Журнал клинических случаев

A Novel Treatment Combination of Sildenafil, Mepivacaine and Glucose With Disease Modifying Properties, in a Pony With Lameness Associated Osteoarthritis: A Case Report

Abstract

Eva Skiöldebrand*, Kristin Abrahamsson Aurell, Saritha Adepu, Anders Lindahl and Elisabeth Hansson

Today no biomarkers reflecting joint tissue destruction or Disease-Modifying Osteoarthritis Drugs (DMOADs) are available on the market. This case report decscribes a new pharmaceutical drug combination consisting of Sildenafil, Mepivacaine and Glucose (SMG) used for intra-articular treatment of lameness associated osteoarthritis of the right distal interphalangeal joint in a nine-year-old Swedish pony. The pony had a history of moderate lameness during five months and were treated with intra articular corticosteroids three times without any recovery of lameness (visit 1-5). Clinical lameness examinations, including intra articular anaesthesia, radiological examination, standing low-field MRI and quantification of biomarkers for cartilage and bone degradation (COMP156 and BGN262) in synovial fluid and serum was performed over a period of 24 months post intervention. At inclusion (visit 6) the pony showed lameness and levels of synovial fluid COMP156 was 98 μg/ml and serum 6.0 μg/ml and serum BGN262 1124 ng/ml. Intra-articular treatment with SMG was performed twice with 4 weeks interval. One month after the first injection (visit 7), the horse was non lame and the concentrations of COMP156 was remarkable reduced to 17.6 μg/ml in the synovial fluid. The MRI data indicated improved subchondral bone sclerosis and healed bone inflammation. The horse remained sound and the longitudinal follow up of COMP156 and BGN262 levels in serum declined during the post-treatment observation period of 24 months. Intra articular treatment of SMG injection was well tolerated, as no clinically adverse effects were observed.