Non steroidal anti-inflammatory drugs (ketorolac, etoricoxib, metacam,
bufexin)
NSAIDS have been available for some time. Bufexamac was reported to be
inferior to methylprednisolone in human patients with rheumatoid arthritis. In
horses, intra-articular administration was well tolerated although the higher
dose (100 mg) caused a transient increase in synovial total protein and
leukocyate concentrations (Suominen 2001).
Ketorolac tromethamine is a non-steroidal anti-inflammatory drug (NSAID) in
the family of heterocyclic acetic acid derivatives, used as an analgesic
indicated for short-term management of moderate to severe pain. It is used
mainly with/without local anesthesia for postoperative pain control in human
arthroscopy and joint replacement procedures. Most recently, a study
suggested that intra-articular ketorolac was equally effective to injection of a
corticosteroid for the management of knee OA in humans (Sajeed and Desai
2015). Intra-articular use in the horse has not been reported so far.
Autologous Conditioned Serum (IRAP)
Autologous conditioned serum (ACS) is an example of an available treatment
that may become more targeted in the future when clearer indications are
developed. It uses the idea of specific inhibition of deleterious cytokines and
mediators using anti-inflammatories inflammatory substances produced by the
animals own blood cells. Extrapolation from the human data, and recently
published equine data, suggests that there would be up-regulation of IL-1
receptor antagonist, IL-4, IL-10, fibroblast growth factor and transforming
growth factor-b in such serum. Specifically IRAP, a substance that inhibits IL1 activity, decreases the progression of joint disease and is believed to be
present in high amounts in ACS.
Use of this medication requires incubation of equine whole blood with beads
coated with chromium sulfate to obtain the ACS solution. The white blood
cells are stimulated by medical-grade glass beads exposed to chromium
sulfate to produce a variety of anti-inflammatory proteins. Following
incubation, the serum is separated and collected for immediate intra-articular
injection, or frozen for later use.
Controlled data on its efficacy in clinical cases is are currently lacking,
although in the CSU OA model, treated horses showed a significant
improvement in lameness and improvement in some parameters of articular
morphology (Frisbie et al. 2007).
The original indication was joint disease that failed to respond to intra-articular
corticosteroids. However, clinical impressions in chronic lameness have been
disappointing. Therefore it is used predominantly in cases of mild synovitis
and early OA, particularly in patients where corticosteroids may be
contraindicated. ACS is also commonly used as ‘maintenance’ injections in
mild lameness and performance problems in competition horses. Horses
successfully treated with IRAP that return to competition often receive
prophylactic treatment before, after or during competitions. Therefore, it is
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February
2016
East
London
Convention
Centre,
East
London,
South
Africa
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