Journal of Clinical Case Reports

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.