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Introduction Proper identification of healthy subjects is essential in case–control studies. However, standardized definitions of healthy controls are lacking in equine orthopaedic research. Objectives The aim of this study was to define the non-invasive methods used for selecting healthy control horses in osteoarthritis (OA), desmitis and tendinitis research. Methods Systematic review. Case–control studies with a healthy control group and longitudinal studies where horses had to be healthy at the start were included. Studies where joints were visualized by arthroscopy or post-mortem examination were excluded. Results From 2,472 OA papers and 2,746 desmitis/tendinitis papers, 127 and 84 papers met the inclusion criteria respectively. For OA, 11 methods were identified for defining healthy subjects with a median of three methods used per paper. Dynamic examination, radiographic evaluation and clinical examination were the most frequent. Eight different methods were identified in the desmitis/tendinitis papers with a median of three methods per paper; ultrasonography, clinical- and dynamic examination were the most frequent. Conclusions Overall, the OA and desmitis/tendinitis studies used similar methods for defining subjects as healthy, but the way the examinations were performed and interpreted was inconsistent. In several studies, healthy controls were not examined for lameness. The most common methods have limitations for detecting horses with early OA, which may have implications for interpretation of results. Standardized use of more sensitive and objective methods could be beneficial.

Osteoarthritis is common in horses and is a cause of pain and compromised welfare. Osteoarthritis-associated pain in horses is currently diagnosed by subjective and objective measurements of joint pain; however, there is a need to develop methods for evaluation of the systemic osteoarthritic pain that has been recognised in other species. Nerve growth factor (NGF) is associated with pain and osteoarthritis in humans, dogs, cats and lab animals but little is known about NGF in the horse. The aim of this thesis was to determine the presence of NGF in the equine joint and circulation, and to investigate its connection to osteoarthritis-associated lameness. Serum and synovial fluid from lame horses with osteoarthritis were analysed by ELISA, and NGF levels were compared to those in sound horses. Cartilage and synovial membranes from osteoarthritic and healthy joints were analysed by immunohistochemistry for NGF and for the NGF receptors (TrkA and p75NTR). Chondrocyte lysates obtained from healthy and osteoarthritic cartilage were analysed by western blot and capillary simple western. On a group level, serum NGF was higher in horses with osteoarthritis-associated lameness than in sound horses. Joints with acute or chronic inflammation had higher mean synovial fluid NGF than healthy joints and the expression of NGF and NGF receptors was increased in osteoarthritic articular cartilage compared to healthy articular cartilage. NGF receptor expression in osteoarthritic synovial membranes was also increased with marked individual variation in the relative TrkA/p75NTR expression. Two NGF precursor forms, 40 and 45 kDa, could be identified in equine articular chondrocytes and these forms did not appear to change with inflammation. The results show that NGF is associated with osteoarthritis in the horse, in line with the findings in other species. The correlation between NGF and pain, individual variations in NGF receptor expression and the role of different precursor forms of NGF warrants further investigation.

Nerve growth factor (NGF) is a neurotrophin that has been implicated in pain signaling, apoptosis, inflammation and proliferation. The resultant effects depend on interaction with two different receptors; tyrosine kinase A (TrkA) and p75(NTR). NGF increases in synovial fluid from osteoarthritic joints, and monoclonal antibody therapy is trialed to treat osteoarthritis (OA)-related pain. Investigation of the complex and somewhat contradictory signaling pathways of NGF is conducted in neural research, but has not followed through to orthopaedic studies. The objectives of this study were to compare the expression of NGF receptors and the downstream regulator BAX in synovial membranes from joints in various stages of OA. The horse was used as a model. Synovial membranes were harvested from five healthy horses postmortem and from clinical cases with spontaneous OA undergoing arthroscopic surgery for lameness. Four horses with synovitis without gross cartilage changes, four horses with synovitis and cartilage damage, and four horses with synovitis and intracarpal fractures were included. Samples were investigated by immunohistochemistry and results showed that nuclear staining of TrkA, p75(NTR) and BAX increases in OA-associated synovitis. TrkA expression increased in early disease stages whereas increases in p75(NTR) were most prominent in later disease stages with cartilage damage and fibrosis. Clinical significance: Suppression of NGF may result in varied effects depending on different stages of the osteoarthritic disease process.

Nerve growth factor (NGF) is a neurotrophin with many functions. In humans, it is involved in inflammation, nerve growth, apoptosis and pain signalling. Increased concentrations of NGF in synovial fluid has been shown in humans and dogs with osteoarthritis. Despite osteoarthritis being a common problem in horses, no studies have previously been published on NGF in the equine joint. The aim of this study was to quantify NGF in equine synovial fluid from healthy joints, acutely inflamed septic joints and joints with structural changes associated with osteoarthritis. A secondary aim was to identify the localisation of NGF and its two receptors, TrkA and p75(NTR) in healthy and osteoarthritic articular cartilage. NGF concentrations in synovial fluid from osteoarthritic joints (n = 27), septic joints (n = 9) and healthy joints (n = 16) were determined by ELISA. In addition, articular cartilage from osteoarthritic and healthy joints was examined for NGF, TrkA and P75(NTR) using immunohistochemistry staining. NGF was present in equine synovial fluid and articular cartilage. Compared to synovial fluid from healthy joints, NGF concentration was higher in synovial fluid from joints with structural osteoarthritic changes (P = 0.032) or acute septic inflammation (P = 0.006). In articular cartilage with severe osteoarthritic changes, there was more abundant positive immunohistochemistry staining for NGF and its receptors than in normal articular cartilage. Further studies should focus on identifying precursor forms of NGF, and on receptor expression and downstream signalling of TrkA and P75(NTR) in health and disease. (C) 2020 The Author(s). Published by Elsevier Ltd.

Objective To identify prognostic variables for adult equids and foals with tetanus. Design Multicenter retrospective study (2000–2014). Setting Twenty Western, Northern, and Central European university teaching hospitals and private referral centers. Animals One hundred fifty-five adult equids and 21 foals with tetanus. Interventions None. Measurements and Main Results Variables from history and clinical examination were statistically compared between survivors and nonsurvivors (adults: 49 survivors, 85 nonsurvivors; foals: 7 survivors, 10 nonsurvivors). Cases euthanized for financial reasons were excluded. Mortality rates in adults and foals were 68.4% and 66.7%, respectively. Variables associated with survival in adults included: standing, normal intestinal sounds and defecation, voluntarily drinking, eating soft or normal food, lower heart and respiratory rates, high base excess on admission, longer diagnosis time, treatment and hospitalization delay, and mild severity grade. Variables associated with death included: anorexia, dysphagia, dyspnea, low blood potassium concentration on admission, moderate and severe disease grading, development of dysphagia, dyspnea, recumbency and seizures during hospitalization, treatment with glycerol guaiacolate, intravenous fluids, and intravenous glucose solutions. Variables associated with survival in foals included standing on admission, voluntarily eating soft food and drinking, older age, and longer hospitalization delay. Outcome was not different between different tetanus antitoxin (TAT) dosages, although there was a trend of increasing survival rate with increasing TAT dosages. Cases with appropriate vaccination prior to development of tetanus were rare, but had improved outcome and shorter hospitalization. Conclusions Prognosis for equine tetanus is poor with similar outcome and prognostic factors in foals and adults. The prognostic assessment of cases with tetanus provides clinicians with new evidence-based information related to patient management. Several prognostic indicators relate to the ability to eat or drink, and more severe clinical signs relate to poor outcome. Increasing intravenous dosages of TAT has no significant effect on outcome, but the positive trend identified may support a recommendation for high intravenous TAT dosages. Further evaluation is warranted.

OBJECTIVE: To describe clinical data of hospitalized adult equids and foals with tetanus. DESIGN: Multicenter retrospective study (2000-2014). SETTING: Twenty Western, Northern, and Central European university teaching hospitals and private referral centers. ANIMALS: One hundred fifty-five adult equids (>6 months) and 21 foals (

BACKGROUND: Otitis externa is rare in horses and the condition is poorly described in the literature. OBJECTIVE: To describe clinical signs, treatment regimens and prognosis of otitis externa in horses. ANIMALS: Eight horses diagnosed with otitis externa during 2011–2018. METHODS: Retrospective review of medical records and follow‐up contact with owners. RESULTS: Common clinical signs seen in affected horses were pruritus, ear discharge and ear droop of affected ears. The most common cytological findings were neutrophils, bacteria and yeast. All horses responded well to treatment; two horses were reported to have recurrent problems. CONCLUSION AND CLINICAL IMPORTANCE: Otitis externa in horses is a rare and treatable condition. The condition may be present for prolonged periods before owners become aware, compromising the welfare of affected horses. Untreated otitis externa is a suggested cause of otitis media and temporohyoid osteoarthropathy, emphasizing the importance of identifying and treating this condition at an early stage. For this reason, clinicians should include a brief inspection of the pinnae and external ear canal in the clinical examination of horses.

Summary A newborn male foal was diagnosed with a greatly enlarged urinary bladder (megavesica), a urinary bladder diverticulum, and a herniated and abnormal umbilical remnant. Approximately 50% of the cranial bladder including the abnormal structures was surgically resected; the foal recovered and was still asymptomatic 15 months after surgery. The aetiology of megavesica in foals is unknown but successful outcome may be achieved with surgical intervention and adequate medical support.

Background: Signs of tachypnea after sedation of febrile horses with α2-agonists have been noted previously but have not been further investigated. Objectives: To examine the effects of xylazine and detomidine on respiratory rate and rectal temperature in febrile horses and to investigate if either drug would be less likely than the other to cause changes in these variables. Animals: Nine febrile horses and 9 healthy horses were included in the study. Methods: Horses were randomly assigned to sedation with xylazine 0.5 mg/kg or detomidine 0.01 mg/kg. Heart rate and respiratory rate were recorded before sedation and at 1, 3, and 5 minutes after injection. Hourly measurements of rectal temperature were performed starting before sedation. Results: All febrile horses experienced an episode of tachypnea and antipyresis after sedation. Rectal temperature in the febrile group was significantly lower at 1, 2, and 3 hours after sedation. In several measurements, the decrease was >1°C. Respiratory rate in the febrile group was significantly increased after sedation. All febrile horses were breathing >40 breaths/min and 3 horses >100 breaths/min 5 minutes after sedation. No differences were noted between the 2 treatments. No significant changes in respiratory rate or temperature were noted in the reference group. Conclusions and Clinical Importance: Febrile horses can become tachypneic after sedation with detomidine or xylazine. The antipyretic properties of α2-agonists need consideration when evaluating patients that have been sedated several hours before examination.

Background: Mycotic rhinitis is an uncommon disease in horses with a wide range of clinical signs and treatment options based on case studies of a single or only a few individuals. Moreover, while dogs with mycotic rhinitis appear to respond well to treatment with topical enilconazole, this approach has yet to be reported in horses. Objectives: The aim of this study was to describe the clinical findings, results of diagnostic investigations, treatment, and outcome in horses with mycotic rhinitis treated with topical enilconazole. Animals: Eight horses were included in the study. Methods: Medical records from 1995 to 2007 from an equine veterinary teaching hospital were reviewed to identify cases with a diagnosis of mycotic rhinitis. Results: Eleven cases were identified, of which 8 were treated with topical enilconazole. Seven of those 8 horses recovered and had normal appearance of the nasal passages on endoscopic examination. Fungal culture, where positive, yielded only Aspergillus spp. Treatment was readily performed and no adverse effects were noted in these horses. In 5 horses, long-term follow-up revealed complete recovery for an average of 5 years. Conclusions and Clinical Importance: Mycotic rhinitis owing to Aspergillus spp. in horses can be effectively and safely treated with topical enilconazole.

To describe clinical data of hospitalized adult equids and foals with tetanus.Multicenter retrospective study (2000-2014).Twenty Western, Northern, and Central European university teaching hospitals and private referral centers.One hundred fifty-five adult equids (6 months) and 21 foals (6 months) with tetanus.None.Information on geographic, annual and seasonal data, demographic- and management-related data, clinical history, clinical examination and blood analysis on admission, complications, treatments, and outcomes were described and statistically compared between adults and foals. The described cases were often young horses. In 4 adult horses, tetanus developed despite appropriate vaccination and in 2 foals despite preventive tetanus antitoxin administration at birth. Castration, hoof abscesses, and wounds were the most common entry sites for adults; umbilical cord infections and wounds for foals. Stiffness was the commonest observed initial clinical sign. Blood analyses frequently revealed an inflammatory response, hemoconcentration, muscle damage, azotemia, negative energy balance, liver damage, and electrolyte and acid base disturbances. Common complications or clinical signs developing during hospitalization included dysphagia, dyspnea, recumbency, hyperthermia, seizures, hyperlipemia, gastrointestinal impactions, dysuria, and laryngeal spasms. Cases were supported with wound debridement, antimicrobial treatment, tetanus antitoxin, muscle spasm and seizure control, analgesia, anti-inflammatory drugs, fluid therapy, and nutritional support. Mortality rates were 68.4% in adult horses and 66.7% in foals. Foals differed from adult horses with respect to months of occurrence, signalment, management-related data, potential causative events, clinical signs on admission, blood analysis, complications, and severity grades.This is the first study that rigorously describes a large population of equids affected by tetanus. The information provided is potentially useful to clinicians for early recognition and case management of tetanus in adult horses and foals. Tetanus affects multiple organ systems, requiring broad supportive and intensive care. Neonatal and adult tetanus in the horse should be considered as distinct syndromes, as in human medicine.

To identify prognostic variables for adult equids and foals with tetanus.Multicenter retrospective study (2000-2014).Twenty Western, Northern, and Central European university teaching hospitals and private referral centers.One hundred fifty-five adult equids and 21 foals with tetanus.None.Variables from history and clinical examination were statistically compared between survivors and nonsurvivors (adults: 49 survivors, 85 nonsurvivors; foals: 7 survivors, 10 nonsurvivors). Cases euthanized for financial reasons were excluded. Mortality rates in adults and foals were 68.4% and 66.7%, respectively. Variables associated with survival in adults included: standing, normal intestinal sounds and defecation, voluntarily drinking, eating soft or normal food, lower heart and respiratory rates, high base excess on admission, longer diagnosis time, treatment and hospitalization delay, and mild severity grade. Variables associated with death included: anorexia, dysphagia, dyspnea, low blood potassium concentration on admission, moderate and severe disease grading, development of dysphagia, dyspnea, recumbency and seizures during hospitalization, treatment with glycerol guaiacolate, intravenous fluids, and intravenous glucose solutions. Variables associated with survival in foals included standing on admission, voluntarily eating soft food and drinking, older age, and longer hospitalization delay. Outcome was not different between different tetanus antitoxin (TAT) dosages, although there was a trend of increasing survival rate with increasing TAT dosages. Cases with appropriate vaccination prior to development of tetanus were rare, but had improved outcome and shorter hospitalization.Prognosis for equine tetanus is poor with similar outcome and prognostic factors in foals and adults. The prognostic assessment of cases with tetanus provides clinicians with new evidence-based information related to patient management. Several prognostic indicators relate to the ability to eat or drink, and more severe clinical signs relate to poor outcome. Increasing intravenous dosages of TAT has no significant effect on outcome, but the positive trend identified may support a recommendation for high intravenous TAT dosages. Further evaluation is warranted.

A6 1/2-month-old Morgan filly was examined because of a history of abnormal behavior, teeth grinding, hypothermia, and electrolyte disturbances when weaned. She was from a breeding farm with several other Morgan horses. The 11-year-old dam had been purchased the year before as a proven broodmare, which had several previous foals. Breeding, gestation, and birth of this foal were normal. She was raised with 4 other mares and their offspring on pasture with free access to shelter in an open barn. Supplementary feeding consisted of oats and timothy hay. The owners reported that the foal showed unusual behavior, such as lack of apprehension of people, lack of distress from maternal separation, and a higher activity level than other foals of the same age. The foal extensively chewed the dam's tail and mane, masticated oats slowly with rapid jaw movements without actually swallowing them, and ground her teeth. She frequently nibbled the handler's clothes without biting, ate pebbles, and played with the salt block in the paddock. At 4 1/2 months of age, she was treated for suspected gastroduodenal ulcers and weaned. The referring veterinarian examined her 5 days after weaning because of dull demeanor and excessive teeth grinding. The foal was in thin body condition, hypothermic (37°C, 98.6°F), and tachycardic (60 beats per minute [bpm]) and had decreased borborygmi. Major abnormalities on serum biochemistry were severe hypernatremia (166 mmol/L; reference range 136–144 mmol/L) and hyperchloremia (128 mmol/L; reference range 94–104 mmol/L), azotemia (urea, 11.3 mmol/L; reference range 4.2–8.9 mmol/L), and hyperfibrinogenemia (5.2 g/L, reference range 1.6–2.9 g/L). The only abnormality on the CBC was hemoconcentration (PCV, 0.57 L/L; reference range 0.28–0.44 L/L). The foal was treated with penicillin procaine Ga (20,000 IU/kg [9072 IU/1b] IM q12h) and rifampinb (5 mg/kg [2.7 mg/1b] PO q8h). The next day the tachycardia worsened (120 bpm) and the foal was estimated to be 5–8% dehydrated. IV fluid therapy with lactated Ringer solutionc (LRS) was initiated, and the antibiotic was changed to ceftiofurd (2 mg/kg [0.91 mg/1b] IV q12h). The foal and dam were rejoined, and the foal's clinical status improved with resumption of nursing. Serial laboratory testing showed persistent hypernatremia 160 mmol/L) and hyperchloremia (123 mmol/L), azotemia urea 11.3 mmol/L and creatinine 168 umol/L; reference range 80–130 μmol/L), hyperglycemia (8.7 mmol/L; reference range 3.7–6.7 mmol/L), high aspartate aminotranferase activity (662 U/L; reference range 259–595 U/L), and high creatine kinase (CK) activity (1,196 U/L; reference range 108–430 U/L). The foal's condition improved and IV fluids were discontinued. Ceftiofur administration was discontinued and trimethoprim-sulfamethoxazolee (25 mg/kg [11.3 mg/1b] PO q12h) was administered for 3 days. During the next month the foal was stable but the abnormal behavior persisted. She was weaned again, and within days marked behavior changes such as circling, throwing the head around compulsively, and severe hind-end shivering recurred. At examination, the foal was dull, tachycardic (60 bpm), was hypothermic (33.6°C, 92.5°F), had dark red mucous membranes, and was estimated to be 5% dehydrated. Laboratory findings were similar to those of the previous tests except for high fibrinogen (7.1 g/L). The foal was again rejoined with the dam, treated with intramuscular penicillin, and referred