Paradigm shifts in understanding equine laminitis.
Authors: Patterson-Kane, Karikoski, McGowan
Journal: Veterinary journal (London, England : 1997)
Summary
# Editorial Summary: Paradigm Shifts in Understanding Equine Laminitis Patterson-Kane, Karikoski, and McGowan's 2018 review fundamentally reframes laminitis as a clinical syndrome arising from multiple systemic disease states—notably endocrinopathy, sepsis, and systemic inflammatory response—rather than as a singular disease entity. The authors synthesise emerging research to establish that endocrinopathic laminitis (associated with conditions like equine metabolic syndrome and pituitary pars intermedia dysfunction) now represents the predominant presentation in lameness cases, shifting focus away from the traditionally emphasised sepsis-related forms. Critically, the conventional model emphasising primary basement membrane destruction has given way to evidence of a variable subclinical phase characterised by gross capsular changes and early lamellar cell stretching and elongation—architectural disturbances that precede the severe pathology previously thought to be initiating events. These mechanistic revisions have profound implications for clinical practice: earlier detection and management of underlying systemic disease becomes paramount, diagnostic protocols must prioritise endocrine screening, and interventions should target the lamellar cell pathophysiology during the subclinical window rather than focusing exclusively on acute inflammatory management. Understanding laminitis as a multi-aetiological syndrome rather than a discrete disease fundamentally alters how equine professionals approach prevention, diagnosis, and therapeutic strategy across all disciplines.
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Practical Takeaways
- •Laminitis cases should be investigated for underlying systemic disease, particularly endocrine disease, rather than treated as an isolated condition
- •Understanding that lamellar cell stretching and elongation are early key events offers new targets for intervention and management strategies
- •The recognition of a variable subclinical phase suggests potential for earlier detection and prevention if systemic disease triggers are identified and managed promptly
Key Findings
- •Laminitis is now understood as a clinical syndrome associated with systemic disease (endocrine disease, sepsis, SIRS) or altered weight bearing rather than a discrete disease entity
- •Endocrinopathic laminitis is the predominant form in horses presenting with lameness
- •Early pathophysiology involves stretching and elongation of lamellar cells with variable subclinical phase and gross hoof capsule changes, rather than primary severe basement membrane pathology