Regenerative Alternatives

The regenerative medicine umbrella includes stem cell therapy as well as biologic therapies that concentrate or stimulate specific blood components to trigger natural processes that alleviate inflammation and promote healing. With the latter, the concentration of platelets in platelet-rich plasma or the stimulation of white blood cells causes the release of proteins such as interleukin-1 receptor antagonist protein (IRAP), says Schnabel.

That helps alleviate inflammation and restore normal joint health, she says. IRAP specifically blocks the receptor for the major inflammatory protein in joint disease, which is interleukin-1, thereby blocking its effect.

Many of the kits only take 20 to 30 minutes for the veterinarian to process and administer at the barn.

Biologic agents such as PRP, autologous conditioned serum, and autologous protein solution are showing promising results to support healing rather than simply reduce inflammation like corticosteroids do, explains Niklas J. Drumm, DMV, Dipl. ACVS-LA, ECVS, of Tierklinik Lsche im Sanakena, in Germany.

Ideally, these alternatives offer a longer-lasting effect than steroids, he says. However, the prognosis much more depends on the disease (chronicity and severity) and horse (age, discipline, build) than the treatment alone.

Stem cell therapies are also popular joint injection options following an injury. Whether taken from the patients own bone marrow or derived from another source, such as the umbilical cord or amnion, stem cells can encourage healing, says Schnabel.

David decides whether to use corticosteroids, PAAG, or regenerative therapies based on the horses pain level and the time allocated to return the horse to soundness. He typically reserves regenerative therapy for horses with mild pain or when the owner can afford a significant break in the horses competition schedule.

Regenerative therapies let us dig more into the problem itself and try to change the course of the disease, he says. The problem with regenerative therapies is that when embarking on that road you have to stick with the protocol, and it can take a while before you can conclude if this treatment is going to help the horse.

If a horses healing is progressing slowly, he says not to be discouraged because the goal is to target the disease itself. After an initial IRAP injection, for example, he says he follows up every seven to 10 days for three to six additional treatments. Each regenerative product involves a specific protocol that he adjusts to each injury or condition, patient, and owners wallet.

Corticosteroids are popular joint injection options because they cost $40 to $100 per injection. Synthetic joint lubricants are the next step up, costing around $300 to $500. Schnabel estimates that biologic treatments set you back about $500 to $1,000 and regenerative therapies average $2,000 to $3,000. Fees vary by location and clinic, however, and do not include the farm call, associated diagnostics, or actual joint injection fees, she adds.

Again, with most alternative options, it takes several weeks for their full effect to be visible. Like David, vets might administer IRAP in multiple doses over six to 12 weeksthe same goes for stem cells. And, as mentioned, it might take two to four weeks to see the effects of PAAG injections. Researchers are still working to determine how long the benefits of the latter therapy last, but they expect six months to a year or longer in some cases.

Most of these therapies are used in high-motion joints such as the coffin joint, fetlock, and carpus (knee), for which full range of motion is critical for performance or racing, but they are also commonly used in difficult-to-manage joints like the coffin and pastern joints, Schnabel says. They are less commonly used in low-motion joints that can be fused, like the distal (lower) hock joints.

While these joint therapies are exciting, they are not appropriate for every horse and disease, says Drumm. Its the vets discretion and responsibility to choose the right treatment for each case. Plus, when treating joint disease, youll never find a panacea but, rather, a combination of approaches, including systemic and intra-articular medications, controlled exercise programs, supplements, and physiotherapy, that works for your horse.

We are just at the beginning of understanding these therapies and how to best use them for optimal results, Schnabel says. Im very excited to continue to work on optimization of these therapies, particularly for cases of cartilage damage and soft tissue injury within the joint for which steroids typically dont work well or for very long.

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