Ringbone -v- Arthritis of the Pasterns

[Fruddy]

Hi, can I just ask what you all think?

My pony has been diagnosed with "mild arthritic changes to the pasterns." On various websites and forums, I have been told that this is ringbone. When I spoke to my vet and queried this, he said that this wasn't the case.

I trust my vet completely but I am now totally confused - are they one and the same? and if so, what can I do??

I now have my horse on Cortaflex HA, Pernamax and one sachet of bute. He is completely sound and has been for a while and I am bringing him off the bute now the good weather shows signs of staying. He has not been on Pernamax long enough to know whether or not it is making a difference, but is there anything else I should be doing? he is back in very light work - unfortunately I cannot hack as he is not 100% on the roads and that is all there is round my parts.

 

[Spot1]

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My pony has been diagnosed with "mild arthritic changes to the pasterns

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Could be inflammation of the joint, simple arthritis, without any bony changes (osteoarthritis). Simple arthritis is considered mild and it is reversible.

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." On various websites and forums, I have been told that this is ringbone.

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Your vet is in the best position to tell if there is any ring bone present. Ring bone is bony growth on the pastern, it is different from arthritis.

Perhaps ask your vet what might have been the cause. You may then be able to take steps to prevent recurrence.

 

[aran]

" Could be inflammation of the joint, simple arthritis, without any bony changes (osteoarthritis). Simple arthritis is considered mild and it is reversible. "

Sorry but osteoarthritis (OA) is my thing - I research it and have worked on equine and human OA for over 4 years solidly now!

right - OA is all about cartilage and bone. Early OA is characterised by mild changes to the cartilage - this progresses - and in late OA there is no cartilage left just polished bone. 'simple' arthritis is not a recognised term.
OA can be caused by infection/inflammation/trauma/age/use but always involves the cartilage and bone. Also it is not reversible and cannot be cured - it is a degenerative disease. You can help slow progression and in certain joints (Pastern and Hock) you can fuse the joint and so halt the arthritis (as there is no joint left).

Osteoarthritis of the proximal interphalangeal joint (pastern) is also known as high ringbone. You see radiographic abnormalities to the joint. OA of the distal interphalangeal joint (coffin) is also known as low ring-bone and again you see changes to the joint on x-ray.

You can also get peri-articular ring-bone - which is non-articular - so does not involve the joint - the prognosis for this is good as it doesnt affect the joint.

Good luck with your pony - any help please feel free to PM me.

 

[AmyMay]

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You can also get peri-articular ring-bone - which is non-articular

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So Aran, can you explain in syllables of two or less, the difference between Peri and Non Articular ringbone.

Amy has non articular. Although have to be honest, not entirely sure what that means

 

[aran]

peri-articular is the same as non-articular - its a pain when things have lots of names (as bit like all the bone spavin names!)

Non-articular ringbone result from inflammation of the bone covering (perisotitis) or trauma to it. It refers to new bone growth on any of the bones (proximal, middle and distal phalanx); it doesn't involve the joint. Because of this its long term prognosis is much better (if it is on the distal phalanx the prognosis worse than if its on the higher bones).

Basically you should never say 'my horse has ring bone' - you should say my horse has articular/non-articular low/high ringbone (delete as appropriate!).

Hope this makes sense?

 

[AmyMay]

Thanks Aran. Very enlightening.

High everyone - My name is Amy May and I have Non Articular Ringbone!

 

[Spot1]

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Sorry but osteoarthritis (OA) is my thing - I research it and have worked on equine and human OA for over 4 years solidly now!


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Just trying to keep it "simple"

. No doubt you will have heard of mild serous arthritis.

The diagnosis we are told is [ QUOTE ]
"mild arthritic changes to the pasterns."

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Why do you take this to be OA? The Vet would appear to think not.

The Question asked was, is this diagnosis the same as ringbone? IMO it is not the same.


Peri articular means around the joint. Non articular ringbone is not arthritis at all but periostitis

 

[aran]

I didn't take it to be OA - i was simply clarifying on your statements which is why I replied to you and not her directly

'Could be inflammation of the joint, simple arthritis, without any bony changes (osteoarthritis). Simple arthritis is considered mild and it is reversible.'

Your statement is not keeping it simple it is simply not correct. Inflammation of the joint is OA. Without any bony changes cannot be OA. OA (ie arthritis in a joint) is not reversible - if it was then the NHS would be a very different place!

Also 'ringbone' is OA - however non-articulating (or peri-articular) ringbone is not - it is simply extra bone growth which is why the prognosis is very different (this is why I havent called it OA).
the confusions lie in the fact that they are given the same name and not often well described by the vet. It is like a splint - however due to location can cause a lot more trouble that a standard one.

I cant comment on her diagnosis - I'm not a vet (just an OA scientist) and I havent seen the xrays - from her description I'd say the pony has high non-articulating ring-bone - which has by far the best prognosis and once the new bone formation stops (providing no other structures are involved) the pony should become totally sound.

 

[_Jazz_]

Very interesting post and reply

I was literally about to post 'this post', talk about timing!
We (my EMRT lady and I) have a ? regarding my mare and our vet is coming on Thursday to investigate. I was aware of high and low ringbone but I am now obviously keen to learn much more, just in case. Thank you for posting Fruddy and many thanks to Aran for such an informative reply

 

[Spot1]

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Your statement is not keeping it simple it is simply not correct. Inflammation of the joint is OA.

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Are you saying that you can not have inflammation of the joint (arthritis) without having bony changes (OA)?

In my statement I am suggesting that you can. ( Quote: arthritis, without any bony changes)

I am also speculating that this is indeed the case and not any form of ringbone.

I would suggest that the cause for confusion is some forms of ring bone (articular ring bone) involve the joint surface and could be said to be a form of OA.
I would define Periarticular ring bone as being around the joint, not involving the joint surface (non articular).
As you state "high" in this context means the pastern joint (pipa). "low" the pedal joint (dipa)


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from her description I'd say the pony has high non-articulating ring-bone

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May be

May be not

 

[aran]

you can get joint inflammation of a healthy joint - but that in itself is joint inflammation not arthritis. Any arthritis that is caused by inflammation is secondary osteoarthritis as the inflammation causes the synovium to release catabolic mediators which degrade the cartilage setting up the OA cascade. You can also get OA joints which swell due to pain and inflammatory responses (but that is a symptom which is not OA specific).

You cannot have arthritis which does not involve the cartilage (and subchondral bone) as arthritis is a condition caused by degeneration of the cartilage accompanied with bony change. Bony changes come in all degrees: they could be as mild as simply stiffening of the subchondral plate or, in more advanced arthritis (OA), osteophyte formation.
If you are saying that this pony has joint inflammation and not ringbone then you have obviously seen the synovial fluid analysis results and the x-rays. Joint inflammation would be picked up by synovial fluid analysis and swelling of the joint. This vet has only described mild arthritic changes to the pasterns. This therefore is joint independent (and so has nothing to do with joint inflammation) and means high non-articular ringbone.

Your reasons for confusion over terminology are the same as mine - you've just condensed what I've said! They have combined to conditions: arthritis and 'low' splints.

Also what does the 'a' stand for after PIP and DIP as this is not terminology we use with our vets or researchers?

 

[Spot1]

Thanks for the information on arthritis. I have checked a number of references for the definition of arthritis most seem to agree on "a general term for joint inflammation" and I have used it in this context on this thread. I have been told that breakdown in the hyaluronic acid molecules is reversible before the resultant changed synovial fluid causes cartilage damage. Would you agree?

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If you are saying that this pony has joint inflammation and not ringbone then you have obviously seen the synovial fluid analysis results and the x-rays.

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Yes

, but I'm not "saying" I'm suggesting joint inflammation not ringbone (as I haven't seen any test results) this could be the case, as for tests, I completely agree and I would be interested to hear the results, but testing is a matter for the owner and the vet, if the general consensus is that I am wrong then it would be inappropriate to suggest such tests.

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This vet has only described mild arthritic changes to the pasterns. This therefore is joint independent (and so has nothing to do with joint inflammation)

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How can arthritic changes be joint independent?

back to definitions again

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Also what does the 'a' stand for after PIP and DIP

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articulation. (Or "am I a pain"

)

 

[Lucy_Ally]

Osteoarthritis by definition is degradation of articular cartilage in all the journal articles that I have read

joint inflammation and changes in synovial fluid composition may be a consequence of OA or lead to it but are not in themselves OA. Joint inflammation is a very general term and its initial presence may be unrelated to OA (infection or synovitis for instance).

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I have been told that breakdown in the hyaluronic acid molecules is reversible before the resultant changed synovial fluid causes cartilage damage

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There are several problems I have with this statement:

1) Is the breakdown of hyaluronic acid a consequence of OA or is it causing it? Whilst there may be some sort of feedback system that will exacerbate the OA symptoms as more HA frgaments are released, more likely the release of HA from the synovium is a compensatory mechanism to combat changes within the joint.
2) The function of HA within the joint is primarily lubrication and in OA the lubrication is reduced due to degradative changes in the HA molecule. The addition of intact HA to a joint is mainly for pain relief and not reversing the effects of OA (as this is not possible).
3) Extracellular matrix protein frgaments such as fibronectin that are relaesed into the synovial fluid with HA fragments are potent catabolic mediators and so modulating changes in the HA molecule when it is accompanied in the synovial fluid with other degradative protein fragments will not prevent or reverse OA.

The problem with the original post is the lack of specificity. There is actually no mention of any joint merely changes to the pasterns. This may just mean changes to the proximal or maybe middle phalanx with no association to the joint (which would be non-articular ringbone). Or it may mean changes within the joint, without speaking to the vet in question or seeing x-rays one is not to know.

 

[aran]

The definitions that you have found are simply not correct. Arthritis has many definitions however they all describe a group of disorders characterised by deterioration of the articular cartilage accompanied by changes in the subchondral bone. All agree that arthritis involves a loss of function of the cartilage. It is not a general term for inflammation. You can get inflammation if you have an arthritic joint, however you can also get inflammation without cartilage damage (and imaging shows this). Inflammation can also be caused by infection which untreated or severe can result in arthritis.

For your 'arthritis' to be reversible it would mean that the SF causes the cartilage damage - this is not true (plus changes to the SF without cartilage changes is not arthritis). If arthritis was simply caused by a degradation in the HA molecule then the pathogenesis would be simple and again we would have a lot less suffers. Indeed it is probably never caused by this mechanism. It is true to say that in OA you do find a reduced HA molecular size but this was not the cause simply part of the resulting cascade of events. Giving injections of HA does in some patients help to relieve the pain of OA but it does not reverse the changes occurred and still the joint will deteriorate.

Back to what the vet has said - by arthritic changes - he's meaning bony changes. As he has said pastern and not joint then he is talking about the pastern bones.
Your correct on the terminology - he should have made it clear as to whether he is talking about an arthritic joint or bony changes to the pasterns - mainly as the prognosis is very different between them! Either way arthritic changes to the pastern definitely does not mean an inflamed PIP joint.

 

[aran]

I totally agree!
How does it feel to move over from the dark side - cartilage is way more interesting than tendons!!!

 

[Spot1]

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joint inflammation and changes in synovial fluid composition may be a consequence of OA or lead to it

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If, as you say, joint inflammation can lead to OA then it follows that you can have joint inflammation and not have OA. As Aran states #1879603 [ QUOTE ]
inflammation causes the synovium to release catabolic mediators which degrade the cartilage setting up the OA cascade.

[/ QUOTE ] Unless you feel that OA is an inevitable conclusion of joint inflammation then it is not unreasonable to suppose that early treatment could be effective in reversing the chain of progression.

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Is the breakdown of hyaluronic acid a consequence of OA or is it causing it?

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If it were the former there would be a point where OA was present without any HA breakdown, I think it is accepted that the latter can be true, but is it inevitable? A trigger for HA breakdown could perhaps be damage to the joint capsule? Correctable angular imbalances of the limb? From the onset In my "simple" way I have suggested that it is not OA. I think that Aran , after some discussion, reaches a similar conclusion. I did not imagine that my expression "simple arthritis" would cause such inflammation

no bony changes reported as yet

Aran states in post #1874858 [ QUOTE ]
Inflammation of the joint is OA.

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This makes my description, of inflammation of the joint, as being arthritis (arthr- from the Greek arthron, joint. -itis, inflamatory medical condition) seem relatively uncontentious but apparently, it is [ QUOTE ]
simply not correct.

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There is actually no mention of any joint

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Can I refer you to the original post.

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"mild arthritic changes to the pasterns."

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arthritic; adj and n. Indicates joint.

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The problem with the original post is the lack of specificity.

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as I understand the original question the vet has diagnosed "mild arthritic changes to the pasterns." but not ringbone.
Are they or are they not one and the same? Confusion

IMO the diagnosis is quite plausible, they are not necessarily the same, however if it is your considered opinion that any arthritic changes must always indicate bony changes, as Aran #188113 [ QUOTE ]
Back to what the vet has said - by arthritic changes - he's meaning bony changes.

[/ QUOTE ] Then it is clear that the vets two statements could be contradictory and therefore confusing. Further were it to be ringbone then the vet would be simply wrong


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it may mean changes within the joint,

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Here we can concur

 

[Patches]

Patches has non articular ringbone.

Can be seen marked by the red arrow on the x-ray.

Vet isn't concerned about it causing her any problems. She's been x-rayed 9 months apart and it's shown no progression. Common in cobs and upright horses. They suffer more concussion through their joints.

 

[Lucy_Ally]

Mmm I don't personally think that you can reverse the "chain of progression", you may delay OA onset or you may relieve symptoms of OA but reversing it is scientifically not possible as yet.
As has been said before there are problems with terminology and the vet may discuss arthritic changes without meaning the joint - unfortuntaely vets have a habit of using scientific terminology willy nilly and by dumbing down the diagnosis for clients some of the meaning is lost and confusion arises.The term arthritis is actually a misnomer as well, in humans you have to be more specific in your terminology as rheumatoid and osteo arthritis are very different disease processes. In horses RA is not seen but OA is, so whilst the literal greek translation may mean inflammation of the joint osteo also implies changes to the underlying bone. Advances in science have now lead us to increase our understanding of the causes and symptoms of OA, in history (when arthritis was first recognised) the the imaging equipment and scientific expertise and techniques that we now have were not availabe and it is now widely acepted that OA is far more complicated than just joint inflammation. Indeed changes to the cartilage without joint inflammation may represent early stages of OA (Aran has a paper published on this) so I think your term "simple arthritis" is very misleading as OA pathogenesis is anything but simple!

I am not inflamed - it is good to have a healthy debate, however sometimes argument for the sake of argument is not healthy! And arguing with a leading expert in equine OA about her terminology is not likely to be productive!