A Double-Blinded Positive Control Study Comparing the Relative Efficacy of 2.5% Polyacrylamide Hydrogel (PAAG) Against Triamcinolone Acetonide (TA) And Sodium Hyaluronate (HA) in the Management of Middle Carpal Joint Lameness in Racing Thoroughbreds.
Authors: de Clifford Leigh Travis, Lowe Jason Nicholas, McKellar Campbell Duirs, McGowan Catherine, David Florent
Journal: Journal of equine veterinary science
Summary
# Editorial Summary A team of equine clinicians conducted a rigorously designed double-blinded trial to evaluate polyacrylamide hydrogel (PAAG) as an intra-articular treatment for middle carpal joint lameness in racing Thoroughbreds, comparing its efficacy against the established standards of triamcinolone acetonide and sodium hyaluronate. Thirty-one flat-racing horses with grade 1–3 carpal lameness received single intra-articular injections of either 2.5% PAAG, triamcinolone, or hyaluronate (the latter group also receiving two subsequent intravenous doses), then returned to normal training after 48 hours' rest whilst blinded examiners assessed lameness at 2, 4, and 6 weeks. By 6 weeks, 83% of joints treated with PAAG were sound compared to only 27% in the triamcinolone group and 40% with hyaluronate, with these differences reaching statistical significance; notably, horses achieving soundness with PAAG remained lame-free at 12-week follow-up. For farriers and veterinarians managing performance horses with carpitis, this work provides evidence that PAAG offers substantially superior outcomes to conventional intra-articular therapies in selected cases without radiographic fracture or fragmentation, potentially reducing recovery time and enabling faster return to training schedules.
Read the full abstract on PubMed
Practical Takeaways
- •2.5% polyacrylamide hydrogel intra-articular injection offers superior short- to medium-term lameness resolution for carpal joint lameness compared to corticosteroid or hyaluronate monotherapy in racing Thoroughbreds
- •Effects of 2.5% PAAG appear durable through at least 12 weeks post-treatment, suggesting sustained benefit beyond the 6-week assessment period
- •Consider 2.5% PAAG as a first-line intra-articular treatment option for horses with grade 1-3 carpal lameness without radiographic evidence of fracture or significant fragmentation
Key Findings
- •2.5% PAAG achieved 83% lameness-free rate at 6 weeks compared to 27% for triamcinolone acetonide (P=0.007)
- •2.5% PAAG significantly outperformed sodium hyaluronate at 6 weeks (83% vs 40%, P=0.04)
- •No significant difference in efficacy between triamcinolone acetonide and sodium hyaluronate at any timepoint
- •10 of 12 horses (83%) treated with 2.5% PAAG that were lameness-free at 6 weeks remained lameness-free at 12 weeks