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Di Salvo A, Chiaradia E, Nannarone S, Della Rocca G. Intra-articular use of analgesic/antinflammatory drugs in dogs and horses. Res Vet Sci 2020; 134:159-170. [PMID: 33387756 DOI: 10.1016/j.rvsc.2020.12.014] [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: 09/03/2020] [Revised: 11/24/2020] [Accepted: 12/22/2020] [Indexed: 12/27/2022]
Abstract
Joint pain is a major cause of lameness in animals such as horses and dogs, and it may affect their athletic performance and quality of life. The intra-articular administration of analgesic/antinflammatory drugs is a common practice in veterinary medicine, for both lameness diagnosis and joint pain management. It is used either perioperatively, such as in animals undergoing arthroscopy/arthrotomy, and in osteoarthritic animals. However, evidence regarding efficacy and safety of each drug is limited, and controversies persist in these areas. In particular, it is often uncertain whether a defined treatment is effective by simply relieving the symptomatic pain associated with the joint disease, or whether it has a positive effect on the joint environment. Moreover, there is still much hesitation about treatments for joint diseases, related to the time of their application for the best outcome, and to any possible deleterious side effects. This article includes a review of the literature concerning the main analgesic/antinflammatory drugs used intra-articularly for managing acute and chronic joint pain/inflammation in dogs and horses. Three main issues for each class of drugs are considered, including clinical efficacy, pharmacokinetics, and local cytotoxic effects.
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Affiliation(s)
- Alessandra Di Salvo
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo, 4, 06126 Perugia, Italy; Department of Veterinary Medicine, Research Center on Animal Pain, University of Perugia, Via San Costanzo, 4, 06126 Perugia, Italy
| | - Elisabetta Chiaradia
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo, 4, 06126 Perugia, Italy
| | - Sara Nannarone
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo, 4, 06126 Perugia, Italy; Department of Veterinary Medicine, Research Center on Animal Pain, University of Perugia, Via San Costanzo, 4, 06126 Perugia, Italy.
| | - Giorgia Della Rocca
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo, 4, 06126 Perugia, Italy; Department of Veterinary Medicine, Research Center on Animal Pain, University of Perugia, Via San Costanzo, 4, 06126 Perugia, Italy
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Gutierrez-Nibeyro SD, Werpy NM, Gold SJ, Olguin S, Schaeffer DJ. Standing MRI lesions of the distal interphalangeal joint and podotrochlear apparatus occur with a high frequency in warmblood horses. Vet Radiol Ultrasound 2020; 61:336-345. [PMID: 32162431 DOI: 10.1111/vru.12855] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/12/2020] [Accepted: 01/19/2020] [Indexed: 11/30/2022] Open
Abstract
Foot pain is a common presenting complaint in Warmblood horses. The aim of this retrospective, cross-sectional study was to determine the spectrum of foot lesions detected by magnetic resonance imaging (MRI) in Warmblood horses used for dressage, jumping, and eventing. The medical records of 550 Warmblood horses with foot pain that were scanned using standing MRI were reviewed and the following data were recorded: signalment, occupation, lameness, diagnostic analgesia, imaging results, treatments, and follow-up assessments. Associations between standing MRI lesions and chronic lameness following treatment were tested. Abnormalities of the navicular bone (409 horses, 74%), distal interphalangeal joint (362 horses, 65%), and deep digital flexor (DDF) tendon (260 horses, 47%) occurred with the highest frequency. The following abnormalities were significantly associated (P < .05) with chronic lameness following conservative therapy: moderate to severe MRI lesions in the trabecular bone of the navicular bone, mild or severe erosions of the flexor surface of the navicular bone, moderate sagittal/parasagittal DDF tendinopathies, and moderate collateral sesamoidean desmopathies. Also, identification of concurrent lesions of the DDF tendon, navicular bone, navicular bursa, and distal sesamoidean impar ligament was associated with chronic lameness after conservative therapy. Development of effective treatment options for foot lesions that respond poorly to conservative therapy is necessary.
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Affiliation(s)
- Santiago D Gutierrez-Nibeyro
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
| | | | | | - Silvia Olguin
- College of Veterinary Medicine, University of La Plata, La Plata, Buenos Aires, Argentina
| | - David J Schaeffer
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois
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van Zadelhoff C, Schwarz T, Smith S, Engerand A, Taylor S. Identification of Naturally Occurring Cartilage Damage in the Equine Distal Interphalangeal Joint Using Low-Field Magnetic Resonance Imaging and Magnetic Resonance Arthrography. Front Vet Sci 2020; 6:508. [PMID: 32064268 PMCID: PMC6999043 DOI: 10.3389/fvets.2019.00508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/20/2019] [Indexed: 01/30/2023] Open
Abstract
Objectives: To describe detectable and non-detectable naturally occurring cartilage damage of the equine distal interphalangeal (DIP) joint using plain magnetic resonance (MR) imaging and gadolinium and saline MR arthrography. The second objective was to quantify the sensitivity, specificity and accuracy in detection of cartilage damage. Methods: In a pilot study, the distal limbs of two horses with confirmed osteoarthritis of the DIP joint were imaged with low-field MR. Magnetic resonance images were assessed in consensus by three observers and compared to gross pathological findings. Subsequently, a prospective analytical cross-sectional study design was created to compare pre-contrast MR imaging and saline and gadolinium MR arthrography of isolated equine distal limbs to gross observation findings. Hallmarq® low-field MR (0.27T) scans were performed prior to DIP joint injection, saline/gadolinium post-injection scans were performed at 15 min intervals for 2 h. Joints were inspected and the articular cartilage graded subjectively for cartilage damage (0–3). The presence of detectable or non-detectable cartilage damage on MR images was identified, characterized and recorded in consensus by three observers. Sensitivity, specificity and accuracy in detection of cartilage damage related to gross pathology were calculated. Results: The two clinical cases from the pilot study with confirmed osteoarthritis had full thickness cartilage defects; however, only one of these was correctly identified using low-field MRI. In the prospective study, the majority of naturally occurring cartilage damage could not be identified on plain MR or MR arthrography including extensive partial thickness cartilage erosions. Saline and gadolinium MR arthrography did not improve the detection of cartilage damage. The accuracy of cartilage damage detection was 0.63 with a sensitivity of 0.14 and specificity of 0.92. Clinical Relevance: Both, plain low-field MRI and MR arthrography are not sensitive in detection of naturally occurring cartilage damage of the DIP joint. However, if an abnormal contour is seen in the articular cartilage, cartilage damage is likely to be present.
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Affiliation(s)
- Claudia van Zadelhoff
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, United Kingdom
| | - Tobias Schwarz
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, United Kingdom
| | - Sionagh Smith
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, United Kingdom
| | | | - Sarah Taylor
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, United Kingdom
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Gutierrez-Nibeyro SD, McCoy AM, Selberg KT. Recent advances in conservative and surgical treatment options of common equine foot problems. Vet J 2018; 237:9-15. [PMID: 30089549 DOI: 10.1016/j.tvjl.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 12/25/2022]
Abstract
Foot problems are very common causes of lameness in horses. With the recent diagnostic advances to evaluate and treat foot pathology as well as to monitor response to therapy, it is now possible to more accurately evaluate the effectiveness of many of these treatments. This review details some of the recent advances of the most common conservative and surgical treatment options for foot problems in horses, including an overview of evidence on the efficacy to support the use of these treatment options and on factors that may affect prognosis.
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Affiliation(s)
- S D Gutierrez-Nibeyro
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL, USA.
| | - A M McCoy
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL, USA
| | - K T Selberg
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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Bischofberger AS, Fürst AE, Torgerson PR, Carstens A, Hilbe M, Kircher P. Use of a 3-Telsa magnet to perform delayed gadolinium-enhanced magnetic resonance imaging of the distal interphalangeal joint of horses with and without naturally occurring osteoarthritis. Am J Vet Res 2018; 79:287-298. [PMID: 29466042 DOI: 10.2460/ajvr.79.3.287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) features of healthy hyaline cartilage of the distal interphalangeal joint (DIPJ) of horses, to determine whether dGEMRIC can be used to differentiate various stages of naturally occurring osteoarthritis of the DIPJ, and to correlate relaxation times determined by dGEMRIC with the glycosaminoglycan concentration, water content, and macroscopic and histologic findings of hyaline cartilage of DIPJs with and without osteoarthritis. SAMPLE 1 cadaveric forelimb DIPJ from each of 12 adult warmblood horses. PROCEDURES T1-weighted cartilage relaxation times were obtained for predetermined sites of the DIPJ before (T1preGd) and after (T1postGd) intra-articular gadolinium administration. Corresponding cartilage sites underwent macroscopic, histologic, and immunohistochemical evaluation, and cartilage glycosaminoglycan concentration and water content were determined. Median T1preGd and T1postGd were correlated with macroscopic, histologic, and biochemical data. Mixed generalized linear models were created to evaluate the effects of cartilage site, articular surface, and macroscopic and histologic scores on relaxation times. RESULTS 122 cartilage specimens were analyzed. Median T1postGd was lower than the median T1preGd for normal and diseased cartilage. Both T1preGd and T1postGd were correlated with macroscopic and histologic scores, whereby T1preGd increased and T1postGd decreased as osteoarthritis progressed. There was topographic variation of T1preGd and T1postGd within the DIPJ. Cartilage glycosaminoglycan concentration and water content were significantly correlated with T1preGd and macroscopic and histologic scores but were not correlated with T1postGd. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that dGEMRIC relaxation times varied for DIPJs with various degrees of osteoarthritis. These findings may help facilitate early detection of osteoarthritis.
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Influence of Increased Intraarticular Pressure on the Angular Displacement of the Isolated Equine Distal Interphalangeal Joint. J Equine Vet Sci 2016. [DOI: 10.1016/j.jevs.2016.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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
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Brommer H, Schipper P, Barneveld A, van Weeren PR. Systemic or intrasynovial medication as singular or as combination treatment in horses with (peri-)synovial pain. Vet Rec 2012; 171:527. [DOI: 10.1136/vr.100811] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- H. Brommer
- Department of Equine Sciences; Faculty of Veterinary Medicine; University of Utrecht; Yalelaan 112-114 Utrecht NL-3584 CM The Netherlands
| | - P. Schipper
- Department of Equine Sciences; Faculty of Veterinary Medicine; University of Utrecht; Yalelaan 112-114 Utrecht NL-3584 CM The Netherlands
| | - A. Barneveld
- Department of Equine Sciences; Faculty of Veterinary Medicine; University of Utrecht; Yalelaan 112-114 Utrecht NL-3584 CM The Netherlands
| | - P. R. van Weeren
- Department of Equine Sciences; Faculty of Veterinary Medicine; University of Utrecht; Yalelaan 112-114 Utrecht NL-3584 CM The Netherlands
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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
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van Loon JPAM, de Grauw JC, van Dierendonck M, L'ami JJ, Back W, van Weeren PR. Intra-articular opioid analgesia is effective in reducing pain and inflammation in an equine LPS induced synovitis model. Equine Vet J 2010; 42:412-9. [PMID: 20636777 DOI: 10.1111/j.2042-3306.2010.00077.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
REASONS FOR PERFORMING STUDY Intra-articular administration of morphine as a local analgesic and anti-inflammatory drug is widely used in human medicine. In equids, little is known about its clinical analgesic and anti-inflammatory efficacy. OBJECTIVES To use an inflammatory orthopaedic pain model to investigate the analgesic and anti-inflammatory effects of intra-articularly administered morphine as a new treatment modality in horses with acute arthritis. METHODS In a crossover study design, synovitis was induced in the left or right talocrural joint by means of intra-articular injection of 0.5 ng lipopolyssacharide (LPS). The effect of 120 mg morphine, intra-articularly administered at 1 h after induction of synovitis, was evaluated using both physiological and behavioural pain variables. Synovial fluid was sampled at 0, 4, 8, 28 and 52 h after induction of synovitis and analysed for total protein concentration, leucocyte count and for prostaglandin E(2), bradykinin and substance P concentrations by ELISA. Ranges of motion of metatarsophalangeal and talocrural joints were measured as kinematic variables with the horses walking and trotting on a treadmill under sound and lame conditions. Clinical lameness scores and several behavioural variables related to the perception of pain were obtained. RESULTS LPS injection caused marked transient synovitis, resulting in increased concentrations of inflammatory synovial fluid markers, clinical lameness, joint effusion and several behavioural changes, such as increased time spent recumbent, decreased limb loading at rest and decreased time spent eating silage. Intra-articular morphine resulted in a significant decrease in synovial white blood cell count, prostaglandin E(2) and bradykinin levels and improvement in clinical lameness, kinematic and behavioural parameters, compared to placebo treatment. CONCLUSIONS Intra-articular morphine offers potent analgesic and anti-inflammatory effects in horses suffering from acute synovitis. POTENTIAL RELEVANCE Local administration of opioids may be useful for horses with acute inflammatory joint pain and offers possibilities for multimodal analgesic therapies without opioid-related systemic side effects.
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Affiliation(s)
- J P A M van Loon
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, The Netherlands.
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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]
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Crowe OM, Hepburn RJ, Kold SE, Smith RK. Long-term outcome after arthroscopic debridement of distal phalanx extensor process fragmentation in 13 horses. Vet Surg 2010; 39:107-14. [PMID: 20210954 DOI: 10.1111/j.1532-950x.2009.00608.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report long-term outcome after arthroscopic removal of fragmentation of the extensor process of the distal phalanx in horses. STUDY DESIGN Case series. ANIMALS Adult horses (n=13). METHODS Medical records (2003-2004) of horses that had arthroscopic debridement of fragmentation of the extensor process of the distal phalanx were reviewed. Inclusion criteria included: lameness localized to the foot, fragmentation of the extensor process of the distal phalanx debrided arthroscopically, and a follow-up period of > or = 4 years. RESULTS Of the 13 horses, lameness was resolved in 11 (85%) initially but distal interphalangeal joint pain recurred in 2 (15%) within 1 year of surgery. Three (23%) other horses were retired because of lameness at other sites during the follow-up period resulting in 46% (6/13) being not lame and in full work after 4 years. Substantial changes were identified at surgery in the contralateral joint of 7 horses, even when fragments were only present unilaterally. CONCLUSIONS Arthroscopic debridement of fragmentation of the extensor process of the forelimb distal phalanx has a good short-term prognosis for resolution of lameness and return to work but a more guarded prognosis for long-term soundness. CLINICAL RELEVANCE These results allow for more accurate prognostication preoperatively and may support early debridement of fragmentation of the extensor process of the distal phalanx.
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Affiliation(s)
- Oliver M Crowe
- Willesley Equine Clinic, Willesley, Gloucestershire, UK.
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OLIVE JULIEN. DISTAL INTERPHALANGEAL ARTICULAR CARTILAGE ASSESSMENT USING LOW-FIELD MAGNETIC RESONANCE IMAGING. Vet Radiol Ultrasound 2010; 51:259-66. [DOI: 10.1111/j.1740-8261.2009.01663.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Frisbie DD, Kawcak CE, McIlwraith CW, Werpy NM. Evaluation of polysulfated glycosaminoglycan or sodium hyaluronan administered intra-articularly for treatment of horses with experimentally induced osteoarthritis. Am J Vet Res 2009; 70:203-9. [PMID: 19231952 DOI: 10.2460/ajvr.70.2.203] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess clinical, biochemical, and histologic effects of polysulfated glycosaminoglycan (PSGAG) or sodium hyaluronan administered intra-articularly in treatment of horses with experimentally induced osteoarthritis. ANIMALS 24 horses. PROCEDURES Osteoarthritis was induced arthroscopically in 1 middle carpal joint of all horses. Eight horses received hyaluronan (20 mg) and amikacin (125 mg) intra-articularly on study days 14, 21, and 28. Eight horses received PSGAG (250 mg) and amikacin (125 mg) intra-articularly on study days 14, 21, and 28. Eight control horses received 2 mL of saline (0.9% NaCl) solution and amikacin (125 mg) intra-articularly on study days 14, 21, and 28. Clinical, radiographic, synovial fluid analysis, gross, histologic, histochemical, and biochemical findings were evaluated. RESULTS No adverse treatment-related events were detected. Induced osteoarthritis caused a substantial change in lameness, response to flexion, joint effusion, and radiographic findings, and of these, synovial fluid effusion was reduced with PSGAG, compared with control horses. No changes in clinical signs were seen with PSGAG or hyaluronan, compared with control horses. Histologically, the degree of synovial membrane vascularity and subintimal fibrosis was significantly reduced with PSGAG treatment, compared with controls. Histologically, significantly less fibrillation was seen with hyaluronan treatment, compared with controls. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that PSGAG and hyaluronan had beneficial disease-modifying effects and are viable therapeutic options for osteoarthritis in horses.
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Affiliation(s)
- David D Frisbie
- Gail Holmes Equine Orthopaedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523-1678, USA
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