When it comes to joint therapies, steroids are no longer the norm. There are better options that aim to preserve and extend the serviceable use and athletic years of your horse. Steroids are neither the solution for every joint nor for every horse. Steroids can complicate conditions like Cushing's, Insulin Resistance, and laminitis.

Today's medications can be selected for a specific joint's problem. These newer joint treatment options may actually heal the joint, slow disease progression, reduce damage, last longer, and can be introduced sooner in a horse’s life. Also, these regenerative medications are legal/safe for use in both FEI and USEF events nearer to competition and do not have the risk of a positive steroid test result. Joint treatments have greatly advanced beyond steroids and these options are fast becoming the standard of care.

Total Equine Veterinary Associates now has more stall-side treatment options available to best suit your horse’s needs. Let's explore 4 safe alternatives to steroids and when they should be considered. To optimize the benefits to your horse, more than one of these medications may be selected on the same visit in different joints or in succession several weeks apart.

This 4-part series will explain the latest joint treatments available on your farm.

• Part 1: Arthramid® Vet
• Part 2: Noltrex®Vet
• Part 3: Pro-Stride® APS
• Part 4: Alpha2EQ® (α2M)

Part 1: Arthramid® Vet

Arthramid® Vet is a uniquely cross-linked 2.5% polyacrylamide hydrogel (PAAG) that adheres to the synovial lining through its ability to exchange water molecules. Arthramid® Vet has an augmentation effect on both the joint capsule and synovium. It increases the elasticity and tensile strength of the capsule, improving its capacity to transfer load.

Use: Pro-active treatment. A great option for performance horses, horses with arthritis, thin cartilage, and for most causes of joint disease. Discuss with veterinarian.
Cost: Approximately $410 per joint (product only).
Post Injection Care: 2 days stall rest, followed by 10 days hand walking and small paddock turnout, then resume full work. Full effect within 30 days; expect 12 or more months between treatments.
More Information: https://www.conturavet.com/resources

Part 2: Noltrex®Vet

Noltrex®Vet, like Arthramid® Vet, is polyacrylamide. However, Noltrex®Vet is a thicker synthetic 4% polyacrylamide hydrogel (PAAG) used to provide improved joint lubrication. Unlike conventional steroid therapies that address symptoms, Noltrex®Vet addresses a root cause of joint pain by physically reducing friction, acting as a cushion within the joint. A treatment can last 12-15 month.

Use: Horses with significant joint damage and inflammation, usually chronic cases, discuss with veterinarian.
Cost: Approximately $350 per joint (product only).
Post Injection Care: 1 week of pasture turn out without work, then resume work.
More Information: https://noltrexvet.com/resources/#research

Part 3: Pro-Stride® APS

Pro-Stride®: Autologous Protein Solution (APS). Pain and damage in your horse’s joints are caused by a process that breaks down the cartilage. Proinflammatory proteins called cytokines can cause damage to tissues in your horse’s joints. These cytokines, including interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF-alpha), need to be blocked. If not, they bind to the cell surface receptors on cartilage and start the cartilage degradation process.

Your horse has several naturally occurring inhibitors (anti-inflammatory proteins) to block the proinflammatory cytokines. These include the interleukin-1 receptor antagonist protein (IRAP), soluble interleukin-1 receptor (SIL-1R), A2M, and soluble tumor necrosis factor receptors (STNF-Rs). Pro-Stride® APS highly concentrates these inhibitors to help reduce pain and protect the cartilage.

Pro-Stride® APS is derived from your horse's own blood. Pro-Stride® APS can take up to 14 days to be fully effective.

Use: Pro-Stride® APS can be used to treat osteoarthritis, synovitis, soft tissue like tendon or stifle injuries.
Cost: Approximately $600 per kit for 2-3 joints (product only).
Post Injection Care: 1 day stall rest, 3 days turnout, then return to regular work.
More Information: https://www2.zoetisus.com/products/horses/equine-regenerative-medicine/pro-stride-aps

Part 4: Alpha2EQ® (α2M)

Alpha-2-macroglobulin: α2M. Alpha-2-macroglobulin is already a component of your horse's blood. It is a large glycoprotein that acts as a protease inhibitor (proteases are substances that damage tissues such as cartilage and collagen), it regulates gene activity (turns on good genes, turns off bad genes) and it inhibits inflammatory factors. α2M protects cartilage. Blood is collected and processed on the farm for immediate use and because a large volume is produced, the unused remainder can be frozen and stored up to 6-9 months for later use.

Use: For multiple joint injections at one time. Horse that needs more frequent treatment than other horses. Appropriate for all causes of joint disease and tendon/ligament injuries.
Cost: Approximately $1,100 for the harvest of blood, processing, and storage. This results in treatment volume for about 6-8 joint injections. α2M not used in the first visit can be frozen for future visits. Future visits inject the previously collected material.
Post Injection Care: 2 days stall rest, followed by 10 days hand walking and small paddock turn out, the return to work.
More Information: https://www.astariaglobal.com/what-is-alpha2eq

Registered April 2022
Author: Total Equine Veterinary Associates

Information in this article is for educational purposes only and is not a substitute for evaluation by an equine professional. In particular, all horse owners should seek advice and treatment from a licensed veterinarian, such as TEVA, for their horses' medical care.

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