Abstract

PICO question
 In horses with osteoarthritis, is mesenchymal stem cell therapy more effective at managing lameness than intra-articular corticosteroids?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Nine papers were critically reviewed; seven experimental trials and two randomised controlled double-blinded trials.
 Strength of evidence
 Weak to moderate
 Outcomes reported
 There is moderate evidence to suggest that chondrogenically induced mesenchymal stem cells combined with equine allogenic plasma have a good efficacy at reducing lameness in the short-term, in horses with mild to moderate lameness associated with osteoarthritis. However, there is no definitive evidence directly comparing mesenchymal stem cell therapy and corticosteroids, to identify if mesenchymal stem cell therapy is more effective than intra-articular corticosteroids.
 Conclusion
 In horses with mild to moderate lameness associated with osteoarthritis, there is moderate evidence to suggest that mesenchymal stem cell therapies are effective at managing lameness. However, it is undetermined whether they are more effacious than intra-articular corticosteroids.
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision-making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 

Highlights

  • Osteoarthritis (OA) is one of the most common causes of lameness, reduced athletic function and performance in both leisure and sports horses (Rossdale et al, 1985; and Clegg & Booth, 2000) and it will affect approximately 25% of horses in their lifetime (Neundorf et al, 2010; and Broeckx et al, 2019b).OA is the degenerative and progressive degradation of the joint, caused by overloading of a normal joint or normal loading of an abnormal joint, leading to inflammation, which reduces the capacity for proteoglycan synthesis (Kidd et al, 2001)

  • Population: Horses between 2–7 years, free of lameness and carpal effusion, had OA induced by osteochondral fragmentation in one middle carpal joint on one limb

  • Population: Horses aged 2–5 years had OA induced via osteochondral fragmentation in one distal radio-carpal bone and were exercised on a treadmill 5 days a week from days 15 to 72

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Summary

Introduction

OA is the degenerative and progressive degradation of the joint, caused by overloading of a normal joint or normal loading of an abnormal joint, leading to inflammation, which reduces the capacity for proteoglycan synthesis (Kidd et al, 2001). This induces OA due to a cascade of inflammatory mediators (Clutterbuck et al, 2010). There are many different treatment and management options available for veterinary surgeons and owners, including intra-articular (IA) corticosteroids, non steroidal anti-inflammatories and nutraceuticals These treatments are aimed at reducing inflammation and clinical signs associated with OA, these treatments do not alter the disease progression. IA corticosteroids are commonly used in both high- and low-motion joints, with success at reducing lameness in the short and medium term (Frisbie et al, 1997; and McIlwraith, 2010), they have been shown to have deleterious effect on cartilage, in vitro, methylprednisolone acetate (MPA) (Bryon, 2008; and McIlwraith, 2010)

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Results
Conclusion
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