60 Minutes to Healthier JointsLydia F. Gray, DVM, MA

Medical Director/Staff Veterinarian

Jessica NormandSenior Director – SmartSupplements™

October 16, 2012

Your Presenters

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Agenda• Joint Anatomy & Function• What is Osteoarthritis?• Prevention & Therapy• Questions & Answers

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Joint Anatomy & Function

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1. Ligaments2. Joint capsule3. Synovial membrane4. Synovial fluid5. Articular cartilage6. Subchondral bone

Equine Joints Commonly Affected by OA

1. Hock2. Fetlock3. Pastern4. Knee

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What is Osteoarthritis?• Progressive, permanent degeneration of articular cartilage• aka Degenerative Joint Disease (DJD)

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“OA is a by-product of the wear and tear and daily trauma that horses experience during heavy training.”- Dr. Rick Mitchell, Fairfield Equine Associates

Osteoarthritis: Some Statistics• 60% of equine lameness problems are related to osteoarthritis,

making it the most common cause of lameness in the horse.

• Inflammation of the hock joints affects more than 50% of jumpers and grand prix dressage horses, and requires treatment for maintenance of peak performance.

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Osteoarthritis: Effects• OA is a cascading cycle of inflammation that leads to:

1. (Ligaments)2. Joint capsule fibrosis3. Synovial membrane thickening4. Loss of synovial fluid5. Articular cartilage erosion6. Subchondral bone sclerosisand Osteophytes (bone spurs)

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Osteoarthritis: Risk Factors• Acute trauma or sudden injury• Age• Conformation• Foot care• Footing• Workload

– Frequency– Duration– Intensity

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Osteoarthritis: Signs of Lameness• Stiffness• Shortened stride• Uneven gaits• Reluctance to pick up, keep or change canter lead• Reluctance to stop or turn while working at speed

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Prevention & Therapy: Goals• Halt the cascade of inflammation• Stop or limit damage to articular tissue• Promote healing of damaged cartilage• Improve mobility• Alleviate discomfort• Extend the horse’s competitive career

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Methods of Prevention & Therapy• Physical therapy

– Rest or controlled exercise– Ice or other cold therapy– Ceramic or other heat therapy– Compression

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Prevention & Therapy: Methods• Injections

– Intra-articular (joint)• Steroids and/or Hyaluronic Acid • Polysulfated Glycosaminoglycans (Adequan®)

– Intravenous• Hyaluronic Acid (Legend®)

– Intramuscular• Polysulfated Glycosaminoglycans (Adequan®)

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Effects of Oral Glucosamine and Chondroitin Sulfates Supplementation on Frequency of Intra-articular Therapy of the Horse TarsusRodgers MR, Intern J Appl Res Vet Med 2006;4(2):155-162.

Prevention & Therapy: Methods• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

– Aspirin (OTC)– Bute– Equioxx®– Surpass® (topical)

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Prevention & Therapy: Methods• Newer Therapies

– Extracorporeal Shockwave Therapy (ESWT)– Biologics

• IRAP• PRP• Stem Cell

• Complementary & Alternative Therapies– Acupuncture– Chiropractic– Massage– Magnetic

• Corrective shoeing• Oral joint supplements

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Oral Joint Supplements:Key Active Ingredients

• “Mother Nature’s Big Three”– Glucosamine– Chondroitin Sulfate– Hyaluronic Acid (HA)

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Safety of an Oral Chondroprotective Agent in HorsesKirker-Head CA, Kirker-Head RP, Vet Ther. 2001 Fall;2(4):345-53.

Double-Blind Study of the Effects of an Oral Joint Supplement in Horses with Tarsal Degenerative Joint Disease. Clayton HM, Almeida PE, Prades M, et alProceedings. 48th Annu Conv Am Assoc Equine Pract. 2002;48:314-7.

Oral Treatment With a Glucosamine-Chondroitin Sulfate Compound for Degenerative Joint Disease in Horses: 25 CasesHanson RR, Smalley LR, Huff GK, et al, Equine Practice. 1997 Oct;19(9):16-20.

“Mother Nature’s Big Three”Glucosamine is the building block of chondroitin sulfate, a specific type of glycosaminoglycan (GAG).

Chondroitin Sulfate is not only the building block of the much larger molecules hyaluronic acid (HA) and proteoglycan (PG) it also inhibits the effects of various enzymes that degrade cartilage.

Hyaluronic Acid (HA) is an integral component of joint cartilage and joint fluid, providing both lubrication and shock absorption.

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Evidence of the Oral Absorption of Chondroitin Sulfate as Determined by Total Disaccharide Content After Oral and Intravenous Administration to HorsesEddington ND, Du J, White N,Proceedings. 47th Annu Conv Am Assoc Equine Pract. 2001;47:326-8.

Oral hyaluronan (HA) gel reduces post operative tarsocrural effusion in the yearling Thoroughbred.Bergin BJ, Pierce SW, Bramlage LR, Stromberg A., Equine Vet J. 2006 Jul;38(4):375-8.

Oral Joint Supplements:Key Active Ingredients

• Other ingredients to look for– MSM– ASU– Omega 3 Fatty Acids– Cetyl Myristoleate– Herbs

• Devil’s Claw, Yucca, Boswellia, Bromelain, Curcumin, more!– Antioxidants

• Vitamin C, Grape Seed Extract, Resveratrol, Superfruits, more!

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The effect of methylsulphonylmethane supplementation on biomarkers of oxidative stress in sport horses following jumping exercise.Marañón G, Muñoz-Escassi B, Manley W, et al, Acta Vet Scand. 2008 Nov 7;50:45.

Markers of Inflammation in Arthritic Horses Fed Omega-3 Fatty AcidsManhart DR, Scott BD , Gibbs PG, et al, The Professional Animal Scientist 2009;25(2):155–160

Horse in Light Work/Young Horse• Workload Definition from NRC:

– 1-3 hours per week– 40% walk, 50% trot, 10% canter

• Goal:– Maintain healthy joint tissue, avoid future problems

• Ingredients to Look For:– Glucosamine – Also consider Chondroitin Sulfate, MSM

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Horse in Moderate Work• Workload Definition from NRC:

– 3-5 hours/week – 30% walk, 55% trot, 10% canter, 5% low jumping, cutting/other skill work

• Goal:– Support joints in day to day stress

• Ingredients to Look For:– Glucosamine, Chondroitin Sulfate, MSM

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Horse in Heavy Work• Workload Definition from NRC:

– 4-5 hours per week – 20% walk, 50% trot, 15% canter, 15% gallop, jumping/other skill work

• Goal:– Provide comprehensive support for joint, tendon/ligament health,

avoid discomfort and stiffness

• Ingredients to Look For:– Glucosamine, Chondroitin Sulfate, MSM, HA– Tendon/Ligament Support from Silica & Collagen

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Horse in Very Heavy Work• Workload Definition from NRC:

– 1 hour/week of speed work to 6-12 hours/week of slow work– Includes elite performance horses in intense, strenuous work

• Goal:– Provide aggressive support for joint, tendon and ligament health, minimize

discomfort and stiffness caused by intense training and competition

• Ingredients to Look For:– Glucosamine, Chondroitin Sulfate, MSM, HA– Tendon/Ligament Support from Silica and Collagen– Antioxidants (Resveratrol, Superfruits, Grape Seed Extract)

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Horse in Recovery• Ingredients to Look For:

– Glucosamine, Chondroitin Sulfate, MSM, Hyaluronic Acid (HA)– Tendon/Ligament Support from Silica & Collagen– Antioxidants– Herbs (Devil’s Claw, Yucca, Boswellia, Bromelain, Curcumin, more)– Omega 3 Fatty Acids– Essential Amino Acids (Lysine, Methionine, Threonine)

• Goal:– Help minimize inflammation, alleviate discomfort and support the

healing process

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Senior Horse• Ingredients to Look For:

– Glucosamine, Chondroitin Sulfate, MSM, Hyaluronic Acid (HA)– Herbs (Devil’s Claw, Yucca, Boswellia, Bromelain)– Antioxidants– Probiotics & prebiotics for digestive Support

• Goal:– Ease stiffness and discomfort, support joint and digestive health,

provide antioxidants

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Active Ingredient Guidelines

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GlucosamineChondroitin

SulfateHyaluronic

Acid MSM Other

Young Horse/Horse in Light Work

4,000 mg 5,000 mg Vitamin C

Horse in Moderate Work

8,000 mg 1,000 mg 10,000 mg Vitamin C

Horse in Heavy Work

10,000 mg 1,000 mg 100 mg 10,000 mg Vitamin C, Silica, Collagen

Horse in Very Heavy Work

10,000 mg 1,000 mg 150 mg 10,000 mg Vitamin C,Silica, Collagen, Antioxidants,Cetylated Fatty Acids

Horse in Recovery

5,000 mg 400 mg 100 mg 12,000 mg Vitamin CSilica, Collagen, Antioxidants,Amino Acids,Herbs

Senior Horse 7,000 mg 500 mg 50 mg 12,000 mg Vitamin CPro/PrebioticsHerbs

Product Selection Guidelines

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Horse Product Recommendations

Young Horse/Horse in Light Work SmartFlex I Maintenance,Cosequin,Grand Flex

Horse in Moderate Work SmartFlex II Support,Cosequin SP,Glucosamine XL Plus w/MSM

Horse in Heavy Work SmartFlex III Resilience,Cosequin ASU,HylaSport,Grand HA Synergy

Horse in Very Heavy Work SmartFlex IV Ultimate,Cosequin ASU Plus,Recovery EQ Extra Strength

Horse in Recovery SmartFlex Rehab,Recovery EQ,Recovery EQ Extra Strength

Senior Horse SmartFlex Senior,Senior Flex or Senior Flex HA Pellets,Grand Flex Senior

Questions & Answers

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Questions1. Aside from jumping at shows is there a "safe" height we can jump frequently

at home for schooling that won't wear down the horse's joints too much? 2. I'd like to hear about joint care in warm weather vs. in cold weather. What

supplements should you feed at different times of year, how should you warm your horse up, etc.?

3. Assuming the horse has been on an oral supplement for several weeks, how long before it becomes effective after administering? What is the optimum time to allow before working a horse after feeding a daily supplement?

4. How do you accurately evaluate the impact of joint supplements and IV/IM medications given how subtle differences can be? What would you recommend the owner looks for and what are good metrics/benchmarks to watch for?

5. Are joint supplements meant to be an ongoing, lifelong basis or are they meant to be fed on an as-needed basis?

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Questions6. Please tell us how to use MSM effectively for our horses. 7. Can you feed a Cushings-positive horse a supplement that contains glucosamine? 8. I have a 16 year-old thoroughbred not on any supplements. He currently has shoes all the way around and is used as a long stirrup 2'3"" hunter. He has, on occasion, started out stiff during warm-up. Would you recommend starting a supplement? Which one? 9. My horse is 7. Isn't he too young for me to be worried about his joints? 10. My older mare is exhibiting stiffness when ridden. However, she has had gastric ulcers in the past and I am concerned that ingredients in joint supplements could affect her digestive system. Is there a specific joint supplement that is recommended?

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Questions11. If you had to choose 2-3 supplements for a 12 year-old H/J that is worked 4-5 times per week, what would they be? 12. I currently give my 24-year-old mare Cosequin. I've been giving it to her since she was 15 not because she needed it, but so she wouldn't 'need' it later. Is it good for her or not? She moves as though she's still 15. She is a Shire/Thoroughbred mix. 13. Are there any scientific studies in equines to support the use of supplements with improvements in radiographs or decreased pain ( how do you measure this in a horse)? 14. From my warmblood H/J show horse to my tamed wild mustang who is a trail riding horse, why hock problems and how to prevent them? I understood why my hunter might have problems but why does a 13 year-old mustang from the wild also have problems?

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Questions15. I'd like to hear about joint care for senior horses that are retired and being worked vs. joint care for senior horses that are still actively being shown and worked on a regular basis. 16. I have one mare that looks smooth when I ride her and has checked out sound in a vet examination, but every so often I hear a click/pop sound in her hocks. She is a 7 year-old mare and she does not act lame when I hear this. 17. I have a foal who went through OCD surgery at 11 months. He had two in his left fetlock and one on his left stifle. All are removed and his recovery was textbook. Is there anything I should be doing now to continue to help those joints heal and become strong? 18. "Lexi" is a 10 year-old mare that has arthritis in her back legs and left front leg. She is on Adequan and Legend every month, gets supplements in SmartPaks and gets exercise every day with rest one day a week. Now she's getting stiff more often. Please help.

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Questions19. How much does proper farrier work help with joints? My vet says my horse is alot more prone to joint and suspensory damage when the farrier has not done a good job on her feet. Please comment.20. Should you give Adequan once a month or give the full loading dose twice a year? 21. I'm interested in hearing about injections vs. supplements and how to work them together.

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