October 31, 2017

Joint Supplement Shows Promise in Managing Cranial Cruciate Ligament Rupture

A new class of joint supplements with anti-inflammatory activity may change the way cranial crucial ligament rupture is managed in veterinary medicine.
By JoAnna Pendergrass, DVM
Cranial cruciate ligament rupture (CrCLR) is a common canine orthopedic injury that frequently causes hindlimb lameness and osteoarthritis (OA). Surgery is the gold standard for CrCLR repair, with tibial plateau leveling osteotomy (TPLO) being preferred for medium- to large-breed dogs. However, TPLO does not prevent or delay OA, to which chondrodegeneration and inflammation likely contribute.

Many dietary joint supplements have been developed to manage OA. A relatively new joint supplement class enhances joint repair and exerts anti-inflammatory and antioxidant activity, providing a new approach to OA management. Ingredients in this new class include N-palmitoyl-D-glucosamine for anti-inflammation and quercetin for antioxidant activity, in addition to chondroitin and glucosamine.

In the first study of its kind, published in the International Journal of Veterinary Science and Medicine, an Italian research team demonstrated that combination TPLO and joint supplement therapy with N-palmitoyl-D-glucosamine and quercetin rapidly rebalanced the joint microenvironment following CrCLR repair.

Treatment
Thirteen pet dogs (15­–55 kg) with acute unilateral CrCLR and mild to moderate stifle OA underwent TPLO. Following surgery, the dogs were randomized into 2 treatment groups:
  • Control (n=7): No further treatment
  • Treated (n=6): Once-daily joint supplement for 90 days starting the day after surgery

The supplement contained N-palmitoyl-D-glucosamine, quercetin, chondroitin, glucosamine, vitamin E, and omega-3 fatty acids.

Synovial fluid from the affected stifle was collected before TPLO (V0) and 30 and 90 days post-TPLO (V30, V90). Spectroscopy was used to determine each samples’ metabolic OA profile, with particular attention on lactate, whose concentration increases in dogs with OA.

All dogs were examined for hindlimb lameness and radiographic evidence of OA on V0, V30, and V90.

Results
Synovial Fluid Analysis
From V0 to V30, lactate concentration markedly decreased in treated but not control dogs, suggesting the supplement’s early anti-inflammatory effect. Creatine concentration similarly decreased in treated dogs from V0 to V30, indicating the supplement’s effect on muscle metabolism rebalancing post-TPLO; to the researchers’ knowledge, this was the first observation of creatine rebalancing within synovial fluid.

From V30 to V90, lactate and creatine concentration decreased similarly between treatment groups.

Lameness and OA
Lameness scores improved in all 13 dogs over time. Notably, from V30 to V90, lameness scores in treated dogs improved approximately 2-fold over those in control dogs, indicating the supplement’s potential clinical benefit.

OA scores were generally similar between groups over time, suggesting that the supplement may not favorably affect OA. However, the study duration may have been too short to detect radiographic changes of OA, the researchers acknowledged; longer studies will be needed to fully determine the supplement’s effect on OA.

Limitations and Implications
In addition to short study duration, the study was limited by small sample size and the absence of synovial fluid analysis of the contralateral healthy stifle. Despite these limitations, the researchers noted the supplement’s benefits demonstrated in the study: rapid and significant improvement in joint metabolism and a trend toward a better clinical outcome.

Taken together, the study results provide early evidence of the anti-inflammatory and functional benefits of joint supplements containing N-palmitoyl-D-glucosamine and quercetin. The researchers concluded that the “use of joint health nutraceuticals targeting inflammation besides chrondrodegeneration should be considered in the combined treatment to canine OA.”

 
Dr. Pendergrass received her Doctor of Veterinary Medicine degree from the Virginia-Maryland College of Veterinary Medicine. Following veterinary school, she completed a postdoctoral fellowship at Emory University’s Yerkes National Primate Research Center. Dr. Pendergrass is the founder and owner of JPen Communications, a medical communications company.

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