“Are there any new treatments available for arthritis of the coffin joint?”

Denise A. Gorondy, DVM

We are fortunate to be in a time where significant progress is being made with treatments for arthritis. In addition to the treatments mentioned (joint injection and Adequan), there are some newer treatment modalities that could potentially be appropriate to treat and or manage a horse with osteoarthritis of the coffin joint.

  • Therapeutic shoeing, although not a new modality, is often times overlooked in instances of chronic conditions such as coffin joint arthritis. However, utilizing radiographs to guide the farrier in ideal shoeing can dramatically improve a distal limb origin lameness. The goal of utilizing radiographs is to allow the farrier to specifically identify where to place the breakover thereby reducing any unnecessary stress on the boney and soft tissue structures of the digit.  Additionally, foot balance radiographs are used to ensure that the distal limb is properly balanced from side to side (referred to as medial to lateral balance).
  • Tildren is a bisphosphate medication that is administered intravenously. In the horse’s body, there is a balance between bone building (performed by cells called osteoblasts) and bone breakdown (performed by cells called osteoclasts). In arthritic processes, the natural balance of bone metabolism is shifted toward osteoclastic activity. Tildren medication acts to shift the horse’s own bone metabolism away from excessive osteoclastic activity and re-establish proper balance of bone metabolism. One of the added benefits of Tildren is that it has the potential to treat multiple joints in the body. The frequency of administration of Tildren depends on the individual case. Some horses with an acute issue are treated once, other horses with more chronic issues are treated on a recurring basis.
  • IRAP (Interleukin Receptor Antagonist Protein) is a therapy that utilizes the horse’s own blood proteins to combat inflammation. Interleukin – 1 is a blood protein that is one of the key perpetuators of active inflammation. During IRAP therapy, the horse’s own blood is harvested in a specially formulated syringe that contains chromium sulfate coated beads. This syringe is incubated and processed in a manner that results in an exponential increase in the horse’s owner IRAP molecules. The resulting IRAP rich serum is then harvested and injected directly into the affected area of the horse (ie the coffin joint). During the IRAP harvesting, multiple doses are obtained and any unused portion can be frozen to be used at a later date. The IRAP or antagonist proteins in the serum effectively eliminate the Interleukin – 1 and result in a decrease or elimination of the active inflammation present at the site of injection.
IRAP

Dr. Gorondy performing IRAP

 

Although there is truthfully no way to cure arthritis of any joint, there are many therapies and management changes that can be made to improve these conditions to the point where the horse is comfortable enough to continuing working in some capacity.