative state reduction, decreasing the production of ROS and free radicals induced by agents oxidizing xenobiotics, increasing GSH levels, as well as the activity of GPx, and decreasing lipid peroxidation. These results are significant since the synthesis of GSH develops exclusively in the cell cytoplasm, and its quantity under an oxidation-reduction imbalance may be defective. Therefore, the results allow us to consider these nanostructures as a helpful study tool to reduce the damage associated with oxidative stress in various diseases such as osteoarthritis.
Collapse
Affiliation(s)
- Patricia Ramírez-Noguera
- Multidisciplinary Research Unit, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Carretera Cuautitlán-Teoloyucan Km. 2.5, San Sebastián Xhala, Cuautitlán Izcalli CP 54714, Mexico; (P.R.-N.)
| | - Iliane Zetina Marín
- Multidisciplinary Research Unit, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Carretera Cuautitlán-Teoloyucan Km. 2.5, San Sebastián Xhala, Cuautitlán Izcalli CP 54714, Mexico; (P.R.-N.)
| | - Blanca Margarita Gómez Chavarin
- School of Medicine, Universidad Nacional Autónoma de México, Circuito Interior, Ciudad Universitaria, Av. Universidad 3000, Mexico City CP 04510, Mexico
| | - Moisés Eduardo Valderrama
- Equine Hospital, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Carretera Cuautitlán-Teoloyucan Km. 2.5, San Sebastián Xhala, Cuautitlán Izcalli CP 54714, Mexico
| | - Laura Denise López-Barrera
- Multidisciplinary Research Unit, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Carretera Cuautitlán-Teoloyucan Km. 2.5, San Sebastián Xhala, Cuautitlán Izcalli CP 54714, Mexico; (P.R.-N.)
| | - Roberto Díaz-Torres
- Multidisciplinary Research Unit, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Carretera Cuautitlán-Teoloyucan Km. 2.5, San Sebastián Xhala, Cuautitlán Izcalli CP 54714, Mexico; (P.R.-N.)
| |
Collapse
|
2
|
de Clifford LT, Lowe JN, McKellar CD, McGowan C, David F. A Double-Blinded Positive Control Study Comparing the Relative Efficacy of 2.5% Polyacrylamide Hydrogel (PAAG) Against Triamcinolone Acetonide (TA) And Sodium Hyaluronate (HA) in the Management of Middle Carpal Joint Lameness in Racing Thoroughbreds. J Equine Vet Sci 2021; 107:103780. [PMID: 34802625 DOI: 10.1016/j.jevs.2021.103780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022]
Abstract
The purpose of this prospective double-blinded positive control study was to compare the efficacy of 2.5% polyacrylamide hydrogel (2.5% PAAG) in the management of middle carpal joint lameness in Thoroughbreds against treatments of triamcinolone acetonide (TA) or sodium hyaluronate (HA). A total of 31 flat-racing Thoroughbreds with lameness (grade 1-3/5) localized to the carpus by intra-articular analgesia were selected. Following a radiological assessment of the carpi confirming the absence of fragment/fracture, the horses were randomly assigned for intra-articular treatment with either 2 ml of 2.5% PAAG, 12 mg TA or 20 mg HA (followed by two further intravenous treatments of 40 mg, at weekly intervals in the HA group only), by a treating veterinarian. All horses were rested for 48 hours post-treatment and then re-entered an unaltered training regimen. Subsequent examinations at 2, 4, and 6 weeks were performed by a blinded examining veterinarian for all groups, while horses treated with 2.5% PAAG were monitored for 12 weeks for recurrence of lameness. Significantly more joints treated with 2.5% PAAG were lame free (83%) at 6 weeks compared to TA (27%; P = .007) and to HA (40%; P = .04). There was no significant difference between TA and HA groups at any time. All the joints treated within 2.5% PAAG that were lame free at 6 weeks (10/12) were still lame-free at 12 weeks. In conclusion, treatment with 2.5% PAAG led to statistically superior results compared to TA and HA in the management of selected middle carpal joint lameness in flat-racing Thoroughbreds, with therapeutic effects persisting up to 12 weeks.
Collapse
Affiliation(s)
| | | | | | - Catherine McGowan
- Equine Clinical Science, University of Liverpool, Leahurst, United Kingdom
| | - Florent David
- Equine Veterinary Medical Center, Member of Qatar Foundation, Al Rayyan, Doha, Qatar; College of Health & Life Science, Hamad Bin Khalifa University, Member of Qatar Foundation, Education city, Doha, Qatar.
| |
Collapse
|
3
|
Bertuglia A, Basano I, Pagliara E, Bottegaro NB, Spinella G, Bullone M. Effect of intravenous tiludronate disodium administration on the radiographic progression of osteoarthritis of the fetlock joint in Standardbred racehorses. J Am Vet Med Assoc 2021; 259:651-661. [PMID: 34448617 DOI: 10.2460/javma.259.6.651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the effects of tiludronate disodium and 3 other medical treatments on clinical and radiographic findings and biomarkers of disease progression in horses with osteoarthritis of the fetlock joint. ANIMALS 100 Standardbred racehorses with spontaneous traumatic injury of the fetlock joint. PROCEDURES Horses were retrospectively grouped by whether they received tiludronate IV or triamcinolone acetonide and hyaluronan, polysulfated glycosaminoglycan, or interleukin-1 receptor antagonist protein intra-articularly. Data were collected on clinical, radiographic, and ultrasonographic findings and results for serum and synovial samples obtained before and 6 months after treatment. Lameness score, joint flexion test response, radiographic score, serum concentrations of tumor necrosis factor-α and carboxy-terminal telopeptides of collagen types I and II (CTX-I and II, respectively), and synovial fluid concentrations of interleukin-1β, prostaglandin E2, and CTX-II were compared among treatments. RESULTS All treatments resulted in a significant improvement in lameness score and joint flexion test response at 6 months. In horses that received triamcinolone acetonide and hyaluronan, synovial fluid interleukin-1β, prostaglandin E2, and CTX-II concentrations decreased after treatment, suggesting this treatment inhibited progression of hyaline cartilage degeneration and inflammatory processes. Horses that received tiludronate were the only group that had a decrease in radiographic score and serum CTX-I concentration after treatment, supporting the effect of tiludronate on bone metabolism. Tiludronate treatment was also followed by increases in serum and synovial fluid concentrations of CTX-II, a marker of cartilage damage. CONCLUSIONS AND CLINICAL RELEVANCE Tiludronate appeared to inhibit the radiographic progression of osteoarthritis in high-motion joints of racehorses at 6 months after treatment by inhibiting subchondral bone remodeling. Whether this effect was associated with a worsening of progressive cartilage damage remains to be ascertained.
Collapse
|
4
|
Rule EK, Boyle AG, Redding LE. Antimicrobial prescribing patterns in equine ambulatory practice. Prev Vet Med 2021; 193:105411. [PMID: 34147960 DOI: 10.1016/j.prevetmed.2021.105411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/23/2021] [Accepted: 06/07/2021] [Indexed: 12/29/2022]
Abstract
Antimicrobial resistance is one of the most important public health risks facing our world today. Antimicrobials are commonly prescribed in equine veterinary medicine, but limited information exists documenting their use in practice. The goal of this study was to investigate antimicrobial prescription patterns in regards to prescription frequency, duration, drug class, clinician and affected body system in an equine ambulatory setting via retrospective analysis of billing and electronic medical records. Risk factors associated with antimicrobial prescription including the nature of the visit, submission of a culture, body system affected and clinician were assessed using multivariable regression. We found that antimicrobials were prescribed in 8.5 % of visits with a median number of 3.5 (IQR 0.8-12.2) animal-defined daily doses (ADD), defined as the number of daily doses of all antimicrobials prescribed to a patient at a single visit. Aminoglycosides were the most common class of antimicrobials prescribed and trimethoprim sulfamethoxazole was the most common drug prescribed overall. Amikacin was primarily used for patients presenting with musculoskeletal signs, and the median number of ADDs for visits where amikacin was prescribed was 1 (IQR 0.9-1.9), while the median number of antimicrobial ADDs for all other visits was 4.4 (IQR 0-14.1). Statistically significant differences in antimicrobial use patterns existed across clinicians, months, years and affected body systems. Horses presenting with ocular (OR 1199; 95 % CI 204-7,037; p < 0.001) and integumentary (OR 365; 95 % CI 87.2-1532; p < 0.001) signs were most likely to be prescribed an antimicrobial. Emergency visits (OR 5.61; 95 % CI 3.19-9.89; p < 0.001) and submission of a bacterial culture (OR 3.58; 95 % CI 2.11-6.09; p < 0.001) were associated with an increased likelihood of an antimicrobial prescription. This observational study was the first to quantitatively characterize antimicrobial use patterns in equine ambulatory practice in the United States, which is an important step needed to determine appropriateness of use and develop and evaluate antimicrobial stewardship guidelines.
Collapse
Affiliation(s)
- Emily K Rule
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, 382 West Street Road, Kennett Square, PA, 19348, USA.
| | - Ashley G Boyle
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, 382 West Street Road, Kennett Square, PA, 19348, USA
| | - Laurel E Redding
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, 382 West Street Road, Kennett Square, PA, 19348, USA
| |
Collapse
|
5
|
Abdelhakiem MAH, Soliman GI, Rushdi M, Elsayed HK. Effect of parasitic infestation on carpal synovial constituents in donkeys (Equus asinus). BULGARIAN JOURNAL OF VETERINARY MEDICINE 2021. [DOI: 10.15547/bjvm.2019-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The present study was carried out to examine the physical, microscopical and biochemical parameters of the synovial fluid from the carpal joints of donkeys suffering from Strongylus spp. and Parascaris equorum infestation. Forty-five donkeys were selected out from a total of sixty animals based on faecal analysis. Animals were divided into 3 groups, which included Strongylus spp. (n=23), mixed infestation (n=17, Strongylus spp. and Parascaris equorum) and control (n=5) groups. The aspirated synovial fluid from all animals (n=45) was examined physically and microscopically. Then, the total protein, albumin, globulins, calcium, phosphorus, magnesium, glucose levels, and gamma glutamyl transferase (GGT) and alkaline phosphatase (ALP) activities were measured in the serum and synovial fluid of all animals. The results revealed no changes of the physical and microscopical features of the synovial fluid of the infested and control animals but there were significant decreases in total protein, albumin, globulin, glucose and magnesium levels in the serum of Strongylus and mixed infection groups. The synovial fluid analysis exhibited an increase of calcium and phosphorus levels, and ALP activity, and decreased levels of total protein, glucose and GGT in Strongylus and mixed groups. The results of this study suggested significant changes in some biochemical parameters in both serum and synovial fluids in donkeys suffering from parasitic infestation.
Collapse
Affiliation(s)
- M. A. H. Abdelhakiem
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - G. I. Soliman
- Postgraduate researcher, Elkoseyia City, Assiut Governorate, Egypt
| | - M. Rushdi
- Clinical Laboratory Diagnosis, Department of Animal Medicine, Faculty of Veterinary Medicine, Assiut University, Egypt
| | - H. K. Elsayed
- Internal Medicine, Department of Animal Medicine, Faculty of Veterinary Medicine, Assiut University, Egypt
| |
Collapse
|
6
|
da Silva Xavier AA, da Rosa PP, de Brum Mackmill L, Roll VFB. An assessment of the effectiveness of hyaluronic acid and polyacrylamide hydrogel in horses with osteoarthritis: Systematic review and network meta-analysis. Res Vet Sci 2020; 134:42-50. [PMID: 33290979 DOI: 10.1016/j.rvsc.2020.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/22/2020] [Accepted: 11/19/2020] [Indexed: 02/08/2023]
Abstract
For several years, hyaluronic acid (HyA) and, more recently, polyacrylamide hydrogel (PHyd) have been used to reduce lameness and pain caused by osteoarthritis. However, there is still a lack of scientific evidence of the efficacy of these substances to allow veterinary experts to make decisions about their use in horses. The objective of this study was to evaluate, through a systematic review and network meta-analysis (NMA), the efficacy of HyA, associated or not with other drugs, and PHyd in relieving lameness in horses with osteoarthritis. The searches for primary studies were conducted on four search platforms. The efficacy of HyA and PHyd was estimated through the relative risk difference method. Heterogeneity was observed in the efficacy of HyA, indicating long-term ineffectiveness of this drug when associated or not with anti-inflammatory drugs. In contrast, the results indicate that PHyd is an effective alternative therapy, with a long period of action in reducing lameness in horses with osteoarthritis. This study provides evidence that the application of PHyd and HyA is effective in reducing lameness caused by osteoarthritis in horses at different time periods, where PHyd has a longer time of action.
Collapse
Affiliation(s)
- Amanda Azambuja da Silva Xavier
- Federal University of Pelotas, Eliseu Maciel Faculty of Agronomy, Department of Animal Science, Eliseu Maciel Avenue, CEP 96160-000 Capão do Leão, Rio Grande do Sul, Brazil.
| | - Patrícia Pinto da Rosa
- Federal University of Pelotas, Eliseu Maciel Faculty of Agronomy, Department of Animal Science, Eliseu Maciel Avenue, CEP 96160-000 Capão do Leão, Rio Grande do Sul, Brazil
| | - Laurett de Brum Mackmill
- Federal University of Pelotas, Eliseu Maciel Faculty of Agronomy, Department of Animal Science, Eliseu Maciel Avenue, CEP 96160-000 Capão do Leão, Rio Grande do Sul, Brazil
| | - Victor Fernando Buttow Roll
- Federal University of Pelotas, Eliseu Maciel Faculty of Agronomy, Department of Animal Science, Eliseu Maciel Avenue, CEP 96160-000 Capão do Leão, Rio Grande do Sul, Brazil.
| |
Collapse
|
7
|
Johnston GCA, Wood KA, Jackson KV, Perkins NR, Zedler ST. Evaluation of the inflammatory response to two intra-articular hyaluronic acid formulations in normal equine joints. J Vet Pharmacol Ther 2019; 43:38-49. [PMID: 31660636 DOI: 10.1111/jvp.12818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 09/22/2019] [Accepted: 10/02/2019] [Indexed: 01/05/2023]
Abstract
Intra-articular (IA) hyaluronic acid (HA) is commonly used to treat equine arthritis. Inflammatory response or "joint flare" is a recognized potential side effect. However, the incidence and severity of inflammation following IA HA injection in horses is not well documented. This study compared the effects of two IA HA formulations of different molecular weight (MW) and a saline control on clinical signs and synovial fluid markers of inflammation in normal equine joints. Eight adult horses each had three healthy fetlock joints randomly assigned to treatment with either 1.4 mega Dalton HA, 0.8 mega Dalton HA or saline control once weekly for three weeks. Clinical evaluation and synovial fluid analysis were performed by blinded assessors. Outcomes of interest were lameness score, joint effusion score and synovial fluid white cell count and differential, total protein, viscosity and serum amyloid A. Joints injected with HA developed significant mild-to-moderate inflammatory responses often associated with lameness and joint effusion compared with saline control joints. The higher MW HA formulation elicited a significantly greater inflammatory response than the lower MW HA after the first injection. In HA injected joints, viscosity remained poor for the entire study. Both IA HA formulations in this study induced an inflammatory response in healthy equine joints. This may have implications for the use of HA in equine joints. The findings in this study are limited to the two HA formulations used. Further investigation of different HA formulations and the use of HA in normal and arthritic equine joints is warranted.
Collapse
Affiliation(s)
| | - Kelly A Wood
- School of Veterinary Science, University of Queensland, Gatton, Qld, Australia
| | - Karen V Jackson
- School of Veterinary Science, University of Queensland, Gatton, Qld, Australia
| | - Nigel R Perkins
- School of Veterinary Science, University of Queensland, Gatton, Qld, Australia
| | - Steven T Zedler
- School of Veterinary Science, University of Queensland, Gatton, Qld, Australia
| |
Collapse
|
8
|
Moyer CT, Bramlage LR, Werre SR, Ruggles A, Embertson R, Hopper S. Osteochondral fragments of the pastern joint at the origin of the collateral ligament of the distal sesamoid bone: performance after arthroscopic removal (2000-2015). Vet Surg 2019; 48:1181-1187. [PMID: 31456256 DOI: 10.1111/vsu.13307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 07/13/2018] [Accepted: 08/01/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the presence of fragments in the dorsal proximal interphalangeal (PIP) joint and to report flat racing performance after surgical treatment. STUDY DESIGN Retrospective study. SAMPLE POPULATION Thirty-nine affected thoroughbred flat racehorses and 169 age- and sex-matched maternal siblings. METHODS Medical records from 2000 to 2015 were reviewed for thoroughbred horses that underwent arthroscopic removal of osteochondral fragments in the dorsal aspect of the PIP joint. The horses' 2-year-old year, 3-year-old year, and career athletic performances were compared with their matched siblings. RESULTS Thirty-nine thoroughbred horses were included, varying in age from 4 months to 4 years, with osteochondral fragments in 42 PIP joints. Hind limbs (92%) were more commonly affected than forelimbs (8%). Fragments were located within the origin of the collateral ligament of the distal sesamoid (navicular) bone. After surgery, the likelihood of starting a race did not differ between treated horses (27/39 [69%]) and maternal siblings (129/169 [76%], P = .15). Race earnings did not differ between treated horses and their siblings during their 2-year-old year (P = .66), 3-year-old year (P = .43), or career (P = .60). CONCLUSION Removing osteochondral fragments from the origin of the collateral ligament of the distal sesamoid bone did not impair the ability to race or earning potential for affected thoroughbred racehorses compared with their maternal siblings. CLINICAL SIGNIFICANCE Fragments from the dorsal aspect of the PIP joint in racehorses can be removed arthroscopically resulting in a good clinical outcome and future flat racing performance comparable to matched controls.
Collapse
Affiliation(s)
- Christine T Moyer
- Marion duPont Scott Equine Medical Center, Virginia Polytechnic Institute and State University, Leesburg, Virginia
| | | | - Stephen R Werre
- Laboratory for Study Design and Statistical Analysis, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Alan Ruggles
- Rood and Riddle Equine Hospital, Lexington, Kentucky
| | | | - Scott Hopper
- Rood and Riddle Equine Hospital, Lexington, Kentucky
| |
Collapse
|
9
|
McCoy AM, Smith RL, Herrera S, Kawcak CE, McIlwraith CW, Goodrich LR. Long-term outcome after stifle arthroscopy in 82 Western performance horses (2003-2010). Vet Surg 2019; 48:956-965. [PMID: 31199028 DOI: 10.1111/vsu.13241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/09/2018] [Accepted: 11/23/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the outcome of horses engaged in Western performance disciplines after stifle arthroscopy and identify prognostic factors for return to performance. STUDY DESIGN Retrospective case series. SAMPLE POPULATION Eighty-two Western performance horses undergoing stifle arthroscopy. METHODS Medical records were reviewed for horses involved in athletic performance/training for various Western performance disciplines and undergoing arthroscopy for lameness localized to the stifle. Follow-up was obtained ≥2 years postoperatively by telephone interviews with the owners. Preoperative and intraoperative findings as well as postoperative treatment were analyzed for their association with return to athletic performance as the primary outcome of interest. RESULTS The most common disciplines represented were cutting (n = 38), Western pleasure (n = 13), and reining (n = 13). Approximately 40% (32/82) of horses returned to intended use after surgery. Increased age, higher degree of lameness, longer duration of lameness, and the presence of partial-thickness cartilage lesions decreased the odds of returning to athletic performance. Postoperative therapies (intra-articular: stem cells, corticosteroids, interleukin-1 receptor antagonist protein, hyaluronic acid/polysulfated glycosaminoglycans; systemic: nonsteroid anti-inflammatory drugs, hyaluronic acid/polysulfated glycosaminoglycans, oral joint supplements) did not affect the odds of returning to intended use. CONCLUSION Less than half of the Western performance horses that underwent stifle arthroscopy returned to intended use. Older age, longer duration of lameness, and presence of partial-thickness cartilage lesions affected the odds of a horse returning to intended use. Postoperative therapies did not affect the outcome in this population. CLINICAL SIGNIFICANCE The prognosis of Western performance horses undergoing stifle arthroscopy is as guarded as that previously reported in horses of other disciplines.
Collapse
Affiliation(s)
- Annette M McCoy
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, Illinois
| | - Rebecca L Smith
- Department of Pathobiology, University of Illinois, Urbana, Illinois
| | - Stephanie Herrera
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Christopher E Kawcak
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - C Wayne McIlwraith
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Laurie R Goodrich
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| |
Collapse
|
10
|
Niemelä TM, Tulamo RM, Carmona JU, López C. Evaluation of the effect of experimentally induced cartilage defect and intra-articular hyaluronan on synovial fluid biomarkers in intercarpal joints of horses. Acta Vet Scand 2019; 61:24. [PMID: 31146775 PMCID: PMC6543688 DOI: 10.1186/s13028-019-0460-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 05/27/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Inflammatory and degenerative activity inside the joint can be studied in vivo by analysis of synovial fluid biomarkers. In addition to pro-inflammatory mediators, several anabolic and anti-inflammatory substances are produced during the disease process. They counteract the catabolic effects of the pro-inflammatory cytokines and thus diminish the cartilage damage. The response of synovial fluid biomarkers after intra-articular hyaluronan injection, alone or in combination with other substances, has been examined only in a few equine studies. The effects of hyaluronan on some pro-inflammatory mediators, such as prostaglandin E2, have been documented but especially the effects on synovial fluid anti-inflammatory mediators are less studied. In animal models hyaluronan has been demonstrated to reduce pain via protecting nociceptive nerve endings and by blocking pain receptor channels. However, the results obtained for pain-relief of human osteoarthritis are contradictory. The aim of the study was to measure the synovial fluid IL-1ra, PDGF-BB, TGF-β1 and TNF-α concentrations before and after surgically induced cartilage defect, and following intra-articular hyaluronan injection in horses. Eight Standardbred horses underwent bilateral arthroscopic surgeries of their intercarpal joints under general anaesthesia, and cartilage defect was created on the dorsal edge of the third carpal bone of one randomly selected intercarpal joint of each horse. Five days post-surgery, one randomly selected intercarpal joint was injected intra-articular with 3 mL HA (20 mg/mL). RESULTS Operation type had no significant effect on the synovial fluid IL-1ra, PDGF-BB, TGF-β1 and TNF-α concentrations but compared with baseline, synovial fluid IL-1ra and TNF-α concentrations increased. Intra-articular hyaluronan had no significant effect on the biomarker concentrations but a trend of mild improvement in the clinical signs of intra-articular inflammation was seen. CONCLUSIONS Creation of the cartilage defect and sham-operation lead to an increase of synovial fluid IL-1ra and TNF-α concentrations but changes in concentrations of anabolic growth factors TGF-β1 and PDGF-BB could not be documented 5 days after the arthroscopy. Intra-articular hyaluronan was well tolerated. Further research is needed to document possible treatment effects of intra-articular hyaluronan on the synovial fluid biomarkers of inflammation and cartilage metabolism.
Collapse
Affiliation(s)
- Tytti Maaria Niemelä
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014 Helsinki, Finland
| | - Riitta-Mari Tulamo
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014 Helsinki, Finland
| | - Jorge Uriel Carmona
- Grupo de Investigación Terapia Regenerativa, Departamento de Salud Animal, Universidad de Caldas, Calle 65 No26-10, Manizales, Caldas, Colombia
| | - Catalina López
- Grupo de Investigación Terapia Regenerativa, Departamento de Salud Animal, Universidad de Caldas, Calle 65 No26-10, Manizales, Caldas, Colombia
| |
Collapse
|
11
|
Niemelä TM, Tulamo RM, Aaltonen K, Sankari SM, Hielm-Björkman AK. Changes in biomarkers in equine synovial fluid two weeks after intra-articular hyaluronan treatment: a randomised double-blind clinical trial. BMC Vet Res 2018; 14:186. [PMID: 29907111 PMCID: PMC6003042 DOI: 10.1186/s12917-018-1512-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/01/2018] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Inflammatory and degenerative activity inside the joint can be studied in vivo via analysis of synovial fluid (SF) biomarkers, which are molecular markers of inflammatory processes and tissue turnover. The aim of this study was to investigate the response of selected biomarkers in the SF after an intra-articular (IA) high-molecular-weight non-animal stabilized hyaluronic acid (NASHA) treatment. Our hypothesis was that prostaglandin E2 (PGE2), substance P, aggrecan chondroitin sulfate 846 epitope (CS846), and carboxypeptide of type II collagen (CPII) concentrations in SF would decrease more in the NASHA than in the placebo group. Twenty-eight clinically lame horses with positive responses to diagnostic IA anaesthesia of the metacarpophalangeal or metatarsophalangeal joints were randomized into treatment (n = 15) and control (n = 13) groups. After collection of baseline SF samples followed by IA diagnostic anaesthesia, horses in the treatment group received 3 ml of a NASHA product IA. Those in the placebo group received an equivalent volume of sterile 0.9% saline solution. The horses were re-evaluated and a second SF sample was obtained after a 2-week period. RESULTS CS846 concentration decreased in the NASHA group only (P = 0.010). Both PGE2 and CPII concentrations decreased within the groups (PGE2, P = 0.010 for the NASHA group; P = 0.027 for the placebo group; CPII, P < 0.001 for NASHA group; P = 0.009 for placebo group). No significant treatment effect for any biomarker was found between groups. NASHA induced an increase in white blood cell count; this was significant compared with baseline (P = 0.021) and the placebo group (P = 0.045). CONCLUSIONS Although the SF concentration of the cartilage-derived biomarker CS846 decreased in the NASHA group, no statistically significant treatment effect of any of the biomarkers were observed between treatment groups. The significant increase in SF white blood cell count after IA NASHA may indicate a mild inflammatory response. However, as no clinical adverse effects were observed, we conclude that IA NASHA was well tolerated.
Collapse
Affiliation(s)
- Tytti M Niemelä
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland.
| | - Riitta-Mari Tulamo
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland
| | - Kaisa Aaltonen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland
| | - Satu M Sankari
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland
| | - Anna K Hielm-Björkman
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland
| |
Collapse
|
12
|
Kilborne AH, Hussein H, Bertone AL. Effects of hyaluronan alone or in combination with chondroitin sulfate and N-acetyl-d-glucosamine on lipopolysaccharide challenge-exposed equine fibroblast-like synovial cells. Am J Vet Res 2017; 78:579-588. [PMID: 28441052 DOI: 10.2460/ajvr.78.5.579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate effects of hyaluronic acid (HA) or HA combined with chondroitin sulfate (CS) and N-acetyl-d-glucosamine (NAG) by use of a lipopolysaccharide (LPS) in vitro method. SAMPLE Monolayer cultures of synovial cells from 4 adult horses. PROCEDURES Synovial cell cultures were untreated or treated with HA alone or HA-CS-NAG for 24 hours, subsequently unchallenged or challenge-exposed with 2 LPS concentrations (20 and 50 ng/mL) for 2 hours, and retreated with HA or HA-CS-NAG for another 24 hours. Cellular morphology of cultures was evaluated at 0, 24 (before LPS), 26 (after LPS), and 50 (24 hours after end of LPS) hours. At 50 hours, cell number and viability and prostaglandin (PG) E2, interleukin (IL)-6, matrix metalloproteinase (MMP)-3, and cyclooxygenase (COX)-2 production were measured. RESULTS LPS challenge exposure induced a significant loss of characteristic synovial cell morphology, decrease in cell viability, and increases in concentrations of PGE2, IL-6, MMP-3, and COX-2. Cells treated with HA or HA-CS-NAG had significantly better viability and morphology scores and lower concentrations of PGE2, MMP-3, IL-6, and COX-2 than untreated LPS challenge-exposed cells. Cells treated with HA had significantly better morphology scores at 50 hours than cells treated with HA-CS-NAG. Cells treated with HA-CS-NAG had significantly superior suppression of LPS-induced production of PGE2, IL-6, and MMP-3 than cells treated with HA alone. CONCLUSIONS AND CLINICAL RELEVANCE HA and HA-CS-NAG protected synovial cells from the effects of LPS. Treatment with HA-CS-NAG had the greatest anti-inflammatory effect. These results supported the protective potential of HA and HA-CS-NAG treatments.
Collapse
|
13
|
King MR, Haussler KK, Kawcak CE, McIlwraith CW, Reiser RF, Frisbie DD, Werpy NM. Biomechanical and histologic evaluation of the effects of underwater treadmill exercise on horses with experimentally induced osteoarthritis of the middle carpal joint. Am J Vet Res 2017; 78:558-569. [PMID: 28441054 DOI: 10.2460/ajvr.78.5.558] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effects of exercise in an underwater treadmill (UWT) on forelimb biomechanics and articular histologic outcomes in horses with experimentally induced osteoarthritis of the middle carpal joint. ANIMALS 16 horses. PROCEDURES An osteochondral fragment was induced arthroscopically (day 0) in 1 middle carpal joint of each horse. Beginning on day 15, horses were assigned to exercise in a UWT or in the UWT without water (simulating controlled hand walking) at the same speed, frequency, and duration. Thoracic and pelvic limb ground reaction forces, thoracic limb kinematics, and electromyographic results for select thoracic limb muscles acting on the carpi were collected on days -7 (baseline), 14, 42, and 70. Weekly evaluations included clinical assessments of lameness, response to carpal joint flexion, and goniometric measurements of thoracic limb articulations. At study conclusion, articular cartilage and synovial membrane from the middle carpal joints was histologically examined. RESULTS Exercise in a UWT significantly reduced synovial membrane inflammation and resulted in significant clinical improvements with regard to symmetric thoracic limb loading, uniform activation patterns of select thoracic limb muscles, and return to baseline values for carpal joint flexion, compared with results for horses with simulated hand walking. CONCLUSIONS AND CLINICAL RELEVANCE Overall improvements in thoracic limb function, joint range of motion, and synovial membrane integrity indicated that exercise in a UWT was a potentially viable therapeutic option for the management of carpal joint osteoarthritis in horses.
Collapse
|
14
|
Miller SM, Spargo KE. Science-in-brief: Clinical highlights from 50th Congress of the South African Equine Veterinary Association 2017. Equine Vet J 2017; 49:266-268. [DOI: 10.1111/evj.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 11/26/2022]
Affiliation(s)
- S. M. Miller
- Summerveld Equine Hospital; Summerveld South Africa
- Section Diagnostic Imaging; Department of Companion Animal Clinical Studies, Faculty of Veterinary Science; University of Pretoria, Onderstepoort; Pretoria South Africa
| | - K. E. Spargo
- Section Diagnostic Imaging; Department of Companion Animal Clinical Studies, Faculty of Veterinary Science; University of Pretoria, Onderstepoort; Pretoria South Africa
| |
Collapse
|
15
|
Clinical Presentation, Progression, and Management of Five Cases of Ross River Virus Infection in Performance Horses Located in Southeast Queensland: A Longitudinal Case Series. J Equine Vet Sci 2017. [DOI: 10.1016/j.jevs.2016.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
16
|
Frisbie DD, McIlwraith CW, Kawcak CE, Werpy NM. Efficacy of intravenous administration of hyaluronan, sodium chondroitin sulfate, andN-acetyl-d-glucosamine for prevention or treatment of osteoarthritis in horses. Am J Vet Res 2016; 77:1064-70. [DOI: 10.2460/ajvr.77.10.1064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
17
|
Niemelä TM, Tulamo RM, Hielm-Björkman AK. A randomised, double-blinded, placebo-controlled clinical study on intra-articular hyaluronan treatment in equine lameness originating from the metacarpophalangeal joint. BMC Vet Res 2016; 12:60. [PMID: 27005478 PMCID: PMC4804525 DOI: 10.1186/s12917-016-0687-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 03/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Intra-articular inflammation resulting in lameness is a common health problem in horses. Exogenous intra-articular hyaluronic acid has been shown to provide an analgesic effect and reduce pain in equine and human osteoarthritis. High molecular weight non-animal stabilized hyaluronic acid (NASHA) has gained popularity in the treatment of human arthritic conditions due to its long-acting pain-relieving effects. The aim of this study was to compare the response to treatment of lameness localized in the equine metacarpophalangeal joint injected with non-animal stabilized hyaluronic acid (NASHA) and placebo (saline). Twenty-seven clinically lame horses with a positive response to diagnostic intra-articular anaesthesia of the metacarpophalangeal joint and with no, or at most mild, radiographic changes in this joint were included in the study. Horses in the treatment group (n = 14) received 3 mL of a NASHA product intra-articularly, and those in the placebo group (n = 13) received an equivalent volume of sterile 0.9 % saline solution. Results The change in the lameness score did not significantly differ between NASHA and placebo groups (P = 0.94). Scores in the flexion test improved more in the NASHA group compared with placebo (P = 0.01). The changes in effusion and pain in flexion were similar (P = 0.94 and P = 0.27, respectively) when NASHA and placebo groups were compared. A telephone interview follow-up of the owners three months post-treatment revealed that 14 of the 21 horses (67 %) were able to perform at their previous level of exercise. Conclusions In the present study, a single IA NASHA injection was not better than a single saline injection for reducing lameness in horses with synovitis or mild osteoarthritis. However, the results of this study indicate that IA NASHA may have some beneficial effects in modifying mild clinical signs but more research is needed to evaluate whether the positive effect documented ie. reduced response in the flexion test is a true treatment effect.
Collapse
Affiliation(s)
- Tytti M Niemelä
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki,, P.O. Box 57, 00014, Helsinki, Finland.
| | - Riitta-Mari Tulamo
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki,, P.O. Box 57, 00014, Helsinki, Finland
| | - Anna K Hielm-Björkman
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki,, P.O. Box 57, 00014, Helsinki, Finland
| |
Collapse
|
18
|
Remst DFG, Blaney Davidson EN, van der Kraan PM. Unravelling osteoarthritis-related synovial fibrosis: a step closer to solving joint stiffness. Rheumatology (Oxford) 2015; 54:1954-63. [PMID: 26175472 DOI: 10.1093/rheumatology/kev228] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Indexed: 01/01/2023] Open
Abstract
Synovial fibrosis is often found in OA, contributing heavily to joint pain and joint stiffness, the main symptoms of OA. At this moment the underlying mechanism of OA-related synovial fibrosis is not known and there is no cure available. In this review we discuss factors that have been reported to be involved in synovial fibrosis. The aim of the study was to gain insight into how these factors contribute to the fibrotic process and to determine the best targets for therapy in synovial fibrosis. In this regard, the following factors are discussed: TGF-β, connective tissue growth factor, procollagen-lysine, 2-oxoglutarate 5-dioxygenase 2, tissue inhibitor of metalloproteinase 1, A disintegrin and metalloproteinase domain 12, urotensin-II, prostaglandin F2α and hyaluronan.
Collapse
Affiliation(s)
- Dennis F G Remst
- Radboud University Medical Center, Experimental Rheumatology, Nijmegen, The Netherlands
| | | | - Peter M van der Kraan
- Radboud University Medical Center, Experimental Rheumatology, Nijmegen, The Netherlands
| |
Collapse
|
19
|
Goodrich LR, Grieger JC, Phillips JN, Khan N, Gray SJ, McIlwraith CW, Samulski RJ. scAAVIL-1ra dosing trial in a large animal model and validation of long-term expression with repeat administration for osteoarthritis therapy. Gene Ther 2015; 22:536-45. [PMID: 25902762 DOI: 10.1038/gt.2015.21] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/22/2015] [Indexed: 11/09/2022]
Abstract
A gene therapeutic approach to treat osteoarthritis (OA) appears to be on the horizon for millions of people who suffer from this disease. Previously we described optimization of a scAAVIL-1ra gene therapeutic vector and initially tested this in an equine model verifying long-term intrasynovial IL-1ra protein at therapeutic levels. Using this vector, we carried out a dosing trial in six horses to verify protein levels and establish a dose that would express relevant levels of therapeutic protein for extended periods of time (8 months). A novel arthroscopic procedure used to detect green fluorescence protein (GFP) fluorescence intrasynovially confirmed successful transduction of the scAAVGFP vector in both the synovial and cartilage tissues. No evidence of intra-articular toxicity was detected. Immune responses to vector revealed development of neutralizing antibodies (Nabs) within 2 weeks of administration, which persisted for the duration of the study but did not lower protein expression intra-articularly. Re-dosing with a different serotype to attain therapeutic levels of protein confirmed establishment of successful transduction. This is the first study in an equine model to establish a dosing/redosing protocol, as well as examine the Nab response to capsid and supports further clinical investigation to determine the clinical efficacy of scAAVIL-1ra to treat OA.
Collapse
Affiliation(s)
- L R Goodrich
- Orthopaedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, CO, USA
| | - J C Grieger
- UNC Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J N Phillips
- Orthopaedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, CO, USA
| | - N Khan
- UNC Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S J Gray
- UNC Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C W McIlwraith
- Orthopaedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, CO, USA
| | - R J Samulski
- UNC Gene Therapy Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
20
|
Tnibar A, Schougaard H, Camitz L, Rasmussen J, Koene M, Jahn W, Markussen B. An international multi-centre prospective study on the efficacy of an intraarticular polyacrylamide hydrogel in horses with osteoarthritis: a 24 months follow-up. Acta Vet Scand 2015; 57:20. [PMID: 25887429 PMCID: PMC4403890 DOI: 10.1186/s13028-015-0110-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/09/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Polyacrylamide hydrogel (PAAG) was evaluated recently to treat osteoarthritis (OA) in horses with highly encouraging results; however no long term field-study was done to explore its clinical efficacy and lasting effect. The objective of this study was to evaluate the efficacy of PAAG in improving clinical signs of OA in horses. We hypothesized that lameness grade would significantly improve and the effect would last at least 2 years in osteoarthritic joints treated with PAAG. Forty three horses older than 2 years with OA in only one joint based on clinical evaluation, intra-articular anaesthesia and imaging (radiography) were included in this study. Horses were injected with 2 ml of PAAG into the affected joint and were followed up at 1, 3, 6, 12 and 24 months. Efficacy of PAAG was evaluated by blinded clinical assessment of lameness. Adverse reactions to joint injection were assessed. Data relating to case details, type of activity, joint and limb involved, lameness duration, lameness grading, previous joint treatment, joint effusion grading, radiographic grading, and owner assessment were recorded. Factors associated with the outcome measure "lameness grading" were analyzed using generalized linear mixed model for logistic regression. RESULTS At 1, 3, 6, 12 and 24 months follow-up, 59%, 69%, 79%, 81/% and 82.5% of horses were non-lame respectively. Reduction of joint effusion was observed over time. No side effect was observed in the treated joints. There was a significant decrease in lameness grade from baseline to 1, 3, 6, 12 and 24 months (P < 0.0001) and a significant positive association with joint effusion (P < 0.0001). Estimates for odds ratio (OR) showed that the effect of treatment increased over time (OR for lower lameness from month 1 to month 24 relative to baseline increased from 20 to 58). CONCLUSIONS PAAG significantly alleviated lameness and joint effusion in osteoarthritic joints. PAAG is a safe and lasting (at least 24 months) OA treatment in horses. PAAG is a promising new treatment for OA in horses.
Collapse
Affiliation(s)
- Aziz Tnibar
- Department of Large Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Hoejbakkegaard alle 5, DK-2630, Taastrup, Denmark.
| | - Hans Schougaard
- Noerlund Hestehospital, Roedebækvej 2, DK-8653, Them, Denmark.
| | - Linus Camitz
- Camitz equestrian, Aasoe Mosevej 13, DK-4171, Glumsoe, Denmark.
| | - Jonas Rasmussen
- Hoejgaard Hestehospital, Rugaardsvej 696, DK-5462, Morud, Denmark.
| | - Marc Koene
- Tieraerztlische Klinik fuer Pferde, Essener Strasse 39a, D-49456, Bakum, Germany.
| | - Werner Jahn
- Pferdeklinik Bargteheide, Alte Landstrasse 104, D-22941, Bargteheide, Germany.
| | - Bo Markussen
- Department of Mathematical Sciences, Laboratory of Applied Statistics, University of Copenhagen, Universitetsparken 5, DK-2100, Copenhagen, Denmark.
| |
Collapse
|
21
|
de Grauw JC, Visser-Meijer MC, Lashley F, Meeus P, van Weeren PR. Intra-articular treatment with triamcinolone compared with triamcinolone with hyaluronate: A randomised open-label multicentre clinical trial in 80 lame horses. Equine Vet J 2015; 48:152-8. [DOI: 10.1111/evj.12383] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 10/28/2014] [Indexed: 11/27/2022]
Affiliation(s)
- J. C. de Grauw
- Department of Equine Sciences; Faculty of Veterinary Medicine; Utrecht University; The Netherlands
| | | | - F. Lashley
- Equine Clinic de Raaphorst; Wassenaar The Netherlands
| | - P. Meeus
- Veterinary Clinic Ridderkerk; The Netherlands
| | - P. R. van Weeren
- Department of Equine Sciences; Faculty of Veterinary Medicine; Utrecht University; The Netherlands
| |
Collapse
|
22
|
Braga PC, Dal Sasso M, Lattuada N, Greco V, Sibilia V, Zucca E, Stucchi L, Ferro E, Ferrucci F. Antioxidant activity of hyaluronic acid investigated by means of chemiluminescence of equine neutrophil bursts and electron paramagnetic resonance spectroscopy. J Vet Pharmacol Ther 2014; 38:48-54. [DOI: 10.1111/jvp.12141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 05/14/2014] [Indexed: 01/18/2023]
Affiliation(s)
- P. C. Braga
- Centre of Respiratory Pharmacology; School of Medicine; Università degli Studi di Milano; Milano Italy
- Department of Medical Biotechnology and Translational Medicine; School of Medicine; Università degli Studi di Milano; Milano Italy
| | - M. Dal Sasso
- Department of Medical Biotechnology and Translational Medicine; School of Medicine; Università degli Studi di Milano; Milano Italy
| | - N. Lattuada
- Department of Medical Biotechnology and Translational Medicine; School of Medicine; Università degli Studi di Milano; Milano Italy
| | - V. Greco
- Department of Medical Biotechnology and Translational Medicine; School of Medicine; Università degli Studi di Milano; Milano Italy
| | - V. Sibilia
- Department of Medical Biotechnology and Translational Medicine; School of Medicine; Università degli Studi di Milano; Milano Italy
| | - E. Zucca
- Department of Health, Animal Science and Food Safety; School of Veterinary Medicine; Università degli Studi di Milano; Milano Italy
| | - L. Stucchi
- Department of Health, Animal Science and Food Safety; School of Veterinary Medicine; Università degli Studi di Milano; Milano Italy
| | - E. Ferro
- Department of Health, Animal Science and Food Safety; School of Veterinary Medicine; Università degli Studi di Milano; Milano Italy
| | - F. Ferrucci
- Department of Health, Animal Science and Food Safety; School of Veterinary Medicine; Università degli Studi di Milano; Milano Italy
| |
Collapse
|
23
|
Koenig TJ, Dart AJ, McIlwraith CW, Horadagoda N, Bell RJ, Perkins N, Dart C, Krockenberger M, Jeffcott LB, Little CB. Treatment of experimentally induced osteoarthritis in horses using an intravenous combination of sodium pentosan polysulfate, N-acetyl glucosamine, and sodium hyaluronan. Vet Surg 2014; 43:612-22. [PMID: 24819506 DOI: 10.1111/j.1532-950x.2014.12203.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 03/01/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effects of sodium pentosan polysulfate (PPS), N-acetyl glucosamine (NAG), and sodium hyaluronan (HA) in horses with induced osteoarthritis (OA). STUDY DESIGN Experimental. ANIMALS Adult Standard bred horses (n = 16). METHODS OA was induced arthroscopically in 1 intercarpal joint; 8 horses were administered 3 mg/kg PPS, 4.8 mg/kg NAG, and 0.12 mg/kg HA (PGH), intravenously (IV), weekly and 8 horses were administered an equivalent volume of saline IV until study completion (day 70). Horses underwent a standardized treadmill exercise program. Clinical and radiographic findings and synovial fluid analysis were evaluated throughout the study. Macroscopic, histologic, histochemical, and biochemical findings were evaluated after necropsy. Comparisons of interest included OA and non-OA joints of saline treated horses and OA joints of PGH treated horses and OA joints of saline treated horses. Results were statistically analyzed with significance set at P < .05. RESULTS OA caused increases in clinical assessment scores, synovial fluid variables, radiographic, macroscopic, and histologic cartilage scores, synovial fluid and cartilage chondroitin sulfate 846-epitope and glycosaminoglycan concentration. Total radiographic scores, total macroscopic joint pathology and macroscopic cartilage pathology scores were significantly reduced in horses treated with PGH compared with saline treated horses. Synovial fluid total protein concentration and white blood cell count were higher in OA joints of PGH treated horses compared with saline treated horses. There were no other significant differences between treatment groups. CONCLUSIONS Improvements in macroscopic variables were not supported by other outcomes. Further evidence is needed before PGH can be recommended as a therapeutic option for osteoarthritis in horses.
Collapse
Affiliation(s)
- Toby J Koenig
- Research and Clinical Training Unit, University Veterinary Teaching Hospital Camden, Faculty of Veterinary Science, University of Sydney, Camden, Australia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Bertone AL, Ishihara A, Zekas LJ, Wellman ML, Lewis KB, Schwarze RA, Barnaba AR, Schmall ML, Kanter PM, Genovese RL. Evaluation of a single intra-articular injection of autologous protein solution for treatment of osteoarthritis in horses. Am J Vet Res 2014; 75:141-51. [PMID: 24471750 DOI: 10.2460/ajvr.75.2.141] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate intra-articular autologous protein solution (APS) for the treatment of osteoarthritis in horses. Animals-40 client-owned horses with naturally occuring osteoarthritis. PROCEDURES APS was generated from a dual-device system that concentrated plasma and WBC proteins and enriched platelet growth factors. Horses were randomly assigned to receive an intra-articular injection of 5 mL of saline (0.9% NaCl) solution (n = 20) or APS (20), exercised on a treadmill, and evaluated on the basis of lameness grades, kinetic gait analysis, joint circumference, and range of motion for 14 days. Horses that received saline solution were administered APS at termination of the study, and clients scored horses for lameness and discomfort before, 12 weeks after, and 52 weeks after the APS injection. RESULTS The APS group had significant improvements in lameness grade, asymmetry indices of vertical peak force, and range of joint motion by 14 days, compared with baseline or control group values. No adverse effects associated with APS treatment were evident. Clients assessed lameness and comfort as improved at 12 and 52 weeks. The APS had greater likelihood (OR, 4.3 to 30.0) of a therapeutic response in horses with a lameness score < 4, < 10% vertical force asymmetry, or absence of marked osteophyte formation, subchondral sclerosis, or joint space narrowing. Concentration of interleukin-1 receptor antagonist in APS was 5.8 times that in blood. CONCLUSIONS AND CLINICAL RELEVANCE Intra-articular administration of APS can be considered an effective treatment option for equine osteoarthritis, with the potential for disease-modifying effects.
Collapse
Affiliation(s)
- Alicia L Bertone
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Frisbie D, McIlwraith C, Kawcak C, Werpy N. Evaluation of intra-articular hyaluronan, sodium chondroitin sulfate and N-acetyl-d-glucosamine combination versus saline (0.9% NaCl) for osteoarthritis using an equine model. Vet J 2013; 197:824-9. [DOI: 10.1016/j.tvjl.2013.05.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/20/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
|
26
|
Boyce MK, Trumble TN, Carlson CS, Groschen DM, Merritt KA, Brown MP. Non-terminal animal model of post-traumatic osteoarthritis induced by acute joint injury. Osteoarthritis Cartilage 2013; 21:746-55. [PMID: 23467035 PMCID: PMC3624059 DOI: 10.1016/j.joca.2013.02.653] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 02/12/2013] [Accepted: 02/21/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Develop a non-terminal animal model of acute joint injury that demonstrates clinical and morphological evidence of early post-traumatic osteoarthritis (PTOA). METHODS An osteochondral (OC) fragment was created arthroscopically in one metacarpophalangeal (MCP) joint of 11 horses and the contralateral joint was sham operated. Eleven additional horses served as unoperated controls. Every 2 weeks, force plate analysis, flexion response, joint circumference, and synovial effusion scores were recorded. At weeks 0 and 16, radiographs (all horses) and arthroscopic videos (OC injured and sham joints) were graded. At week 16, synovium and cartilage biopsies were taken arthroscopically from OC injured and sham joints for histologic evaluation and the OC fragment was removed. RESULTS OC fragments were successfully created and horses were free of clinical lameness after fragment removal. Forelimb gait asymmetry was observed at week 2 (P = 0.0012), while joint circumference (P < 0.0001) and effusion scores (P < 0.0001) were increased in injured limbs compared to baseline from weeks 2 to 16. Positive flexion response of injured limbs was noted at multiple time points. Capsular enthesophytes were seen radiographically in injured limbs. Articular cartilage damage was demonstrated arthroscopically as mild wear-lines and histologically as superficial zone chondrocyte death accompanied by mild proliferation. Synovial hyperemia and fibrosis were present at the site of OC injury. CONCLUSION Acute OC injury to the MCP joint resulted in clinical, imaging, and histologic changes in cartilage and synovium characteristic of early PTOA. This model will be useful for defining biomarkers of early osteoarthritis and for monitoring response to therapy and surgery.
Collapse
Affiliation(s)
- Mary K. Boyce
- Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, MN
| | - Troy N. Trumble
- Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, MN
| | - Cathy S. Carlson
- Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, MN
| | - Donna M. Groschen
- Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, MN
| | - Kelly A. Merritt
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Murray P. Brown
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| |
Collapse
|
27
|
Goodrich LR, Phillips JN, McIlwraith CW, Foti SB, Grieger JC, Gray SJ, Samulski RJ. Optimization of scAAVIL-1ra In Vitro and In Vivo to Deliver High Levels of Therapeutic Protein for Treatment of Osteoarthritis. MOLECULAR THERAPY-NUCLEIC ACIDS 2013; 2:e70. [PMID: 23385523 PMCID: PMC3586798 DOI: 10.1038/mtna.2012.61] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Osteoarthritis (OA) affects over 40 million people annually. We evaluated interleukin-1 receptor antagonist (IL-1ra) gene transfer in an equine model based on IL-1ra protein therapy which inhibits inflammation through blocking IL-1. Using the self-complementary adeno-associated virus (scAAV)IL-1ra equine gene as a starting construct, we optimized the transgene cassette by analyzing promoters (cytomegalovirus (CMV) versus chicken β-actin hybrid (CBh)), coding sequences (optimized versus unoptimized), vector capsid (serotype 2 versus chimeric capsid), and biological activity in vitro. AAV serotypes 2 and 2.5 CMV scAAVoptIL-1ra were tested in equine joints. We evaluated two doses of scAAVIL-1ra, scAAVGFP, and saline. We developed a novel endoscopy procedure and confirmed vector-derived transgene expression (GFP) in chondrocytes 6 months post-injection. AAVIL-1ra therapeutic protein levels were 200-800 ng/ml of synovial fluid over 23 and 186 days, respectively. No evidence of intra-articular toxicity was detected and no vector genomes were found in contralateral joints based on GFP fluorescence microscopy and quantitative PCR. Finally, we assayed vector-derived IL-1ra activity based on functional assays which supported anti-inflammatory activity of our protein. These studies represent the first large animal intra-articular gene transfer approach with a therapeutic gene using scAAV and demonstrate high levels of protein production over extended time supporting further clinical investigation using scAAV gene therapy for OA.Molecular Therapy - Nucleic Acids (2013) 2, e70; doi:10.1038/mtna.2012.61; published online 5 February 2013.
Collapse
Affiliation(s)
- Laurie R Goodrich
- Orthopaedic Research Center, College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado, USA
| | | | | | | | | | | | | |
Collapse
|
28
|
McIlwraith CW, Frisbie DD, Kawcak CE. The horse as a model of naturally occurring osteoarthritis. Bone Joint Res 2012; 1:297-309. [PMID: 23610661 PMCID: PMC3626203 DOI: 10.1302/2046-3758.111.2000132] [Citation(s) in RCA: 174] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 09/24/2012] [Indexed: 01/15/2023] Open
Abstract
Osteoarthritis (OA) is an important cause of
pain, disability and economic loss in humans, and is similarly important in
the horse. Recent knowledge on post-traumatic OA has suggested opportunities
for early intervention, but it is difficult to identify the appropriate
time of these interventions. The horse provides two useful mechanisms
to answer these questions: 1) extensive experience with clinical
OA in horses; and 2) use of a consistently predictable model of
OA that can help study early pathobiological events, define targets
for therapeutic intervention and then test these putative therapies.
This paper summarises the syndromes of clinical OA in horses including
pathogenesis, diagnosis and treatment, and details controlled studies
of various treatment options using an equine model of clinical OA.
Collapse
Affiliation(s)
- C W McIlwraith
- Orthopaedic Research Center, Colorado State University, 300 West Drake Road, Fort Collins, Colorado 80523, USA
| | | | | |
Collapse
|
29
|
McIlwraith CW, Frisbie DD, Kawcak CE. Evaluation of intramuscularly administered sodium pentosan polysulfate for treatment of experimentally induced osteoarthritis in horses. Am J Vet Res 2012; 73:628-33. [PMID: 22533393 DOI: 10.2460/ajvr.73.5.628] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess clinical, radiographic, histologic, and biochemical effects of sodium pentosan polysulfate (NaPPS) administered IM for treatment of experimentally induced osteoarthritis in horses. ANIMALS 18 horses. PROCEDURES Osteoarthritis was induced arthroscopically in 1 middle carpal joint of all horses. Nine horses received NaPPS (3 mg/kg, IM) on study days 15, 22, 29, and 36. Nine control horses received the same volume of saline (0.9% NaCl) solution IM on study days 15, 22, 29, and 36. Clinical, radiographic, gross, histologic, histochemical, and biochemical findings as well as findings of synovial fluid analysis were evaluated. RESULTS No adverse treatment-related events were detected. Induced osteoarthritis caused a substantial increase in lameness, response to flexion, joint effusion, radiographic findings, synovial membrane inflammation, and articular cartilage fibrillation. Articular cartilage fibrillation was substantially reduced by NaPPS treatment, and concentrations of chondroitin sulfate 846 epitope were significantly increased in the synovial fluid of osteoarthritic and non-osteoarthritic joints of treated horses. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that NaPPS has some beneficial disease-modifying effects and may be a therapeutic option for osteoarthritis in horses.
Collapse
Affiliation(s)
- C Wayne McIlwraith
- Gail Holmes Equine Orthopaedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA.
| | | | | |
Collapse
|
30
|
Clegg TE, Caborn D, Mauffrey C. Viscosupplementation with hyaluronic acid in the treatment for cartilage lesions: a review of current evidence and future directions. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 23:119-24. [PMID: 23412441 DOI: 10.1007/s00590-012-0940-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 01/07/2012] [Indexed: 12/26/2022]
Abstract
Diseases involving the articular cartilage are one of the leading causes of physical impairment among the adult population. While surgical technique and advancement have allowed us effective means at treating these diseases, this is not without significant risk and morbidity. With a very solid safety profile, viscosupplementation with hyaluronic acid (HA) derivatives has become an excellent modality for treating diseased articular cartilage. Recent literature supports the use of HA not only in the management of the pain associated with osteoarthritis but also as a disease-modifying agent as well. Further studies have started to define exciting new roles for viscosupplementation in the treatment for acute injuries to the joint microenvironment.
Collapse
Affiliation(s)
- Travis E Clegg
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
| | | | | |
Collapse
|
31
|
Kay AT, Hunt RJ, Rodgerson DH, Spirito MA, Santschi EM, Payne RJ. Osteomyelitis of the patella in eight foals. Vet Surg 2012; 41:307-15. [PMID: 22225421 DOI: 10.1111/j.1532-950x.2011.00937.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the characteristics of osteomyelitis lesions of the patella and to report short- and long-term outcome after treatment in 8 foals. STUDY DESIGN Retrospective case series. ANIMALS Foals (n = 8). METHODS Medical records (2003-2007) and radiographs of foals that had osteomyelitis of the patella were reviewed. Inclusion criteria included clinical, radiographic, and surgical findings consistent with osteomyelitis of the patella, and a long-term follow-up of >15 months. Information acquired included signalment, hematologic and serum biochemical profile results, clinical and radiographic signs, surgical technique and perioperative treatment. Follow-up radiographs were evaluated and outcome was determined from veterinary examination, race records, and telephone questionnaire. RESULTS Six foals survived long term (15 months-4 years); all had intralesional and systemic antimicrobial therapy, along with synovial lavage and antimicrobial medication. All were sound and achieved either yearling sales (n=3), show hunter or racing (2). Two foals died in the short term from renal failure and suppurative peritonitis secondary to cecal perforation, 1 remaining lame with suppurative osteonecrosis confirmed at necropsy. This foal was not administered intralesional antimicrobial therapy. CONCLUSIONS Prompt medical and surgical therapy for osteomyelitis of the patella can result in a good prognosis for soundness and a potential athletic career. Concurrent septicemia or other systemic perinatal disease can result in prolonged therapy and delayed recovery.
Collapse
|
32
|
Kawcak CE, McIlwraith CW. Comparison of Synovial Fluid in Middle Carpal Joints Undergoing Needle Aspiration, Infusion with Saline, and Infusion with a Combination of N-Acetyl-d-Glucosamine, Hyaluronic Acid, and Sodium Chondroitin Sulfate. J Equine Vet Sci 2011. [DOI: 10.1016/j.jevs.2011.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
33
|
Clegg PD. Investigating the efficacy of articular medications in the horse: the science behind clinical practices. Equine Vet J 2010; 42:484-6. [PMID: 20716186 DOI: 10.1111/j.2042-3306.2010.00210.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P D Clegg
- Musculoskeletal and Locomotion Research Group, Faculty of Health and Life Sciences, University of Liverpool, UK
| |
Collapse
|
34
|
Edwards SHR. Intra-articular drug delivery: the challenge to extend drug residence time within the joint. Vet J 2010; 190:15-21. [PMID: 20947396 DOI: 10.1016/j.tvjl.2010.09.019] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 09/20/2010] [Accepted: 09/22/2010] [Indexed: 02/02/2023]
Abstract
The rationale behind developing sustained release microsphere formulations of non-steroidal anti-inflammatory drugs (NSAIDs) administered via the intra-articular (IA) route is to minimise the systemic bioavailability and attendant side-effects associated with oral drug administration. Overall dose is reduced whilst therapeutic benefit within the joint is maintained. The potential benefits of IA therapy for osteoarthritis (OA) are not achieved using currently available medications and delivery vehicles due to the rapid clearance of therapeutic substances from the synovial space. There is a need for sustained release delivery systems if the potential of IA drug administration is to be realised. Rationally designed microspheres taken up by synovial macrophages offer a strategy to sustain drug delivery within the joint, and to deliver NSAIDs directly to pivotal inflammatory cells. The efficacy of microsphere candidates may be evaluated in large animal models of OA. The principles of IA microsphere drug delivery may also be applicable to other classes of drugs.
Collapse
Affiliation(s)
- Scott H R Edwards
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia.
| |
Collapse
|
35
|
McILWRAITH CW. The use of intra-articular corticosteroids in the horse: What is known on a scientific basis? Equine Vet J 2010; 42:563-71. [DOI: 10.1111/j.2042-3306.2010.00095.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|