Joint Disease Treatment
Once the problem joint has been identified, the next step is to formulate a treatment plan. The first option is usually to medicate the joint with corticosteroids in combination with hyaluronic acid. There is often bad press given to the use of corticosteroids in horses, but the doses that are regarded as protective to the cartilage in the joint pose little risk of much talked about side effect of laminitis. Inappropriate use of corticosteroids in terms of dose rate and injecting too many joints at one time may result in problems but using corticosteroids would be regarded as routine by myself and many other vets. Corticosteroids cannot be used near the time of competition or the horse will come up positive on a drug test. As such we obey a withdrawal period, which depends on which drug is used. This means that horses that have repeated problems with joints and need medication to help also need a treatment plan worked out based on their competition schedule.
Arthroscopic surgery is an option for chronically diseased joints and is often carried out outside the competition season to allow time for recovery after the surgery. Shockwave can be a very valuable tool for treating some joints such as the flat weight bearing joint of the hocks, where chronic inflammation is called spavin. It is not completely clear how shockwave works, however it does have a desensitizing effect as well as stimulating blood flow by sending acoustic shockwaves through the tissue. Shockwave can also be a useful treatment for ligamentous problems around the joints.
When I am evaluating a horse with a joint problem an assessment of the foot balance is also made, and any findings are discussed with the yard farrier. Often, altering the shoeing will alleviate pain from within a joint, this is often the case with the hind feet and hock pain. It is also worth involving the physiotherapist in the treatment plan, as horses with chronic joint pain will have upper limb and back stiffness issues. The use of glucosamine based food supplements is a useful adjunct to the management of all sports horses, regardless of whether they have joint problems or not.
The key to managing a competition horse in terms of performance is not to wait until the horse is showing signs of lameness, but to identify subtle problems that can be affecting their performance and act before they become a bigger issue.