Concentration of methylprednisolone in the centrodistal joint after administration of methylprednisolone acetate in the tarsometatarsal joint

Abstract

Summary Reasons for performing study: The centrodistal (CD) and tarsometatarsal (TMT) joints are often injected individually with a corticosteroid to resolve lameness caused by osteoarthritis (OA). There are no data available regarding diffusion of methylprednisolone (MP) from the TMT joint to the CD joint. Hypothesis: A therapeutic concentration of MP diffuses into the CD joint after methylprednisolone acetate (MPA) is administered into the TMT joint. Objective: To measure the concentration of MP in the CD joint after MPA was administered into the TMT joint. Methods: MPA was administered into a TMT joint of 16 horses. At different times, the ipsilateral CD joint of these horses was injected with a small amount of saline and recovered saline was measured for concentration of MP using high performance liquid chromatography. Results: Six hours after administration of MPA into the TMT joint, a therapeutic concentration of MP was found in all 10 CD joints sampled at this time. Conclusions: Horses with pain arising from the distal 2 joints of the hock can be treated by administering MPA into the TMT joint alone. Potential relevance: Administering MPA into the TMT joint only, to treat OA of the distal 2 hock joints, reduces the difficulties and risks associated with centesis of the CD joint.

The use of intra‐articular corticosteroids in the horse: What is known on a scientific basis?

“…In order to evaluate whether methylprednisolone (MP) diffuses into the centrodistal (CD) joint after MPA is administered into the tarsometatarsal (TMT) joint, the concentration of MP in the CD joint after MPA was administered into the TMT joint was evaluated (Serena et al. 2005).…”

“…In order to evaluate whether methylprednisolone (MP) diffuses into the centrodistal (CD) joint after MPA is administered into the tarsometatarsal (TMT) joint, the concentration of MP in the CD joint after MPA was administered into the TMT joint was evaluated (Serena et al 2005). Eighty mg of MPA were administered into the left TMT joint of 7 horses and the concentration of MP in the ipsilateral CD joint measured in tissue at 0.5, 1, 3, 6, 9, 12 or 24 h later in one of the test horses.…”

“…Eighty mg of MPA were administered into the left TMT joint of 7 horses and the concentration of MP in the ipsilateral CD joint measured in tissue at 0.5, 1, 3, 6, 9, 12 or 24 h later in one of the test horses. Using high-performance liquid chromatography, a therapeutic concentration of MP was demonstrated in all CD joints sampled 6 h after administration following administration of MPA into the TMT joint (Serena et al 2005). Another study documented plasma, urine and synovial fluid disposition of methylprednisolone acetate (the authors also looked at isoflupredone acetate, IPA).…”

Is there a relationship between clinical presentation, diagnostic and radiographic findings and outcome in horses with osteoarthritis of the small tarsal joints?

“…These findings suggest that radiographic changes within the TMT joint may be clinically more significant as an indicator of response to therapy. If true, medication of the TMT joint alone may be sufficient for a favourable outcome, either due to a direct, physical communication or diffusion of pharmaceutical agent between the TMT and CD joints (Gough et al 2002;Serena et al 2005). Alternatively, CD joint pathology may have less of an effect on the lameness as compared to TMT joint pathology.…”

Musculoskeletal Injuries in Nonracing Quarter Horses

“…Methylprednisolone acetate or triamcinolone on its own or with hyaluronan is typically used. Corticosteroids injected into the tarsometatarsal joint have been shown to diffuse into the distal intertarsal joint [48]; however, injecting both joints may provide a greater degree of confidence of the desired level of medication being reached at each site and, anecdotally, seems to provide superior results. A commonly held belief expressed by horse owners is that injection of the distal tarsal joints promotes fusion of these joints over time; evidence to support this is lacking, and in the author's experience, this does not seem to be a consistent effect of treatment.…”