Inflammation in a horse is an inflammatory response to an injury, infection or disease.
Although part of the natural recovery and rehabilitation process, a horses body can react with an inflammatory response which actually creates negative results on the overall health of the animal by damaging healthy tissues.
The biochemical origin of all pain directly relates to inflammation.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771434/
To reduce the negative effects of inflammation many therapists, vets and owners will adopt a series of techniques to manipulate and reduce the inflammatory response using a variety of therapies and/or medications.
In the majority of cases, inflammation will begin with a thermal increase in the effected area, often owners will report the ability to ‘feel the heat’ in the area of concern. This may also result in a redness of the skin and a level of swelling. Depending on the severity of the cause some horses will become lame with some experiencing a dramatic reduction in mobility levels.
When an injury or invasion of microorganisms is experienced within the cells of the horses body, a release of enzymes and proteins are created to signal to the living system to release white blood cells. These white blood cells migrate to the effected site of the injury and start to ‘clean up’ the debris caused by the trauma and begin the horses natural repair process. As they begin to clean-up the debris more white blood cells are created and the blood vessels leading to the site of the trauma begin to leak allowing for the white blood cells to impact the injury. This is the cause of the fluid build up which we know as swelling.
These natural healing processes are necessary to help protect the body from more severe and worsened injury, clean the area of damaged tissue, promote healing and assist the return of function to the site. In many cases though, too much support is given. This is where treatments and therapies developed to help reduce inflammation come into play.
Interestingly, the ultimate cause of the heat experienced with a new injury, and redness seen on the skin, is due to the release of these enzymes and proteins.
Injuries can also be created by wounds, cuts and abrasions and via a variety of traumatic injuries through the failure of tendons, ligaments, muscles or splints.
Inflamed tendons, ligaments and muscles in horses are extremely common and are often created through poorly fitted tack, bad riding techniques or through the horses extensive range of movements within exercise.
If the horses joint is effected the horse is likely to pull up lame and refuse to put weight on that limb.
The majority of these internal injuries mean the inflammatory response is not visible. The reaction by the horse will be the first sign that something is not right and that it may be showing early signs of lameness.
If the inflammatory response continues, even after applying initial treatment then the system begins to uncontrollably create an inflammatory response which is the point where intervention is a necessity.
More serious conditions which will lead to an inflammatory response are Cellulitis and Lymphedema (or Lymphangitis) which both effect the horses legs. Cellulitis is an inflammatory condition of the skin and the soft tissues directly under the skin whereas lymphangitis develops when the inflammation spreads to the deeper tissues of the horse. Both of these conditions can create a bacterial infection and require immediate medial care.
Less serious conditions of inflammation such as windgalls are mainly superficial and 'cosmetic in nature’ and can be treated with non invasive techniques such as bandages and various tack.
Swollen legs can be a frequent occurrence in many horses and will often occur if the horse is standing for long periods of time. It is likely you have had to carry out this procedure, or know someone that has, and it can be a tiresome and never-ending task - only for the inflammation to keep returning.
Edema is the visible accumulation of fluid directly in the tissue and forms following trauma or surgery. This form of inflammation can delay the bodies natural ability to recover.
To combat inflammation several modalities are used within the equine community.
Analysing your horses health
Whatever treatment you provide your horse, whether approved by medical authorities or not, choosing a program which is bespoke and individual to your horses needs is vital.
Many equestrians now look for additional information on what their horse may need by using vitamin and mineral testing technologies and spotting early signs of lameness.
Horse hair analysis services look for nutritional deficiencies in your horse to determine the status of the horses performance level, the function of its immune system and if toxic minerals are present. Relatively new-to-market this aspect of analysis is only set to improve and represents an invaluable insight on your horses overall wellbeing.
Blood samples are commonly taken within the equine community and are routine for equine veterinarians when establishing the cause of a condition. A relatively simple procedure many owners (and vets) now adopt routine blood tests as they can pick up on issues before clinical signs develop.
Blood samples are also taken when a horse is travelling to screen horses for possible signs of diseases and pathogens.
Blood tests are routinely carried out to check for signs of PPID. Levels of a hormone known as ACTH are monitored and if it is detected that they are too high they can be treated to help remain at a lower level. PPID is extremely common in elderly horses and can lead to many clinical problems such as laminitis, hoof issues, dental problems and infections. Other conditions that are checked using blood tests and monitoring antibodies levels are EMS (equine metabolic syndrome), tapeworms, strangles and various viral infections.
Although these analysis services do not specifically look for inflammation they provide owners the ability to detect issues which may lead to an inflammatory response and swelling later on.
Anti-Inflammatory Medications (NSAIDs) for horses
The most common applied treatment for musculoskeletal problems remain anti-inflammatory medication, NSAIDs.
Non-steroidal anti-inflammatory drugs (NSAIDs) are probably some of the most widely used drugs used in both human and equine medicine. Aspirin is an NSAID medication.
These types of medications work by inhibiting cyclooxygenase enzymes (COX). It’s at this point where explaining how NSAIDs work we became acutely aware of just how tedious this article will become and equally unlikely to be content you’re looking to read on our blog! So we’ll skip how NSAIDs work and move on….
If you have a horse, particularly an older one who has shown arthritic tendencies, then it’s very likely you’ve heard of phenylbutazone (aka “Bute”) - the most commonly administered NSAID within the equine community.
As with any medication, NSAID medicines can have systemic side effects and ideally should only be used short-term and always under the supervision of a veterinarian. In some cases it becomes a challenge to know if the NSAID painkiller is helpful or harmful to the horse. Prescriptions are required to purchase NSAID medications.
NSAIDs, or Non-steroidal anti-inflammatory drugs, inhibit prostaglandins. These are hormones that are involved in healing processes such as inflammation, blood flow and even blood clotting. The hormones however reduce the mucous production levels in the horse which in turn can lead to other complications such as gastrointestinal ulcers and stomach issues.
Adverse reactions to NSAIDS, and using them over long periods of time, can lead to poor gut health, nutrient absorption and deficiencies, reduced immune function and a lower level of overall wellbeing. It is for this reason that many horses looking for longer term support for their horse adopt a range of alternative therapies and complimentary treatments.
Dimethyl Sulfoxide is a potent anti inflammatory NSAID medication prescribed by professionals which provides a wide spectrum of pharmacological effects on horses with inflammation. Mainly applied a typical gel or administered in liquid form orally, it is classified as a NSAID medication as it has antioxidant properties which help interrupt the inflammatory response. Its main issue is how the heat is generated when applied to the horses skin, often the last thing you wish for when managing inflammation.
The most potent anti-inflammatory medication used in veterinary medicine are corticosteroids which inhibit enzyme production in all phases of the inflammatory process. These very potent drugs have a few serious side effects so are rarely used with the plethora of other treatments available.
Anti-Inflammatory Supplements for horses
Far better as a long-term solution for your animal. Providing your horse with various joint supplements which combat inflammation within the horses joints are now available and widely adopted.
There are many brands and concoctions available with varying claims of efficacy or scientific support. Aside from the claims, there are compounds found in many of these formulas which have achieved clinical support and are gathering pace within the supplement market. There are however many claims which are not substantiated by medical proof and as such the market becomes highly competitive and saturated - making the decision on what to administer more difficult for horse owners.
Senior or heavily worked horses are likely to benefit from the use of joint supplements.
It is worth noting that many equine joint supplements on the market remain unauthorised for sale as they are unproven by medical authorities, meaning that manufacturers using these ingredients should be making no medical claims around their efficacy.
Controlling the dose of each supplement and understanding how the horses body absorbs the supplements is a key element of controversy.
The UK Advertising Agency has recently taken over the authority on enforcing medical claims within the pet industry in the UK (previously managed by the Veterinary Medicines Directorate (VMD) and its published regulations are black and white, yet, many of these supplements are marketed in direct breach of these regulations. In the USA the FDA (The Food and Drug Administration) are responsible for the same processes.
The ASA and the FDA both state:
A medical/medicinal claim is a claim that a product or its constituent(s) can be used with a view to making a medical diagnosis or can treat or prevent disease, including an injury, ailment or adverse condition, whether of body or mind, in human beings. To obtain a medical device authorisation fully peer-reviewed studies are required, published by authorised business journals.
With so many supplements now advertised to horse owners we take a quick look at some the leading compounds and what evidence they have within the equine medical community and whether these manufacturers are permitted to claim various health benefits.
Fatty Acids (Omega-3’s)
Omega-3 fatty acids are found in marine oils and plants, such as flax seed. With a multitude of supplement manufacturers using fatty acids in their recipes their claims are supported by efficacy evidence and a good volume of studies published supporting the claims.
Evidence showed that using fatty acids on horses can benefit them from improving symptoms of osteoarthritis {1) and even increase the horses stride lengths. {2}
Evidence supports their use on horses meaning fatty acids are now an important ingredient in many supplement diets given to horses and can be advertised as such.
Methylsulfonylmethane (MSM)
MSM is widely available in its natural form of sulphur and is considered one of the safest supplements to add to a horses diet to aid inflammation. The compound is well tolerated by horses and is an important component of collagen and glucosamine which are found in body tissues.
Early evidence does support MSM use for anti-inflammatory purposes in horses but further studies are required to achieve full clinical status and allow the promotion of any medical claim. {3}
As such, manufacturers of supplements containing MSM are breaching UK advertising regulations if they make any medical claim relating to MSM and its purpose of use. Likewise, MSM herbal products are not yet approved by the FDA in the USA.
Hyaluronic Acid
Hyaluronic Acid is a vital component in many tissues of the body, including joints, cartilage and various connective tissues and is abundantly found in synovial fluid.
It is widely used as an injection which is administered directly into the joint but dietary supplements containing Hyaluronic Acid are increasingly being seen in the equine community.
There remains a high-volume of evidence to support claims that Hyaluronic Acid supports osteoarthritis in horses and increasing the horses overall joint health. {4}
Hyaluronic acid is fully approved by medical authorities in the UK and by the FDA in the United States and as such manufacturers are able to make medical claims surrounding their use but only if they are injected.
Oral supplementation of Hyaluronic Acid is relatively new to market and does require further studies, but early signs do show similar results to the injected form. {5} Manufacturers of supplement powders where MSM is not injected are currently not authorised to claim any health benefit.
Resveratrol
Resveratrol is an interesting compound which is found in many plants such as pine trees, grape skin (and yes, wine is included in that!) blueberries, raspberries and even peanuts. These compounds are produced by these plants when the plant is under attack by pathogens such as a fungi or bacteria.
Early studies show that Resveratrol has antioxidant properties which have the ability to create an anti-inflammatory response when consumed. With ingredients such as Japanese Knotweed showing high levels of Resveratrol some equine supplements are now including ingredients containing levels of Resveratrol within their ingredients.
Although there is some efficacy evidence to support its claims on horses {6}, further studies are required to achieve full clinical approval so the compound remains an unproven form of therapy and as such manufacturers are unable to make a medical claim for its purpose of use and any doing so are in breach of regulations.
Glucosamine
Glucosamine is a natural occurring compound which create the building blocks of cartilage, the structural support of tissue founds between joints in a horses body.
As a supplement, glucosamine is sourced from beef and marine sources and is now synthetically manufactured. There are three main forms of glucosamine; Glucosamine Sulfate, Glucosamine Hydrochloride and N-acetyl-D-glucosamine.
Glucosamine Hydrochloride is highly bioavailable allowing it to be easily absorbed by the body whereas Glucosamine Sulfate directly supports cartilage repair and the production of collagen for improved joint health. Many supplements using glucosamine use both types to provide the most effective benefits but there remains much scepticism surrounding how much glucosamine is actually used in these products!
Given the amount of glucosamine products sold within the equine market, there have been no clinical studies on the effectiveness of orally administered glucosamine and many use evidence collected across other species (including humans) to advertise their benefits. Even though many clinical trials have taken place using glucosamine of humans, there remains much controversy surrounding the results.
One manufacturer has been approved by the FDA in 1989, Adequan® which contains polysulfated glycosaminoglycan and has proven to support joint disease in horses, restore synovial joint lubrication, repair cartilage and reduce inflammation. {7}
More studies are required to prove glucosamines effectiveness on horses and as such the UK and US regulations do not currently permit advertising of Glucosamine as a medication for the treatment of inflammation in horses without appropriate clinical evidence to support those claims.
Green Lipped Muscles
Green lipped muscles have begun to appear within the equine community in a variety of supplements.
Green Lipped muscles, normally harvested from New Zealand, are freeze dried and then directly absorbed within a supplement. This powder contains high levels of the protein called Pernin, which has high contents of omega-3, glucosamine and chondroitin sulphates. These have shown in other studies to support reduction in inflammation.
There is research which supports it use with horses, but it remains a non proven form of treatment and thus any medical claim for its use is banned from advertising.
FDA determined that Green Lipped Mussels intended for use in the mitigation, treatment, or prevention of diseases in animals, which makes it a drug under section 201(g)(1)(B) of the Act [21 U.S.C. 321(g)(1)(B)]. Further, this product is an unapproved new animal drug and marketing it as such violates FDA regulations. {8}
Other natural supplements used on horses
There are many compounds used in the equine community which have not been directly studied or approved by medical authorities but have an extensive following and decades of anecdotal support.
Manufacturers of these holistic products should not be making medical claims for their intended purposes of use, but many do. This adds a level of complication when trying to understand what is best for your individual horse, however, many vets and therapist are well knowledge in what herbs and natural approaches can be used alongside other treatments.
Vitamin C, E or A is often used for their antioxidant properties and are typically added with copper, manganese or selenium.
CBD Oils are now gathering a lot of support and are made using the non-psychoactive component of cannabis, developed to provide pain relief.
Curcumin is a bioactive component of Turmeric which has gathered quite a following in the equine community for its natural anti-inflammatory properties.
Boswellia is a plant extract which like Turmeric has shown anti-inflammatory properties.
Rose Hips are now gathering momentum within the holistic health market due to their high vitamin content of A, D and E, and fatty acids.
And finally, widely used across the equine community for pain relief, Devils Claw is a herb used in a variety of natural supplements.
Treating Inflammation in horses
Compression Bandaging
A commonly used technique when attempting to manage or reduce a horses inflamed and swollen legs is compression bandaging. Compressing the legs with wraps or bandages can help the lymphatic fluid circulate around the leg more efficiently and help reduce the inflammation.
Magnetic Therapy
Widely used within the equine and pet communities are magnetic therapies which have been developed over the years into boots, rugs and various pieces of tack.
Historically creating an issue with inflammation due to the heat they create, magnetic therapy in the past few years have developed into highly advanced technologies creating remarkable anecdotal results which in turn create no heat to the horses legs.
Promoted as a complementary option which work alongside other treatments, advanced magnetic horse bands have shown to be a great option to horse owners when looking to manage a variety of heath issues, including inflammation.
Although not clinically proven, these newly advanced equine products, such as EQU StreamZ horse bands, provide users with a plethora of case studies and efficacy evidence through various double-blind studies and vast anecdotal support for reducing inflammation.
Cold Therapy (Ice therapy)
There are a variety of tack products which are specifically developed to reduce the temperature of the horses legs and help reduce inflammation and swelling. Often quite expensive, these products are mainly used after exercise as part of the horses initial recovery process.
Equine Hydrotherapy
Hydrotherapy is often an overlooked treatment when managing a horses inflammation and is used to support the recovery from injuries of tendons, ligaments, joints, and muscles. It will not contain all the inflammation but is widely accepted as good adjunct to other modalities.
At the most basic level hydrotherapy treatment is something that many horse owners do on a daily basis anyway - cold hosing. This is a form of hydrotherapy as the water lightly massages the legs whist reducing heat.
More advanced treatments of hydrotherapy are offered by specially trained therapists using highly advanced water treadmills. These treadmills provide resistance in movement and are fully adaptable to aid the horses stride length and stride frequency. Treating horses regularly with hydrotherapy has shown to reduce recovery times and improve the horses overall fitness level.
Massage Therapy
Commonly adopted treatments now include massage therapy for horses. By provide regular and targeted massage it has shown to support the horses joints which can result in a reduction in joint inflammation further down the road.
Acupressure or Acupuncture
This form of therapy has been used for thousands of years by stimulating pressure points throughout the horses body.
Chiropractors and Physiotherapists
These therapists provide services which focus on the horses skeleton (chiropractors) and tissues and muscles (physiotherapists) with view to aligning and maintaining the horses natural alignment and preventing injuries which may result in inflammation. These therapies provide separate benefits which are sometimes misunderstood within the equine community.
With much of this therapy concentrating on physical therapy and the horse movement many horse owners now regularly attend an equine therapist and report wonderful results.
In summary
Treating your horses inflammation is an immediate requirement. If you are set to buy a new horse then inspect the horse first for signs of inflammation.
With such a variety of options to chose from it can be confusing on which route to take when looking to manage a horses inflammatory response.
Hopefully this article has shed some light on some of these commonly adopted therapies and what impact they may have.
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REFERENCES CITED:
{1} D R Manhart. Markers of Inflammation in Arthritic Horses Fed Omega-3 Fatty Acids. https://www.sciencedirect.com/science/article/abs/pii/S1080744615307026
{2} Woodward. Supplementation of dietary long-chain polyunsaturated omega-3 fatty acids high in docosahexaenoic acid (DHA) increases plasma DHA concentration and may increase trot stride lengths in horses. https://www.cambridge.org/core/journals/equine-and-comparative-exercise-physiology/article/abs/supplementation-of-dietary-longchain-polyunsaturated-omega3-fatty-acids-high-in-docosahexaenoic-acid-dha-increases-plasma-dha-concentration-and-may-increase-trot-stride-lengths-in-horses/42721267D8CF746ED25E712132FF20AE/
{3} Matthew Butawan. Methylsulfonylmethane: Applications and Safety of a Novel Dietary Supplement. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372953/
{4} David D Frisbie. Prevention or treatment of osteoarthritis in horses. https://pubmed.ncbi.nlm.nih.gov/27668577/
{5} J U Carmona. Effect of the administration of an oral hyaluronan in young horses. https://pubmed.ncbi.nlm.nih.gov/19876524/
{6} Ememe. Ameliorative effects of resveratrol on oxidative stress biomarkers in horses. https://www.sciencedirect.com/science/article/abs/pii/S0737080615001148
{7} D Y Kim. Articular chondrocyte apoptosis in equine osteoarthritis. https://pubmed.ncbi.nlm.nih.gov/12788017/
{8} Green Lipped Muscles cited example of banned marketing resale on USA market - https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/fresh-nutrition-inc-612984-05272021#:~:text=ease joint pain”-,Your Berberine, Echinacea, European Elderberry, Milk Thistle, Lion's,of the Act [21 U.S.C.
{9} Troy Trumble. The Use of Nutraceuticals for Osteoarthritis in Horses. https://www.sciencedirect.com/science/article/abs/pii/S0749073905000532?via%3Dihub
