Introduction
ArthramidVet® is a novel treatment and represents a paradigm shift in how veterinarians and owners think about treating lameness in horses. ArthramidVet® can be used in any joint that is displaying clinical signs of osteoarthritis (OA) such as joint pain, synovitis, effusion, reaction to flexion, lameness that responds to intra-articular analgesia, and those with abnormal joint findings detected using diagnostic imaging modalities such as radiology, ultrasonography, scintigraphy, CT, or MRI. It is recommended for use as early as possible in the OA disease process (e.g. synovitis and capsular stiffness), but is also highly effective in severe or chronic cases.
It is essential that awareness of ongoing infection, concomitant medication, surgery or potential fracture is reviewed prior to injection to prevent possible infections or use of the product for conditions other than for which it is indicated. ArthramidVet® has a non-pharmaceutical mode of action so is suitable in patients where other products, such as corticosteroids, may be contraindicated.
Clinical Safety
Extensive in vitro and in vivo studies have taken place to generate data on the safety of ArthramidVet® in humans and animals. Current OA treatments are focused on reducing symptoms and there are few effective treatments. In addition, some treatments have been associated with significant toxicities and contra-indications, and their use is being restricted across populations.
Any potential cytotoxic effects of ArthramidVet® have been independently analysed using cell growth analysis via BCA-Staining. The methodology employed in this manner of cytotoxicity testing represents one of the easiest methods for the analysis of detrimental effects of substances, and cell culture techniques allow rapid yet sensitive diagnosis of the biological reactivity of diffusible components of materials. The BCA-Staining test predicts cytotoxic or necrotic effects of medical devices or materials with good correlation to animal experiments and high sensitivity. Under this testing model it is shown no cytotoxic substances are released from 2.5% iPAAG.
In vivo, studies have investigated the safety of ArthramidVet® at 1x, 2x, and 5x the standard recommended dose. These studies conducted following VICH GL43 guidelines demonstrate that the intraarticular treatment of horses with 2.5% iPAAG is safe and with no adverse reactions or detrimental clinical effects in any treatment group, even at up to 5x the recommended dose. These findings align with numerous published clinical studies.
Furthermore, the active amount of gel substance in each syringe is actually incredibly low (25 mg = 0.025 mL), or less than a pin head. Studies confirm that an intra-articular injection of 2.5 iPAAG supports cellular growth and integration and, possesses a permanent and stable augmentation effect due to constant water exchange with its host tissue with no evidence of fibrosis or mineralization.
How much ArthramidVet® should I use and can I repeat the dose?
Repeat dosing of ArthramidVet® is safe and effective and there is evidence that there is a dose-dependent response. Doses for each joint can be altered depending on the size of the joint and the severity or chronicity of the disease. e.g. mild, moderate or severe joint disease can be treated with either 1, 2, or 3 mL respectively. The following dosage recommendations have been made based on our observed clinical responses to treatment;
Distal Interphalangeal (Coffin) joint: 1-2mL
Proximal Interphalangeal (Pastern) joint: 1 mL
Metacarpo/tarso-phalangeal (Fetlock) joint: 1-3 mL
Carpus (Knee) joint: 1-3mL
Tarsometatarsal/ Distal Intertarsal (Lower hock) joints: 1 mL
Tarsocrural (Hock) joint: 2-3 mL
Shoulder: 2-3 mL
Stifles: 1-2 mL per compartment
Published clinical trials have indicated horses that partially respond to an initial treatment may benefit from a second dose at 4 to 6 weeks later (this appears to happen in about 15% of cases). Concurrent treatment of multiple joints in the same animal is safe and repeated doses can be given when clinically indicated, typically at 6 to 12 month intervals.
The idea of a treatment such as 2.5 iPAAG that acts as a bio-scaffold and through its presence aids the body’s natural responses to injury or disease represents a paradigm shift in our thinking about the treatment of osteoarthritis. It is important that veterinarians take the time to understand this new technology and adjust their treatment regimens and owner expectations accordingly.
If you have any questions about ArthramidVet® please do not hesitate to contact us Contact@arthramid.com.au. +61 1800 931 812.
