A prospective comparison of the GOLDIC (R) technique and corticosteroid plus hyaluronic acid injections for arthrogenic lameness in horses

Osteoarthritis is one of the most common causes of lameness and often is a career-ending disease in horses. Treatment of osteoarthritis is usually symptomatic and aimed at controlling the inflammation, either systemically or intra-articularly. Common intra-articular treatments include corticosteroids combined with hyaluronic acid and chondroprotective drugs such as glucosamine and chondroitin. The application of gold compounds, either orally or intramuscularly, has been used therapeutically for many decades, primarily in human patients with rheumatoid arthritis. Gold compounds (aurothiomalate) inhibit the production of nitric oxide (NO) of chondrocytes. Nitric oxide mediates the destructive effects of IL-1 and TNF, which include reduced collagen and proteoglycan production, apoptosis of chondrocytes and stimulation of metalloproteases. The purpose of the present study was to compare the efficacy of the GOLDIC (R) treatment with that of corticosteroids and hyaluronic acid in horses with arthrogenic lameness. A prospective randomized controlled, two-centre clinical trial was performed. 30 horses with arthrogenic lameness were enrolled in this study. The horses were treated by four injections of gold-induced, autologous conditioned serum GOLDIC (R) (group B, n = 16) or by a single injection of corticosteroid and hyaluronic acid (group A, n = 14). Lameness was assessed using the MEP Grading system before and 3, 6, 12 and 36 months after treatment. The MEP grade was the primary endpoint. Differences were considered significant at P < 0.05. Secondary endpoints were the results of the flexion test, degree of joint-effusion, radiographic findings, the ability to return to original performance level and adverse effects. Horses of group B had significantly lower lameness grades at the follow-up examinations compared with the value before treatment (p < 0.01). Both treatment groups showed positive effects on the MEP-Score. Group B (Goldic (R)) showed much faster effect on the MEP-Score. Also in the long run group B (Goldic (R)) showed a larger effect on the MEP-Score. Severe side effects did not occur in either group. It has been shown that the treatment of arthrogenic lameness in horses with the gold-induced, autologous conditioned serum method (GOLDIC (R)) is in certain cases a promising alternative to conventional treatment with corticosteroids and hyaluronic acid.