“Dr. Chad Davis recommended that we use the Pro-Stride APS device to support CR’s joints, given the high level of work and impact that he sustains for training as well as competition,” shares Colleen Rutledge, whose horse Covert Rights – called CR – is a retired 5-star eventer. The 2006 gelding now competes in PSG dressage. CR has been on other treatments in the past but has now been on Pro-Stride APS for three years. “As most horse sports are a game of millimeters and seconds, anything that we can do to maximize comfort and minimize damage is always welcome. CR has always been very demonstrative when he doesn’t feel his best, and the Pro-Stride APS device helps him maintain his comfort.”

What is Pro-Stride APS and How Does it Help Horses with Joint Pain?

Pro-Stride APS – autologous protein solution – is a device that produces an all-natural concentrated injectable solution that uses your horse’s blood to help counteract the effects of osteoarthritis and musculoskeletal injuries. “The Pro-Stride device utilizes a combination of concentrated anti-inflammatory proteins, white blood cells and growth factors from platelets derived from the horse’s own blood,” explains Dr. Holly Helbig. “It works primarily by blocking interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF-alpha) from binding to the cartilage surface. These are two major pro-inflammatory proteins that lead to degeneration of the joints.”

Your veterinarian can administer Pro-Stride APS stall-side in about 20-30 minutes. They will draw your horse’s blood and run it through a centrifuge in a two-step process. This creates a concentrated cell solution that contains your horse’s own anti-inflammatory cytokines and growth factors. When injected back into your horse, it helps to reduce inflammation and pain. “Not only does this therapy address inflammation, but it also promotes healing of the joint space,” explains Helbig. “Biological therapies continue to gain the attention of veterinarians and horse owners for corticosteroid-free management of osteoarthritis.”

In a 2014 study published in the American Journal of Veterinary Research, client-owned horses who were evaluated for lameness and then treated with Pro-Stride APS showed significant improvement in lameness grade up to a year later, and in some cases longer, after just one injection.¹

How long effects last will vary from horse to horse, depending on many factors including type of injury or condition being treated. Helbig explains that after one treatment, your veterinarian will assess your horse’s response and create a plan from there. In her experience, Helbig says, “We evaluate the horse’s response to see if the Pro-Stride device improved lameness approximately 4-6 weeks post injection.”

An Alternative Treatment to Steroids for Horses with Joint Pain

While corticosteroids are the norm for treating osteoarthritis and musculoskeletal injuries, Pro-Stride APS may be a better alternative. Steroids are known for being fairly fast-acting, reducing pain quickly, but does not address the healing process like Pro-Stried does. Additionally, there are potential negative side effects to repeated and long-term use. “High doses of corticosteroids as well as repeated use has more recently been associated with degradation of articular cartilage, leading to potential further damage to a horse’s joints,” explains Helbig. This means that the treatment you are using may eventually make the problem you are trying to solve worse.

While all injections have a small risk of complication including localized pain, swelling or infection at the injection site, Pro-Stride APS will not degenerate the joint further like steroids. “The Pro-Stride APS device has safety and efficacy studies showing a strong safety profile and efficacy up to 12 months post-injection,” she adds.

Nonsteroidal anti-inflammatory drugs – NSAIDS – are also common systemic treatment for pain in horses with osteoarthritis and musculoskeletal injuries. However, NSAIDS have negative side effects from prolonged use as well, including papillary necrosis, equine gastric ulcer syndrome and right dorsal colitis, according to “Non-Steroidal Anti-Inflammatory Drugs and Associated Toxicities in Horses” published in 2022.

With Pro-Strides APS, you may be able to ditch the NSAIDS too. “It depends on the condition that we’re treating or managing,” explains Dr. Chad Davis, when asked about stopping NSAIDS with regenerative therapy like Pro-Stride APS. “In our practice, it’s uncommon to keep horses on chronic NSAID therapy or treatment. Rather, we would look to medical devices like Pro-Stride APS to allow for a more comprehensive response and better outcome than using NSAID therapy alone. Our thought process when using orthobiologic devices and therapies is to condition and train the injured location and associated cells to be less inflammatory in response to an injury or disease, and more reparative and regenerative in nature. Inflammation control is key, but how you address inflammation is the science behind the treatments and therapies.”

Can I Compete with Pro-Strides APS on Board My Horse?

A big question with any treatment we use on our horses is whether it’s legal for competition. So can you use Pro-Stride APS before a competition? “There are no drugs, medicines or additives in a Pro-Stride device since it’s a byproduct of the horse’s own blood,” answers Helbig. “Speak with your veterinarian to ensure that your horse is fit for competition, and if lame, has an appropriate diagnosis and plan to ensure timing of the injection. Most equine organizations have a minimum number of days between injection and competition times. Check with your veterinarian or governing body for appropriate rules and regulations.”

“As for using the Pro-Stride APS device before a big event, the short answer is yes,” adds Davis. “The extended answer is to ensure you have enough recovery time after the therapy to achieve the maximal responses. We see many orthobiologic therapies and devices, not only as point-of-care medicine but also as preventive medicine. Preventive medicine ensures optimal performance and predictable outcomes and is a focus at our practice with the Virginia Equine Rehabilitation and Performance Center.”

We all want to keep our horses happy, healthy and pain-free. Pro-Stride APS uses your horse’s amazing power of self-healing to ease discomfort and possibly regenerate the joints. Learn more about Pro-Stride APS at the Zoetis website and ask your vet if it may be right for your horse.

¹ Bertone AL, Ishihara A, Zekas LJ, et al. Evaluation of a single intra-articular injection of autologous protein solution for treatment of osteoarthritis in horses. Am J Vet Res. 2014;75(2):141-151. doi: 10.2460/ajvr.75.2.141.

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“In my experience, horses almost never say no,” says Steve Allday, DVM, an equine lameness specialist with more than 35 years’ experience caring for an impressive list of equine athletes. “Horses can talk, and it is our job to learn how to speak their language and above all, to listen and be their advocate.”

Allday has been the lameness specialist for equine legends that include Triple Crown race winners, 29 Breeders’ Cup race winners, and five Thoroughbred Horses of the Year—including legendary racehorses A.P. Indy and Cigar—among other elites, such as World Equestrian Games jumpers. In addition to being a top sport horse veterinarian, Allday has also founded and developed a line of joint supplements.

1. What is equine osteoarthritis?

Sometimes hidden and other times obvious, equine osteoarthritis (OA) is a condition that impacts horses regardless of age, breed or discipline. It’s estimated that OA is responsible for up to 60 percent of all lameness in horses, according to the American Association of Equine Practitioners (AAEP).

Also referred to as equine degenerative joint disease, OA is a chronic disease-causing degeneration of the joints and resulting in pain, inflammation and reduced flexibility and range of motion. To understand OA, it’s important to understand the three different types of joints horses have:

1. Synovial joints: These allow different degrees of movement and rotation, acting as a hinge for the primary mode of flexion and extension. Examples include fetlocks, knees and hocks.

2. Fibrous joints: These do not allow for movement between the bones, such as the joints between bones of the skull.

3. Cartilaginous joints: These connect bones with cartilage, allowing limited movement and shock absorption, like the joints between the vertebrae of your horse’s spine.

Osteoarthritis can occur in synovial and cartilaginous joints, and it’s a common condition horses can experience.

“Osteoarthritis is ubiquitous in all mammals, and progressive as a rule,” says Allday. “It can occur anywhere on the horse: in their hips, hocks, stifles, knees, fetlocks and other joints.”

2. What causes equine osteoarthritis?

You may have wondered if different equine sports affect specific joints. Although any horse in any discipline can be affected by OA, there are common themes and joint problems that occur in the varying equine sports.

For instance, cutting and reining have greater impact on the hocks and stifles, causing horses to have heightened OA risk to these joints. And jumpers are more likely to have front-limb lameness in the coffin or fetlock joints. The bottom line is that any joint that is more significantly used on a horse increases its likelihood for developing OA.

3. Can osteoarthritis be prevented?

To help avoid joint health problems, you need to get ahead of what problems can—and unfortunately, likely will—arise due to a horse’s conformation flaws, stabling or training environments and everyday injury risks.

“Whether a racehorse, dressage horse, cutting horse or a barrel horse, by maintaining things preventatively and staying a step ahead of potential problems before they become a major issue, you can help ensure your equine partner’s performance,” says Allday.

You can help prevent equine joint health problems by:
◆ Offering quality nutrition for strong bones and healthy cartilage.
◆ Prioritizing hoof care and keeping horses on a regular trim schedule.
◆ Keeping horses at optimum weight and avoiding obesity, which stresses the joints.
◆ Riding on softer footing and limiting work on hard surfaces.
◆ Incorporating joint supplements to help maintain their joints and cartilage.

4. How is osteoarthritis diagnosed?

Allday assures us that as the No. 1 human in your horse’s life, you are the best diagnostician of any changes in your horse’s joint health.

“This is simply because you know your horse,” he says. “I don’t have a crystal ball. When I go look at a horse, I’m taking a snapshot of that moment, while you have known the horse for days and years—sometimes, his entire life—before I got there that day.”

Every time you’re grooming or tacking up for a ride, check your horse for symmetry: If you fear one side is larger than the other, you can just compare it to his opposite side.

Give your horse a proper once-over: Rub his back and palpate it, checking for soreness.

When you pick up his hind leg, check the hock for any fluid. This daily interaction with your horse, coupled with knowledge of his particular history, will be invaluable to your veterinarian when diagnosing any joint problems.

Should your veterinarian suspect joint problems, it’s likely he or she will perform a routine lameness evaluation. According to the American Association of Equine Practitioners, this includes summarizing the horse’s medical history; a visual appraisal of the horse at rest; a thorough, hands-on examination, including palpating the horse’s muscles, joints, bones and tendons for any heat or swelling; an evaluation of your horse’s three gaits in motion; and a joint flexion test.

“Every horse deserves a full and thorough veterinary examination,” says Allday. “It’s not just a choice—it’s a necessity to help maintain these equine athletes and keep them at their best.”

In addition to lameness evaluations, diagnosis of OA can also involve diagnostics such as:
◆ Radiographs
◆ Fluoroscopy
◆ Nuclear scintigraphy
◆ CT
◆ MRI
◆ Nerve and joint blocks
◆ Ultrasound
◆ Thermography

5. Is equine osteoarthritis curable?

While there is, unfortunately, no definitive cure for OA in horses, the pain and inflammation associated with it can be treated. Prevention, along with early diagnosis and treatment, is critical to keep the condition from progressing.

“OA isn’t the end of their career, but it’s certainly something you have to be on top of, address rapidly and maintain routinely,” says Allday. “You have to remember that osteoarthritis is progressive, and as it gets worse as the horse gets older, you’ll need to be very proactive. You may even have to go to anti-inflammatories to maintain a horse’s athletic career.”

6. What are treatment options?

Treatment for equine OA focuses on alleviating pain and inflammation in the joint, allowing horses to have improved mobility. For horses diagnosed with osteoarthritis, veterinarians may recommend prescription medications, like Equioxx, Adequan I.M., Legend or Surpass Topical.

Should OA be diagnosed, your veterinarian will work closely with you on joint health supplements to prevent further progression of joint damage, as well as anti-inflammatory treatments available to manage the pain and inflammation associated with osteoarthritis.

Allday recalls a conversation he had with Allen Paulson, founder of Gulfstream Aerospace and renowned owner of more than 100 graded stakes race winners. Paulson’s horse was the favorite for the Kentucky Derby, but due to a joint injury, he was scratched.

“I told him, ‘A horse isn’t like the planes you build—you have to go with the original equipment.’ And it’s true—you can’t put a horse up on a rack and switch in a new part. Taking care of their original equipment is the epitome of how you can preventatively maintain your horse throughout his career.”

The post Answering 6 Questions About Equine Osteoarthritis appeared first on Horse Illustrated Magazine.

Steve Fisch, DVM, who owns and practices at AVS Equine Hospital in Tallahassee, Fla., particularly enjoys the challenges of diagnosing and treating equine lameness and practicing equine sports medicine. For a lifetime of well-managed equine soundness, he shares his advice on what you can do to protect your horse’s joints.

Horse Joint Health: Soundness Starts Early

Fisch points out that soundness (or lameness) really begins at conception, starting with how the mare is fed. Later, once young foals are eating their own ration, a diet formulated for growing horses at their particular stage of life is required. Many problems that are a result of inadequate nutrition from these earliest times won’t show up until the resulting foal is in training as a 2-year-old or older.

In addition to early nutrition, it’s important to pay close attention to the foal’s leg conformation and evaluate it regularly. Some angular limb deformities can be completely corrected with proper trimming when the foal is young. If not addressed, even slight deformities can compromise soundness and/or performance when the horse is an adult.

Fisch is a believer in the benefits of allowing young horses to exercise freely on pasture.

“Raising them outside in a big pasture is the best way to go,” he advises. “Their joints, ligaments and tendons become strong and more dense as they run around in different directions, able to stop and rest whenever they want to.”

Sound Training Strategy

For any horse, barefoot or shod, regular appointments with a hoof care professional are essential. If feet are not balanced, the horse will land unevenly, placing stress and abnormal concussion on his joints. In addition to quality hoof care, an appropriate exercise program is a vital part of staying sound.

A major cause of joint problems in horses age 2 and older is that the horse is not fit enough for his job. The supporting ligaments and tendons must be strong enough to keep the joints in alignment, and the only way they can get strong enough is to use them. Too much or too vigorous of exercise, however, can cause problems.

For example, cannon bones become more dense and ligaments get stronger with stress and speed, but when workouts are too long or too frequent, it’s counterproductive.

“A horse’s body is made so that the heart, lungs, tendons, ligaments, bones and joints become strong enough to support the maximum effort they are asked to give,” says Fisch.

Depending on the horse’s use, certain joints are at greater risk. Horses competing in the following disciplines experience extra stress on these particular joints:

• Barrel racing: fetlocks, hocks, stifles
• Western pleasure: hocks, stifles, feet
• Dressage: hocks, stifles
• Jumping: fetlocks, knees, hocks, stifles
• Cutting: hocks, stifles
• Reining: hocks, stifles

Horse Joint Health: Signs of Trouble

A synovial joint is a freely movable joint where two bones come together. Synovial joints are most vulnerable to injury and disease because they are high-motion joints in weight-bearing areas associated with the horse’s limbs. Synovial joints have a cavity lined by a membrane and are lubricated by synovial fluid. Examples include the knee, fetlock, pastern, hock and stifle.

Being hands-on and observant will allow you to detect signs that trouble may be brewing in a joint, such as:

• Swelling
• Effusion (excess joint fluid)
• Heat
• Pain upon flexion of joint
• Stiffness/change in gait
• Varying degrees of lameness

“The first sign of trouble is usually effusion or swelling,” says Fisch.

Excess joint fluid is a result of inflammation in the joint. The sooner a problem is diagnosed, the sooner the damage caused by inflammation can be stopped. This means having the horse examined by your veterinarian as soon as you suspect a joint problem. The goal is to return the joint’s environment to normal as soon as possible and hopefully avoid long-term damage.

Diagnosis and Treatment

An accurate diagnosis is essential for accurate treatment, whatever the horse’s age. Your veterinarian should start with a thorough hands-on exam and may use various methods to pinpoint joint problems.

A lameness exam consists of watching the horse move in a straight line and clockwise and counterclockwise circles to identify the affected leg. From that point, the area causing the lameness is further narrowed down with flexion tests, diagnostic nerve/joint blocks, radiographs, ultrasound, et cetera. More advanced options could include doing a bone scan (nuclear imaging), CT, MRI and diagnostic arthroscopy.

Treatments for joint inflammation may vary depending on severity and the specific situation. They can include:

• Rest
• Non-steroidal anti-inflammatory medication (NSAIDs)
• Topical creams containing diclofenac sodium
• Intra-articular corticosteroids (injected directly into joint)
• Hyaluronic acid (injection/oral)
• Cold-water hosing
• Nutraceuticals (joint supplements)

“There are varying degrees of osteoarthritis (OA), with some joints having very minimal OA that is easily manageable,” says Fisch. In cases of severe OA, “The goal is just to have the horse pasture sound. With either end of the spectrum and all degrees in between, make sure the horse’s feet are well-balanced and that any other issues have also been addressed.”

These include thin soles (which can indirectly cause inflammation in the coffin joint) and strained or torn ligaments or tendons that support the synovial joints.

“The best thing is to work with your equine veterinarian to devise a plan for your horse’s particular situation,” says Fisch. “Many people use a ‘one-size-fits-all’ approach and that seldom works. We tailor each OA program for that particular joint in that particular horse, while at the same time keeping in mind the owner’s goals and the horse’s quality of life and safety.”

Joint Health for Horses: Downside of Inflammation

Inflammation is the body’s way of addressing a problem, but it can lead to breakdown and eventual erosion of a joint’s articular cartilage. Cartilage is designed to protect bone, and when cartilage is destroyed, the horse feels pain.

A horse in pain naturally tries to limit his activity, but this lack of movement reduces circulation to the injured joint, making it more difficult for the body to heal. If this vicious cycle isn’t interrupted with treatment, the horse can end up with permanent joint damage.

If untreated, articular cartilage damage can develop into osteoarthritis (OA), also known as degenerative joint disease (DJD). When this happens, the problem can only be managed, not cured. This is why it’s so important to control inflammation and return the joint to normal condition as quickly as possible.

Joint Injections for Horses

Depending on the diagnosis, your veterinarian may choose to inject the joint(s), but there are a multitude of options available.

“In some instances, a program of intramuscular injections of polysulfated glycosaminoglycan (brand name Adequan), or intravenous injections of hyaluronate sodium (brand name Legend), can be used as the sole treatment,” says Fisch, adding that these are sometimes used in conjunction with bisphosphonates (brand names Osphos and Tildren), which are designed to reduce bone breakdown.

Adequan works by supplying some of the building blocks of the articular cartilage and also by helping the joint produce its own hyaluronate. Legend works to increase the hyaluronate level of the joint, allowing the joint to be better lubricated.

Just like in your car’s engine, lubrication helps prevent friction. Friction causes breakdown of the cartilage. Intra-articular injection of hyaluronic acid (HA) and triamcinolone help lubricate the joint and decrease inflammation. Triamcinolone has been shown to be chondroprotective (helps slow degradation of cartilage). Some steroids have negative long-term effects on the cartilage.

“Most veterinarians use joint injections when the joint in question needs more help than intramuscular, intravenous, or nutritional supplements,” Fisch continues. “We make the decision about which route to use when we have all the facts after the diagnosis is made.”

Some owners of performance horses take a preventive approach to joint injections, hoping to avoid future joint problems, but Fisch says there’s no scientific evidence that injecting a normal joint will prolong joint life or improve performance.

“If the joint has a very small amount of OA but the horse is not lame, then preventive joint injections may slow down the process of OA by keeping the joint environment [consisting of the joint fluid and articular cartilage] more healthy than it would be with no injections, and possibly keep him from becoming lame,” says Fisch. He adds that such preventive injections cause no harm as long as chondroprotective medications such as HA and triamcinolone are used.

Joint Health: Oral Supplements for Horses

Horses in the wild are constantly moving at a slow pace throughout the day, walking and grazing.

“A horse’s body is designed to manage the normal wear and tear to joints that comes with being a horse in its natural state,” says Lydia Gray, DVM, medical director and staff veterinarian at SmartPak. “However, the increased demands of riding, training, and competing can put additional stress on a horse’s joint tissues.”

To combat that stress, many horse owners turn to oral supplementation, hoping to supply the horse’s body with the ingredients needed to maintain healthy joints.

“There are a lot of joint ingredients and joint supplements on the market, making it difficult to choose the best one for your horse,” says Gray. “In a way, that’s good news, because it means that veterinarians, researchers, and manufacturers are constantly on the lookout for revolutionary new ingredients, such as collagen, turmeric and resveratrol.”

Here’s a quick look at some common ingredients and what they do.

• Glucosamine is the building block of chondroitin sulfate, a type of glycosaminoglycan (GAG). Research shows glucosamine has two important actions in joints. Not only does it support the production of new GAGs and therefore new cartilage, glucosamine also inhibits the enzymes that break down cartilage.
• Chondroitin sulfate is naturally synthesized by chondrocytes, the living cells inside cartilage. Chondroitin sulfate is the building block of the much larger proteoglycan molecule, stimulating the production of cartilage while also blocking pathways of cartilage destruction.
• Hyaluronic acid is another glycosaminoglycan synthesized by both the chondrocyte cells in cartilage and by the synoviocyte cells in the joint lining. An integral component of both joint cartilage and joint fluid, it provides lubrication and shock absorption between surfaces.
• Methylsulfonylmethane (MSM) supports a normal inflammatory response and neutralizes free radicals through its potent antioxidant activity.
• Vitamin C functions as an antioxidant and as a required co-
  enzyme in the synthesis of connective tissues such as cartilage, bones, tendons, and ligaments.
• Devil’s claw, yucca, and boswellia are herbs commonly used to fight discomfort in joints and to support a normal response to inflammation.

When choosing a supplement, notice if the label bears the National Animal Supplement Council (NASC) Seal of Quality. Only NASC member companies that have been audited for manufacturing, labeling and adverse event reporting are permitted to use this seal.

Since equine joint supplements are intended to support normal healthy joint fluid and tissues, the best time to begin using one is before a horse starts having issues.

“Although some owners report seeing positive results in as little as two to three weeks, we generally recommend giving a joint supplement six to eight weeks for full benefits,” says Gray.

If you suspect your horse may have joint arthritis, work with your vet to diagnose the exact location and determine the best course of treatment. The sooner you start, the better chance you’ll have to extend your horse’s comfort and athletic career.

This article originally appeared in the November 2018 issue of Horse Illustrated magazine. Click here to subscribe!

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