In addition to localizing pain to a certain joint with aide of diagnostic anesthesia, radiographs, ultrasound, computed tomography, magnetic resonance imaging (MRI) techniques and diagnostic arthroscopy have all be used to confirm causes of joint lameness. There is no “gold standard” for the diagnoses of preliminary joint disease in the horse as radiographic changes are usually indicative of irreparable harm.
Aggressive treatment in joint disease is indicated to decrease immediately soft tissue swelling and inflammation as well as to postpone the onset of permanent osteoarthritic changes. There is inherent difficulty in identifying joint pathology by any other means than subjective examination and lameness or “shortness of stride” reports from trainers.
Medications introduced into joints by human physicians that specialize in sports medicine are becoming more commonplace. Previous generalizations and perpetuation of myths about damage to joint environments caused by corticosteroids are primarily unfounded.
Damage may occur from excess corticosteroid injections or when there is cartilage fragmentation and bone alterations in a joint, usually associated with lameness. It has been proven that corticosteroids and HA together allows the natural synovial lining of a joint to make a more favorable environment.
All of these products are labeled for intra-articular use insuring purity and consistency with each individual manufacturer. Arteparon is the human equivalent to Adequate and the chemical structure of the two products is identical.
Chondroitin sulfate is the most commonly used GAG in these products and is harvested from bovine lung and trachea. Chondroitin sulfate, glucosamine, MSM and various other Gags can be found in many oral supplements, none of which are regulated by the Federal Drug Administration.
Small amounts of glucosamine can detect in the bloodstream of horses, but no deficiency has ever been reported, in any species. A number of test-tube studies have shown that glucosamine has biological activity, and various beneficial effects on cartilage cells.
While this should be great news, it should be noted that these studies have generally been conducted with levels of glucosamine that can’t be reached when the substance is fed to horses. Chondroitin sulfate (CS) is a sugar molecule found in cartilage, bone, tendons, and ligaments.
Some people have suggested indirect effects, due to elevated levels in the intestine, or in the liver, but this is just speculation, and hasn’t been demonstrated. This, of course, means that you unless you know specifically what’s in the product you’re feeding to your horse, you can’t anticipate any positive result.
While there’s a large amount of conflicting evidence, from many species, three clinical trials have looked at the combination of glucosamine hydrochloride and CS specifically in horses. This class of drug gained much fame, or infamy, as it is commonly used in racehorses with arthritis and has been blamed for many injuries post-injection.
As we mentioned earlier, enzymes that are produced by diseased or inflamed joints are very destructive to normal cartilage. Joints that are inflamed must be treated with anti-inflammatory medication, as well as HA in some instances, to allow them to return to their normal environment.
It was once said that a “human on corticosteroids can walk to the autopsy room” but now most orthopedic surgeons use these products in the most famous athletes in the world. Substantiation for a direct link between corticosteroid administration and arthritis has persistently been unable to prove by dozens of investigators.
U formation is becoming more recognized as a common occurrence in all breeds of horses due to stress and NSAIDs definitely can contribute to this process Every year, tens of thousands of people who take that prescribed short course of treatment remain ill.
Our recently published peer-reviewed study of over 2,000 participants from MyLymeData begins to answer those questions. Here’s what the prior head of GlaxoSmithKline said about treatment effectiveness rates of drugs in general (Connor, 2003).
Compared to the general population and patients with other chronic diseases, chronic Lyme patients report a substantially lower quality of life and a significant symptom disease burden. In this study, high responders and well patients reported substantially better quality of life, a greater percentage of improvement, and reduction in symptom severity.
Patients who identified as well reported their quality of life comparable to the US general population. To find out what made some patient substantially improve or become well, we turned to our academic partners at the University of California at Los Angeles who specialize in artificial intelligence and machine learning.
Their team looked at 215 features related to diagnostic factors, treatment approach, duration of individual antibiotics, alternative treatments, symptoms, type of clinician, and functional impairment to identify the 30 top predictive features for treatment response (Vend row 2020). Most of the top 30 features identified in their study related to chronic Lyme disease treatment (20), symptom severity (9), and type of clinician treating Lyme disease.
Treatment with antibiotics for Lyme disease was far higher among well patients (76%) and high responders (59%) compared to non-responders (38%). Instead, we might have expected the percentage of people using antibiotics to be roughly the same among the patient subgroups.
But, as the chart below illustrates, in the study longer chronic Lyme disease treatment durations were common. Insurance companies often deny payment for extended antibiotic care for Lyme disease.
This means that these lengths of treatment are common for patients with chronic Lyme disease and reflect clinical practice in the community. As many as 3 million people have chronic Lyme disease in the US, and nobody knows the best way to treat them,” said Lorraine Johnson, CEO of LymeDisease.org.
“The key finding here are that patients who are now well or who report substantial improvement have taken longer courses of antibiotics.” The fact that more patients who are well or have substantial improvement report longer treatment durations tells us that many patients improve with longer treatment durations.
This suggests that the CDC’s conclusion that better clinician training is needed to curb treatment durations is off-base. Instead, it appears that doctors are using their clinical judgement and doing what works for their individual patients.
This is the approach recommended by the International Lyme and Associated Diseases Society (LADS) (Cameron 2014). The implications of this are profound because they suggest that the legal “standard of care” for patients with chronic Lyme disease is for longer treatment durations.
When patients with the most improvement in their health report the longest treatment durations, how can you argue that it should be denied? We asked patients to tell us the type of clinician overseeing their care.
Choices included: family physicians, internists, rheumatologists, infectious disease specialists, and clinicians whose practice focused on tick-borne diseases (often referred to as Lyme Literate MDs or Lands). Seventy-five percent of high responders and well patients report having their care overseen by an LLD.
Physicians who treat Lyme disease as their primary focus might be expected to have better results than physicians who don’t simply because volume of cases handled means a greater experience level. It is commonly recognized in medicine that volume of cases is associated with better treatment outcomes (Joint 2013).
Medical boards, insurance companies, and the government often rely on the treatment guidelines of the IDEA on the basis that IDEA clinicians have the most expertise in infectious diseases and, accordingly, know what is best for patients with Lyme disease. Many of these clinicians specialize in treating chronic Lyme disease and have developed greater experience and knowledge about what works.
This shows that Lands are associated with better patient outcomes and their expertise in this area should be more highly valued. A note of caution: None of this should be taken to suggest that patients should blindly take antibiotics for longer durations to get well.
The other thing this study suggests is that we have a long way to go to determine optimal care for chronic Lyme patients. Thus, it was natural that I would address a legal topic as my first opportunity to give back to a community that had made it possible for me to recover.
But at that time, I was thinking that the two standards of care related to the divergent guidelines of the IDEA and the International Lyme and Associated Diseases Society. With this study, it now seems that the two standards of care still exist, but that they reflect how physicians are treating different stages of the disease.
A few years ago, someone asked me whether it was important to be treated by an LLD or if they should see someone who did not focus on Lyme disease. And, although I told the person “you know, I think you might do better with an LLD,” I had no data to back up that suggestion.
Antibiotic pretreatment of Lyme disease in patients with persistent symptoms: A biostatistical review of randomized, placebo-controlled, clinical trials. et al. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy.
Norton, D.; Levy, L.; Wall, D.; McCall, J.; et al. Two Controlled Trials of Antibiotic Treatment in Patients with Persistent Symptoms and a History of Lyme Disease. Study and treatment of post Lyme disease (STOP-LD): A randomized double masked clinical trial.
Removing the Mask of Average Treatment Effects in Chronic Lyme Disease Research Using Big Data and Subgroup Analysis. Healthcare access and burden of care for patients with Lyme disease: A large United States survey.
Physician Volume, Specialty, and Outcomes of Care for Patients With Heart Failure. Show, S.; Green, C.; Scanty, B.; Phillips, S.; Liner, K.; Burrascano, J.J., Jr.; Mansfield, R.C.
Chronic Lyme Disease: An Evidence-Based Definition by the LADS Working Group. Vend row, J.; Haddock, J.; Nee dell, D.; Johnson, L. Feature Selection on Lyme Disease Patient Survey Data.
The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocyte Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America.