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Dr. Christine Woodford
 We must take careful measures to prevent strain on ligaments, tendons, and joints to keep our equine athletes performing at their peak level. There are many products on the market that claim to aid in the protection of these structures. The most common joint supplements are chondroitin sulfate, methylsulfonylmethane (MSM), glucosamine, polysulfated glycosominoglycan (Adequan) and hyaluronic acid (HA). The goal of this article is to explain how these supplements work in the body and how best to administer them.
These supplements support joint health by slowing the cartilage degeneration process. Cartilage is a specialized connective tissue that covers the ends of bones and acts as a cushion to joint surfaces. Cartilage is a complex matrix of collagen fibers, glycosaminoglycans, and sodium hyaluronate. Cartilage lacks its own blood supply, thus it relies on the surrounding tissue for its nutrients. When cartilage can no longer maintain proper metabolic activity, the destructive process of inflammation and arthritis begin. This happens with normal aging and physical wear and tear of our equine athletes. As responsible owners we ask ourselves, what can we do to prevent pain and arthritis in our athletes and aging horses?
Condroitin sulfate is one of the primary glycosaminoglycans in joint cartilage. It is produced in the cartilage and believed to act as an anti-inflammatory agent by inhibiting enzymes that breakdown cartilage. This compound is in many oral supplements, but there is skepticism about whether the large molecule can survive the harsh acidic environment of the stomach, and be absorbed into the bloodstream intact.
Methylsulfonylmethane (MSM) is a white, tasteless, odorless, crystalline powder, which has probably been the nutraceutical used for the longest period of time. It's an organic compound derived from DMSO (dimethyl sulfoxide, a topical gel or liquid that is used in horses to reduce swelling from trauma), and it appears naturally in small amounts in the bloodstream as well as in milk, vegetables, fruits, and grains. It provides a source of bioavailable sulfur, which is necessary to form connective tissue.
Glucosamine is an amino acid that is present naturally in the body. It is a building block of condroitin sulfate and helps give synovial joint fluid its resilience and elasticity. In addition, it stimulates the production of glycosaminoglycans by joint cartilage and increases the utilization rate of chondroitin sulfate. Unfortunately there are no definitive studies that prove that the oral supplements reach the bloodstream to be available to the joints. There are many compounded forms of injectable glucosamine on the market. This product is recommended to be given a loading dose for the first month and then the horse can be maintained on monthly injections.
Polysulfated glycosaminoglycan (Adequan) is a pharmaceutical drug regulated by the FDA and must be administered under the supervision of a licensed veterinarian. This compound is a building block of the cartilage matrix. It is not the same molecule as glucosamine. Studies have proven that this compound inhibits degradation of cartilage and decreases inflammation. It also stimulates the synovial membrane and increases the viscosity of the synovial fluid. This product is given in the muscle once every 4 days for 28 days, then a monthly dose.
Hyaluronic acid is an important component of articular cartilage and synovial joint fluid. The viscoelasticity of synovial fluid is due to its rich hyaluronan content. Thus, this molecule serves as a principle lubricant of synovial soft tissues. There is major skeptisim about whether this molecule can be absorbed from the intestinal tract if it is fed as an oral supplement. Even if it were absorbed, it is believed to be immediately removed by the liver. Hyaluronic acid is available as an injectable product to be given in the vein. Legend is a pharmaceutical drug that is regulated by the FDA and available through a licensed veterinarian. Studies have shown that this injectable product decreases inflammatory mediators in the joint, decreases cartilage damage and stimulates the production of healthy joint fluid. It is given once a week for three weeks and then once a month.
There are many oral products on the market today that claim to contain ingredients that aid in joint health. These products are considered to be nutraceuticals. Nutraceuticals are comprised of non-toxic food components that can be administered orally. Because they are not designated as drugs, they can be purchased without a veterinary prescription. Unfortunately, there are many unanswered questions regarding nutraceuticals. One is whether or not they contain what the label states. The University of Maryland tested 27 glucosamine or chondroitin sulfate products in one study; a number of them didn't contain the amounts that were listed on the label. In addition, the amounts sometimes varied from month to month.
In an effort to help promote proper practices by manufacturers and standardize the animal supplement industry, the National Animal Supplement Council (NASC) recently initiated a Quality Seal Program. This seal lets consumers know they are buying from a reputable manufacturer that has gone through an independent audit and has implemented specific standards and conformed to quality system requirements.
If you are using an oral joint supplement, be sure that you are using one that is participating in the Quality Seal Program. An alternative to using an oral product is using in injectable product. Glucosamine, polysulfated glycosaminoglycan (Adequan) and hyaluronic acid (Legand) are available in injectable forms. The advantages of these products are that the molecules go into the bloodstream intact and are 100% utilized. Waste and non-absorption problems are eliminated with the injectable products. These products not only establish good joint health in old and injured joints, they also promote good joint health in all ages and conditions of our performance horses.
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