Equine Endocrinopathic Laminitis, once considered a death sentence for horses diagnosed with Cushing's disease or Pituitary Pars Intermedia Dysfunction (PPID), has undergone a transformative understanding in recent years. Thanks to dedicated research and organizations like the Equine Cushing’s and Insulin Resistance Group founded in 1999, our grasp on this condition has significantly improved.
Understanding Acute Laminitis
The term "acute" in laminitis often misleads owners to believe it's a sudden onset condition. However, with endocrinopathy, laminitis is often the result of a prolonged series of metabolic imbalances. As Johnson et al. (2004) highlighted, conditions related to excess glucocorticoids and insulin resistance lead to structural changes in the hoof-lamellar junctional zone. These changes can result in the lengthening and attenuation of the primary and secondary dermal lamellae, irrespective of pain or lameness.
The Insulin Connection
Insulin plays a pivotal role in endocrinopathic laminitis. Approximately 90% of lameness cases due to laminitis are associated with either Equine Metabolic Syndrome (EMS) or PPID (Karikoski et al. 2011). Studies like Coleman et al. 2018 and Menzies-Gow et al. 2017 have pinpointed hyperinsulinemia as a significant risk factor for pasture-induced laminitis.
Signs and Symptoms
Early signs of acute laminitis may not always manifest as lameness. Observable changes include stretching in the white line, hemorrhage in the white line, dropped or flat soles, and possibly rings in the hoof wall. Horses with acute or sub-acute laminitis may exhibit a wooden gait, rigid head carriage, reluctance to trot or turn sharply, and tension through the shoulders, back, and hindquarters.
Triggers and Complications
Several factors can trigger or exacerbate acute laminitis. These include seasonal rises in PPID, dietary indiscretions with high carbohydrate content, and exposure to cold temperatures. Drugs like phenothiazines, sulfa antibiotics, and corticosteroids can also influence insulin levels and increase laminitis risk.
New Treatment Avenues
For cases resistant to traditional management strategies, SGLT2 inhibitors like canagliflozin and ertugliflozin offer promising alternatives. SGLT2 inhibitors, which are also called gliflozins, are a class of drugs that lower your blood sugar levels by preventing your kidneys from reabsorbing sugar that is created by your body and the extra sugar leaves through in your urine. By blocking glucose reuptake in the kidneys, these drugs can reduce the glucose load on the body, subsequently lowering insulin levels and improving laminitis pain (Kellon and Gustafson, Sundra). However, careful monitoring is essential due to potential side effects like elevated triglyceride levels.
Management Strategies
The key to successful management lies in a multi-faceted approach:
Diagnosis: A comprehensive assessment of the horse's history, behavior, and hoof changes, combined with insulin and ACTH testing, is crucial.
Diet and Drugs: Controlled diets low in hydrolyzable carbohydrates and appropriate drug therapies can help regulate insulin and ACTH levels.
Trim: Proper hoof care, emphasizing a realigning trim, is essential for healing and minimizing laminitis pain.
Conclusion
Equine endocrinopathic laminitis is a complex condition that requires a thorough understanding and a collaborative approach from owners, veterinarians, and farriers. With advancements in research and treatment options, horses diagnosed with this condition can lead fulfilling lives with appropriate management strategies in place. Awareness, education, and proactive care remain our most potent tools in combating this challenging equine ailment.
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