Using Pharmaceuticals To Treat Joint Disease - Clinical Evidence Shows Success

Rarely does a new pharmaceutical agent deliver clinically what it appears to do experimentally. Adequan is one pharmaceutical agent that may prove to be even more beneficial in practice than in research laboratories. Academia and specialists in the field of joint disease are beginning to acknowledge anecdotal practitioner information regarding Adequan as having merit. Since I first reported its use in canine joint disease ("Joint Disease -- A New Approach?" Veterinary Forum, October 1987, pg. 17), I have had numerous occasions to use Adequan in other clinical situations. I would like to first reveal recent information of its clinical effects in joint disease and discuss and expand on its clinical applications in small animal practice.

THE EVIDENCE

A recent study in horses by Michael Collier, DVM, Davis Clark, DVM, et al at Oklahoma State University revealed that Adequan does penetrate synovial fluid when given intramuscularly. This was tested by labeling the agent with tritium. This research concluded that Adequan given intra muscularly (IM) "distributes to the blood, synovial fluid and to the articular cartilage within two hours ... and at 96 hours post injection, levels compatible with relevant enzyme persisted in cartilage and bone."

Furthermore, three articles on canine joint diseases and hip dysplasia in a veterinary journal in 1991 reviewed the current status of joint diseases and all three articles stated that therapy with Adequan improved joint function and reduced disease states. They stated, "While the use of polysulfated glycoaminoglycan (Adequan) in small animals with degenerative joint disease are cause for optimism it must be viewed critically until objective information is obtained." (Compendium; David Clark, DVM, Sept. 1991, page 1445.)

Further evidence appeared in the Fall/Winter 1991 issue of Cornell Institute News which revealed that Adequan appeared clinically to reduce hip dysplasia in a controlled study of dogs. In summary, the article says, "Adequan has the potential to prevent hip dysplasia in genetically predisposed dogs."

Finally, in the recent 1992 North American Veterinary Conference proceedings (pages 308, 310, 325), Brian Beale, DVM, from the University of Florida reported, "Adequan has been shown experimentally to preserve articular cartilage following meniscectomy" and "very young dogs may benefit from the cartilage sparing effects of the polysulfated glycoaminoglycans." He added, "this drug is purported to have anti-inflammatory and antienzymatic qualities which allow it to relieve many of the clinical signs associated with degenerative joint disease and maintain the health of the remaining articular cartilage (chondroprotection)."

CLINICAL USE

I have used Adequan in the treatment of hip dysplasia, degenerative joint disease, osteoarthritis, osteochondritis dessicans, following patella luxation surgery, following ruptured cruciate surgery, spondylitis, disc degeneration, discospondylitis and non-specific arthritis in older dogs and even in cats. I have tried it on early cataract development (results still pending), lupus, and rheumatoid arthritis. Results vary with the stage of the disease; however, every case showed at least some improvement while most cases reported dramatic improvement and "temporary" recovery.

Since this drug appears clinically to be non-toxic, it offers a welcomed change from the damaging effect of repeated steroid usage. The treatment regimen is the same for most cases and included weekly injections of Adequan (50mg-150mg) IM for four to six weeks, then one injection every two to four months for maintenance. On several cases of confirmed osteochondritis in Rottweilers, Adequan appeared to clinically cure the pain and lesions before any joint disease and osteophytes occurred.

In the treatment of non-specific disc degeneration (not disc rupture) in older dogs, Adequan reduces pain and stiffness to allow these dogs to mobilize more freely. Most cases are treated only with Adequan; however, initial steroid usages has been helpful with Adequan in selected cases for the first 24-48 hours of acute injury. Repeated steroid usage is avoided as it is known to damage chondrocytes and articular cartilage. More often for pain, non-steroidal agents are given concomitantly. I routinely use Adequan in young dogs given quinoline antibiotics as a chondroprotective agent since these antibiotics are known to damage articular cartilage.

To date, I have used this agent on some 30 cases and no toxicity has been apparent clinically or otherwise. With the mounting evidence that this agent is effective in numerous joint and back diseases, I see no reason not to use it in a clinical and practice situation. It appears that Luitpold Company is attempting to get FDA approval for its use in dogs. Meanwhile, I would recommend it be used in joint and disc disease, following joint surgery and as an anti-aging agent in both the young dysplasia prone dogs and elderly arthritic patients. Any feedback on any positive or negative results regarding this agent would be appreciated. In conclusion, Adequan appears to be a valuable therapeutic agent in the management of joint disease in the practice of both equine and small animal medicine.
Dr. Mandelker (Michigan State, 1968) practices at the Community Veterinary Hospital, Largo, FL. He is a frequent contributor and a member of this magazine's Advisory Board. (813) 585- 2007.
The following letter was received from Dr. Janet Mosten (Dr. Stockner's associate at the Animal Fertility Clinic) who reviewed the above article. She gives her experience with Adequan.

"I have reviewed the paper on Using Pharmaceuticals to Treat Joint Disease. Dr. Stockner had said you would like any comments regarding Adequan. I started using Adequan injections approximately two years ago in dogs that had undergone orthopedic surgery. The surgeons had found fast recovery rates and less degenerative changes in the joints when Adequan was used. Most of the cases were cranial cruciate ruptures -- some animals were given only one injection and others a series of injections.

I have since started using Adequan for treatment of other arthritic conditions. Injections are given in a muscle every 4 to 5 days for 6 treatments and then as needed afterwards which seems to be every 2 to three months. If no improvement is seen after the fourth injection, we recommend discontinuing. Most of the cases Adequan is used in have primarily degenerative joint disease of the hips, elbows or shoulders. I find a better response seen in small, light- weight dogs. Most owners are pleased with results stating that their pets can get up more easily, seem happier, are less stiff in the morning and now want to jump around and play again. In large breed dogs, the response has been less favorable -- I think it truly depends on the type of problem within the joint and how much damage is there at the beginning of treatment. The joints of these large breed dogs have a lot more stress due to weight and muscle mass.

I have not used this drug for disc disease or immune mediated disease. I found no change when used in my large male Golden Retriever which has rheumatoid arthritis.

There is not much published on this drug and no known side effects. It is used extensively in the horse racing industry without problems. My Golden had one episode of bloody diarrhea after the first injection but none on subsequent injections and no clinical problems from that episode. Only one other such case is known and was reported due to another factor and not to Adequan.

Some orthopedic surgeons have found an added benefit in putting dogs on a non-steroidal product such as Ascriptin during the 'induction' phase of the series of injections. This helps decrease the inflammation present at the start and enhances Adequan's effectiveness. I haven't seen a big change with the use of Ascriptin or aspirin products in conjunction with the injections.

This product is something that I recommend to owners to try on any arthritic animal. It will either help or there will be no change. And, thus far there are no known medical contraindications to say not to try it.

There is a lot of information still to acquire on the use of this product in dogs. Please give me a call if you have any further questions."
(Ed. Note/Sharon: I know of one eight year old Mastiff bitch with badly arthritic hips (not dysplastic) that was put on Adequan as a last resort/alternative to surgery. She was experiencing pain that caused her to cry when getting up and down. After initial treatment, she was able to get up and down the stairs to her home's second floor bedrooms where she used to sleep. Looks interesting for those dogs that we are unable to help through our breeding practices. (Thank you Connie for the information.))