New op­tions for nav­ic­u­lar treat­ment

The re­cent ap­proval of two new drugs that tar­get the bone changes as­so­ci­ated with nav­ic­u­lar syn­drome of­fers hope in some of the most frus­trat­ing cases.

EQUUS - - Contents - By Christine Barakat

The re­cent ap­proval of two new drugs that tar­get the bone changes as­so­ci­ated with nav­ic­u­lar syn­drome of­fers hope in some of the most frus­trat­ing cases.

Just a few short years ago, own­ers of horses di­ag­nosed with nav­ic­u­lar syn­drome had very few op­tions. An in­fu­ri­at­ingly vague di­ag­no­sis, the term “nav­ic­u­lar” was of­ten ap­plied to cases of oth­er­wise un­ex­plained heel pain. Ther­a­peu­tic trim­ming and shoe­ing could help pre­serve sound­ness for a few years, as could non-steroidal an­ti­in­flam­ma­tory drugs (NSAIDs), but there was no way to head off the in­evitable: early re­tire­ment for the horse and heartache for the owner.

Then the nav­ic­u­lar land­scape shifted dramatical­ly. Ad­vances in MRI tech­nol­ogy led to more pre­cise iden­ti­fi­ca­tion of in­juries and ab­nor­mal­i­ties in the heel area. A case that may have been chalked up to “nav­ic­u­lar” even five years ago might now be re­vealed as an im­parliga­ment strain that is man­age­able by spe­cific, fo­cused treat­ments. The abil­ity to see all struc­tures in the back of the hoof trans­formed the ve­teri­nary pro­fes­sion’s un­der­stand­ing of what nav­ic­u­lar was and wasn’t. With bet­ter di­ag­nos­tics, op­tions for treat­ments to man­age heel pain, es­pe­cially when caused by soft­tis­sue changes, sud­denly mul­ti­plied.

But mys­ter­ies and frus­tra­tions re­main. Horses who ex­hibit heel pain with no ob­vi­ous soft tis­sue or car­ti­lage dam­age are still tough cases. Le­sions on the nav­ic­u­lar bone, as well as bone edema (bruis­ing), are of­ten found in lame horses, but they are also seen in plenty of horses who are per­fectly sound. The rel­e­vance of “ab­nor­mal” look­ing nav­ic­u­lar bones is still un­clear. And treat­ments to ad­dress nav­ic­u­lar lame­ness re­lated to bone changes were still limited to cor­rec­tive shoe­ing and anti-in­flam­ma­tory med­i­ca­tions. That is, un­til very re­cently.

In the sum­mer of 2014, the nav­ic­u­lar land­scape made a sud­den shift again. That’s when the Food and Drug Ad­min­is­tra­tion (FDA) ap­proved two new med­i­ca­tions for the treat­ment of nav­ic­u­lar syn­drome, specif­i­cally tar­get­ing bony changes seen in many cases. Both drugs, sold un­der the names Til­dren and Osphos, be­long to a med­i­ca­tion class known as bis­pho­s­pho­nates. Both have sim­i­lar ac­tion, and both are pre­scribed with the same in­ten­tions. But they aren’t iden­ti­cal. This means that horse own­ers cop­ing with bone-based nav­ic­u­lar prob­lems have, for the first time in a long time, op­tions.

Til­dren and Osphos are avail­able only by pre­scrip­tion, and a vet­eri­nar­ian will need to de­ter­mine if one or the other may help treat a par­tic­u­lar bone prob­lem. But if you’re car­ing for a horse with nav­ic­u­lar syn­drome, you’ll want to have a con­ver­sa­tion with your vet­eri­nar­ian about the role bis­pho­s­pho­nates might play in your long-term man­age­ment plan. Here’s what you need to know to start that dis­cus­sion.

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