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The new rules for 2006 to win a buckle: To be eligible there had to be 3 club members competing in 3 shows held by NRCHC
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Beginner Horse:Beginner Rider:Snaffle Bit:
ONCE WE CHANGE THE WAY WE THINK, OUR SPIRIT THEN HELPS US TO MAKE THE NECESSARY CHANGES IN THE WAY WE LIVE, BUT TO GET THAT HELP WE HAVE TO ACCEPT LOVE AND RESPONSIBILITY FOR ALL THINGS. Getting the Point of Joint Injections
Galloping down a cross-country course, leaping three-foot fences or sliding to a stop
puts an enormous amount of stress on fine, delicately built equine legs. But there is a lot going on behind the scenes. A sound horse maintains balanced joint function. But
joints that bend and give to absorb that shock are comprised of structures—bone, cartilage, soft tissues, protective synovial fluid—that can all break down. Horse owners
seek out both oral supplements and systemic injections, which are popular defenses against joint problems. But sometimes therapy goes beyond these approaches and
It’s a relief to know that there are options
Rebuild or Restore
available to help your horse, but intra-articular joint injections can be costly, and there are
While intra-articular injections of steroids,
risks. Thomas M. Daniel, DVM, of Southern
Pines Equine Associates in Southern Pines,
N.C., concentrates on sporthorse medicine and treatment, some intramuscular and
was a veterinarian for the U.S. Equestrian
Team in 2000. He says, “Some vets overplay the difficulty or danger involved with joint
injections; [the procedure] is not without
potential downfalls, but it can help horses a
restores synovial lubrication, helping the
To Inject or Not to Inject
treatments don’t: It stops the cycle of
degeneration by inhibiting cartilage damage
Talk to your veterinarian about your horse’s
determine whether joint injections will be
treatment travels into injured joints and
stimulates production of new cartilage, while
beneficial. Bill Moyer, DVM, head of the Large
relieving non-infective degenerative joint
Animal Department at Texas A&M University,
has been practicing veterinary medicine for
Another joint lubrication product that works
inflammation and restore synovial fluid is
Tennessee, he co-authored A Guide to Equine
Joint Injections (Veterinary Learning Systems
hyaluronate). As with any treatment, results
Co., 2002). “Athletes seldom have just one
thing wrong. Often we are looking at changes in
the hocks, a sore back, some navicular changes and maybe the feet are in bad shape. In performance horses, there’s just a lot of wear and tear,” Dr. Moyer says.
Many things can go wrong in an equine joint, but one of the most common problems is arthritis, or degenerative joint disease, which leads to progressive destruction of joint
structures. There is no cure for this disease, but managing it starts with a veterinary lameness exam to confirm diagnosis. Simple flexion tests, diagnostic nerve blocks and
radiographs (X-rays) to evaluate bony changes are all used during the exam. MRI technology is also available, which gives veterinarians a good look at both bone and
soft tissues, but the cost is prohibitive for the majority of horse owners.
Dr. Moyer says the most common joints to inject include the hock, pastern, coffin
joint, fetlock, carpal (knee) and stifle joints. Keep in mind that some joints (knee, stifle and hock) are complex joints made up of more than one joint (for example, the hock
Dr. Moyer continues, “Treating joints, the first thing that you need is a diagnosis to
know what you are attempting to treat. If you have a swollen knee and it has a chip or fracture, and you inject it and the horse feels better, then you can end up doing more
damage.” According to Dr. Moyer, some questions horse owners should ask themselves after talking to their veterinarians are, “Do I have the right diagnosis?” and
“Do I understand the damage in the joint?”
Dr. Moyer points out that he has three things to think about with each case: 1) Is the horse lame? 2) Can the problem be treated, or should the horse be retired? 3) Is the
owner willing and able to pay for the treatment?
Early signs of joint disease can be subtle, so owners must carefully monitor their
horses for signs of joint swelling, heat, lameness or reduced ability to perform. Sometimes, by the time symptoms are noticed, damage may have already started.
Just as with people, in some cases the joints are simply beyond repair, and a career change may be necessary. For instance, a 20-
year-old show jumper or eventer may need to compete only at the lower levels, over smaller
Exercise and Maintenance
In general, the more fit a horse is, the more
What Are They Putting in There?
degenerative changes, the more consistent
Acting similarly to the grease around ball
the exercise, the better, even if that means
bearings, joints are lubricated via synovial fluid. a 20-minute walk every day. On the other
It is normally clear, pale yellow and viscous; in hand, intermittent work is not good because the face of joint damage it tends to lose
it stresses rather than maintains the joints.
viscosity—it becomes watery and is not as efficient.
“For therapeutic reasons, joints that have experienced wear and tear can be injected with a variety of medications that help them heal and remain flexible. This can prolong
the usefulness of the horse,” Dr. Moyer says. There is a long list of possible medications to inject; what is used depends on the diagnosis.
In cases of arthritic changes, corticosteroids can offer pain relief and reduced inflammation. “Injecting [corticosteroids] directly into the joint as opposed to
intravenously, or systemically, is much more profound,” Dr. Moyer says.
He explains that in the joint, inflammation can release all sorts of substances that can
damage the cartilage and joint capsule. “In some cases, decreasing inflammation has a long-term beneficial effect because inflammation itself can be damaging. That’s why it
is important to look at what is going on in the joint before you inject it.”
There are options for steroids, some long-acting, some short-acting. Short-acting
steroids provide results that are likely to be seen in about 12 hours rather than a couple of weeks. Dr. Moyer says that long-acting steroids work similarly to time-
release drugs in humans, providing relief over an extended period of time.
Dr. Daniel warns, “The downside is that sometimes people overuse steroids. They can
be extremely beneficial if used properly, but they can be detrimental if used improperly. They are often misunderstood—it’s not that your horse will never be the
same again because you have put steroids in a joint.”
Sodium hyaluronate, often called hyaluronic acid (HA), helps restore the function of
the naturally occurring hyaluronic acid within the joint to improve the lubrication, stimulate natural production of HA and generally improve the synovial fluid. Injectable
forms of varying molecular weights exist and have been demonstrated to have a positive effect in reducing the pain of arthritis. Also, HA is often used in conjunction
with steroids. Oral forms of HA are also available on the consumer market, but their effectiveness is still being researched.
Adequan I.A. (polysulfated glycosaminoglycan) is an additional option, available for the treatment of non-infective joint disease in the carpal (knee) joint. Risks Joint injections are not without risk, including: Infection
Any time you insert a needle into the body
Questions to Ask Your Vet
there is the potential to introduce bacteria,
which can lead to infection. With proper
1. Does my horse really need joint
preparation of the limb, the risk of infection can be minimized to a large degree. Yet even under 2. Which joint is affected?
the best of conditions, there is always some
3. What substance is being considered for
risk of infection following a joint injection.
Symptoms of infection include heat, swelling and tenderness around the joint, and a
4. What is the cost involved?
reluctance to use the joint normally. Despite
5. How much rest will my horse need?
prompt treatment with antibiotics, once a joint
infection is established, extensive destruction of 6. Will my horse be sound for the articular cartilage may still occur, resulting performance, or simply comfortable at rest?
in debilitating lameness or permanent loss of use. If you have an infection there can be some 7. How long can I expect results to last?
time delay, and the onset of symptoms can be rapid and severe. Contact your veterinarian immediately if your horse shows any signs
Injecting corticosteroids into a damaged joint can help reduce inflammation and relieve pain, but then the joint is more at risk for re-injury when the horse returns to work.
Broken needle In very rare instances, a needle can break. Though it sounds horrendous, the chances
of this happening are slim. Dr. Moyer explains that this used to be a more common occurrence when needles were made of stainless steel and were brittle. Now they are
made of alloys and are more flexible, thus less likely to break. “It’s been years since I’ve heard of it, but the potential is always there, so we have to mention it,” he says. Adverse Reaction to the Chemicals Rarely, some horses react adversely to medication, the same way some people react
to a flu shot. Any adverse reaction should be treated as an emergency. Joint Degeneration
There is a long-term risk of corticosteroids causing cartilage breakdown. This depends on the individual horse: how much damage there was to begin with and how much
joint stress the horse will continue to endure.
While corticosteroids are very useful in treating joint disease, some vets think that in certain instances steroids, especially triamcinolone, can contribute to the onset of
laminitis or founder. Sticking to a small dose and regular schedule, and using steroids only when truly necessary, should help reduce this possible risk.
Lay-up Following an injection, a return to work depends on the joint involved. “The ivory
tower approach is extended lay-up, but we don’t find that necessary,” Dr. Daniel says. “Nobody is wrong here, but we give the horses 24 hours of stall rest and then two to
three days of turnout, then they can start light flat work. We are often dealing with horses that can’t take extended time off. That has forced our hand at minimal lay-up,
Often, older horses have a lot of lumps and bumps to show for their years. If a joint
has been swollen for a long time, the vet will need to remove the fluid, inject the joint, and then the horse will probably need a couple of weeks off. Take Home Message While not for every horse, and not without risk, joint therapy can be a tool for
prolonging your horse’s athletic usefulness. But Dr. Moyer warns that he never uses therapeutic joint injections as a preventive measure where there is no existing
problem. “I won’t be sticking needles into [a joint] because it might have a problem,”
he says. “Every time someone sticks a needle into a joint, there is a risk.”
variables. Everyone has different goals: One
owner may be happy if a horse can walk across
the paddock comfortably, while another will
Amber Heintzberger is a freelance equine
rate success by how an athlete can perform.
journalist based in South Carolina. An active
“One of the things you have to ask yourself is, member of the horse community, she
‘How am I defining success?’ ” Dr. Moyer points eventing.
out. “Was your horse lame and now he isn’t? Was he lame and then sound, and then even
worse than ever? The result is going to vary with the severity of the problem and what is being expected of the horse. Dressage is more forgiving than steeplechasing, for
example.” In the end, each individual responds differently to the various treatments, so tailoring a program to each horse is essential to success. *This article was featured in Horse Illustrated - February 2006.
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Patent and Know-How License Agreement with Huaren Pharmaceutical Co., Ltd. JMS Co., Ltd. (hereinafter “JMS”) announced that JMS has entered into a Patent and Know-How License Agreement with Huaren Pharmaceutical Co., Ltd. (hereinafter “Huaren”), Qingdao-based Chinese company, regarding medical devices and pharmaceutical drugs for Peritoneal Dialysis. 1. Background and Objectives