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  Discussion on Research Summary: Topical vs Oral NSAID use in Arthritis
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Moderator:
DrO

Posted on Thursday, Jun 4, 2009 - 11:48 am:

Here we have further work from the arthritis pros at Colorado State. These are the smartest guys around when it concerns arthritis in horses. In this project they compared the clinical, histological, and physiological effects of no treatment, use of topical diclofenac creme, and oral phenylbutazone. And while I think there conclusions valuable I do have a caveat.

The gist of the research is that oral bute and topical diclofenac creme have beneficial effects when used for the treatment of arthritis but that topical diclofenac has fewer deleterious effects when compared to bute on the histological appearance of cartilage. It should be considered as a therapeutic option. I have no argument so far but I would note that I have seen and we have reports from members on this site of hock and knee osteoarthritis cases that while improved on diclofenac are not sound enough for riding comfortably. These horses responded well to bute. I admit that the early treatment failures, high cost, and minor skin reactions resulted in me discontinuing use of Surpass® fairly early on so my experience is limited. I have not experienced clinically adverse reactions with the use of bute including a perceived increase rate of progression of arthritis when its use and the work load are carefully managed as outlined in the article on arthritis overview.

I have edited the article on the long term care of horses to reflect a treatment program that incorporates the use of topical diclofenac as a treatment option that maximizes safety as I best understand it at this time.
DrO

Am J Vet Res. 2009 Feb;70(2):210-5.
Evaluation of topically administered diclofenac liposomal cream for treatment of horses with experimentally induced osteoarthritis.

Frisbie DD, McIlwraith CW, Kawcak CE, Werpy NM, Pearce GL.

Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523.

Objective-To assess the clinical, biochemical, and histological effects of topically administered diclofenac liposomal cream (DLC) in the treatment of horses with experimentally induced osteoarthritis. Animals-24 horses. Procedures-Osteoarthritis was induced arthroscopically in 1 middle carpal joint of all horses. Eight horses treated with DLC were given 7.3 g twice daily via topical application. Eight horses treated with phenylbutazone were given 2 g orally once daily. Eight control horses received no treatment. Evaluations included clinical, radiographic, magnetic resonance imaging, synovial fluid, gross, and histologic examinations as well as histochemical and biochemical analyses. Results-No adverse treatment-related events were detected. Horses that were treated with DLC or phenylbutazone had significant clinical improvement of lameness, unlike the control horses. Treatment with DLC induced significant improvement in staining and total articular glycosaminoglycan content, compared with no treatment. Treatment with phenylbutazone induced significant reduction in synovial fluid prostaglandin E(2) concentration, compared with DLC and no treatment. Treatment with DLC induced significantly less radial carpal bone sclerosis and overall gross cartilage erosion, compared with phenylbutazone. Conclusions and Clinical Relevance-Results indicated that DLC had both clinical sign-modifying and disease-modifying effects. Only clinical sign-modifying effects were detected in association with phenylbutazone administration. Treatment with DLC had significant beneficial effects, compared with phenylbutazone, and no detrimental effects. Results suggested that DLC is a viable therapeutic option for horses with osteoarthritis.
Member:
ekaufman

Posted on Thursday, Jun 4, 2009 - 11:24 pm:

Hi DrO,

Well, these guys are my local gods, so I'm struggling to understand this result vs. my own spectacularly poor impression of Surpass. I guess I need to figure out how much 7.3g of that stuff really is, and I would love to see how exactly they applied it. I wonder also if they were using Surpass or their own compound, and whether their compound might be better than Surpass.

I want to believe their evidence, but how do I discard the evidence of my own experience with the same products?
Member:
canter

Posted on Friday, Jun 5, 2009 - 7:31 am:

Elizabeth, I gave up on Surpass 5 years ago, after 2 tubes. My experience reflects yours and not that of the study - I saw no noticable benefit and considering what the stuff cost...It's unlikely that I'd ever try it again.
Member:
frances

Posted on Friday, Jun 5, 2009 - 12:48 pm:

I quite agree about the uselessness of diclofenac cream (or gel in the form I have used). It seems to me that this is either because:

1) it's just ineffective

2) I only applied it once a day (my horse is at a
barn) whereas, for humans at least, it should
be applied 3 - 4 times a day. Applied this
frequently I find that it is effective when I
use it on myself.

3) The horse's hair should perhaps be clipped so
that the diclofenac cream/gel can be better
absorbed through the skin.
Moderator:
DrO

Posted on Saturday, Jun 6, 2009 - 9:38 am:

Those are all good questions elk. It is Surpass they used but I am uncertain how the Surpass instructions translate to grams. At 124 grams per tube it might be possible to see how a 5 inch strip may work out about right. You don't discard your experience and in fact your experience is not necessarily contrary to theirs.

I have read several other reviews on the internet about this piece of research and they tend to get it wrong saying that the experiment finds the topical creme is "more effective" than bute. It is not what the report says and they confuse the terms "clinical signs", "disease modifying effects" and "significant". The good doctors found a statistical lessening of clinical signs with the creme but it was unlikely to be as "clinically effective" as bute. It was specifically the disease modifying component that was rated superior to bute and this is the part we cannot ignore. Is it possible that over the long term that horses using Surpass will slow down the rate of progression of the DJD compared with bute?
DrO
Member:
ekaufman

Posted on Saturday, Jun 6, 2009 - 10:17 am:

LL-- the instructions for Surpass indicate once daily application of 5 inch ribbon, rubbed well into the hair.

I realized the research summary doesn't tell us how long they ran the study. I know that I gave up relatively quickly on Surpass, since bute (and other options) showed relief within days, and are much cheaper.

DrO, it wouldn't surprise me if the guys at CSU had longitudinal studies that would address your question, and also the question as to whether as to whether the difference in rates of disease progression were significant within the average performance horse's working career. As I understand it, the bulk of the funding for their research center comes from the cutting and racing communities. The primary interest there would be preserving/extending a competitive career, rather than getting a retired horse from 25 to 35.
Member:
frances

Posted on Saturday, Jun 6, 2009 - 2:31 pm:

Thanks elk.

We don't have Surpass here, so we use the human product Voltaren Emulgel for horses too (as per vet). Each 100g contains 1.16g diclofenac diethylammonium. Is that similar to Surpass?
Member:
rtrotter

Posted on Saturday, Jun 6, 2009 - 4:34 pm:

All,

I have attempted to use Surpass on several of my racehorses in an attempt to try and ward off having to inject them with Hylauronic acid. It was not cost effective for me to use on a regular basis and its effects ( as far as I could tell) did not warrant its use.

Also at the time I used it (several years ago), its use during a racing campaign was limited due to medication withdrawal rules.

Rachelle
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