Apoquel for Perianal Fistulas???

Hello, Summarians!

Apoquel to help with this frustrating and challenging issue? Wow, this would be awesome.

Please give me feedback on ways I can make it more useful to you.

If it is valuable to you please consider sending it on to a friend 😄 

Blinded, Randomized Acupuncture Study in Horses

The musculoskeletal system plays a crucial role in the performance of athletic horses, particularly in racehorses. Back issues and axial stiffness are common problems that can affect racehorses' performance and lead to financial losses. Diagnosing and treating these conditions can be challenging due to the lack of specific clinical signs and imaging limitations. In recent years, veterinarians have become more aware of back problems in horses, and various treatment modalities have been developed. However, many of these treatments are invasive or considered doping by racing authorities, making them unsuitable for use close to race events. Training management is essential but not always feasible for racehorses. To address these constraints, there has been growing interest in alternative therapies such as chiropractics, osteopathy, extracorporeal shockwave therapy, laser therapy, and acupuncture. Acupuncture, a practice originating from traditional Chinese medicine, has been used in modern veterinary medicine to manage pain and various painful conditions in horses. Acupuncture involves stimulating specific points on the body, leading to tissue damage, inflammatory responses, neural excitation, and the release of neurotransmitters that can alleviate pain and improve local microcirculation and muscle function. Several studies have investigated acupuncture's efficacy in treating axial stiffness in horses, with positive clinical results. However, few of these studies were randomized and controlled, and none specifically involved racehorses. The primary objective of this study was to assess the short-term effects of acupuncture on the clinical signs of axial stiffness in steeplechase racehorses. The study aimed to determine if a single acupuncture treatment could lead to improvements in clinical signs for up to two weeks, as perceived by trainers and riders. The study had both primary and secondary outcomes. The primary outcome was based on the assessment of riders and trainers, which has been considered relevant in previous trials evaluating axial stiffness treatments. The results showed that acupuncture treatment significantly improved locomotion and behavior in horses compared to the control group at 7 and 14 days after treatment, as reported by trainers and riders. Among the secondary outcomes, only the subjective visual assessment of back mobility by expert clinicians showed a significant improvement in the acupuncture group compared to the control group, both at trot and during free jumping at the canter, two days after treatment. Objective measurements using Inertial Measurement Units (IMUs) did not show significant differences in the relative mobility of the thoracolumbar region between the two groups. This could be because acupuncture treatment improved overall locomotion patterns without specifically targeting the thoracolumbar segment. The study used IMUs to measure vertical displacements of the back over a whole stride, while other studies have shown half-stride asymmetry of back movement using motion capture. Future studies could explore this aspect in more detail. Additionally, the study suggested that IMUs could be a valuable tool for assessing back mobility in horses. The study did not use diagnostic imaging techniques, reflecting the practical limitations in racehorse stables. Therapeutic strategies were prioritized over expensive imaging, as axial pain or stiffness does not always correlate with imaging findings. In summary, acupuncture showed promise in improving the clinical signs of axial stiffness in steeplechase racehorses, as reported by trainers and riders. Further research with larger sample sizes and longer-term assessments is needed to confirm these results and explore the duration of acupuncture's effects. Additionally, comparing subjective assessments to objective measurements and addressing potential confounding factors would enhance our understanding of the effectiveness of acupuncture in managing axial stiffness in racehorses. 

Terlinden, A., Szymkowiak, M., Jonville, E., Hatrisse, C., De Azevedo, E., Coudry, V., Denoix, J., Pilot-Storck, F., Desquilbet, L., & Bertoni, L. (2023). Acupuncture has potential in managing axial stiffness in steeplechase racehorses: a blinded prospective randomized preliminary study. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.23.04.0197 

Bottom line — Well done pilot study

Thyroid Hormone Variation over 1 Year

This study investigated the variation in thyroid hormones (total thyroxine, free thyroxine, and total triiodothyronine) and thyroid-stimulating hormone (TSH) in cats over a one-year period, with measurements taken every 8 weeks. The primary aim was to determine the extent of intraindividual (within the same cat) and interindividual (between different cats) variation in these hormone levels. The study found that, in cats, the variation in hormone levels between individuals was generally greater than the variation within the same individual over time. This implies that population-based reference intervals may suffice for some hormones, but for others, subject-based reference intervals like reference change values (RCVs) might be more appropriate for detecting biologically significant changes in serial measurements. The research also noted some small positive linear time trends in total thyroxine and free thyroxine, which need to be considered when assessing changes in serial measurements. Moreover, while seasonal variation in thyroid hormones has been observed in other species, it was not convincingly detected in cats in this study. In practical terms, this research underscores the importance of considering factors like the specific hormone being measured, the assay methodology, and the time frame when interpreting thyroid hormone measurements in cats. Subject-based reference intervals, such as RCVs, could be particularly valuable in monitoring older cats for thyroid disease, but further research is needed to refine reference intervals and better understand the biological variation in feline thyroid hormones. 

Prieto JM, Carney PC, Smith SM, Miller ML, Rishniw M, Randolph JF, Salerno VJ, Lamb SV, Place NJ, Farace G, Peterson S, Peterson ME. Biological variation of serum thyrotropin and thyroid hormones concentrations determined at 8-week intervals for 1 year in clinically healthy cats. Vet Clin Pathol. 2023 Sep;52(3):493-502. 

Bottom line — No seasonal variation noted. Intraindividual usually consistent.

Case Report for Apoquel and Perianal Fistulas

Perianal fistula (PAF) is a chronic condition often found in middle-aged German Shepherd dogs, characterized by symptoms like dyschezia, ulcers, sinus tracts around the anus, pain, and hemorrhage. The histopathological features of PAF include a mixed inflammatory infiltrate, periadnexal inflammation, furunculosis, hidradenitis, and epithelium-lined sinus tracts. Immunopathological studies suggest T-lymphocyte-mediated inflammation and a cytokine profile indicative of an immune-mediated process in PAF. Ciclosporin has been a common treatment choice, but it can have adverse effects. Other treatments like prednisolone, metronidazole, azathioprine, mycophenolate mofetil, surgery, cryotherapy, dietary changes, and light therapy have shown variable responses. Research is also exploring human embryonic stem cell-derived mesenchymal stem cell treatment. Oclacitinib, a JAK1 inhibitor, has been used successfully to manage PAF in German Shepherd dogs. It has immunomodulatory effects and has been effective in treating various immune-mediated skin conditions. While the exact mechanism for its effectiveness in PAF is not clear, it may involve suppressing inflammatory mediators and lymphocyte function. Oclacitinib is considered promising for PAF management, potentially causing fewer adverse effects than other treatments like ciclosporin or azathioprine. However, further studies are needed to confirm its effectiveness, determine optimal dosing, assess long-term control, and monitor adverse events for extended use in immune-mediated skin diseases. These cases demonstrate a rapid and sustained response to oclacitinib, even at higher doses than typically used for other conditions like canine atopic dermatitis. 

 Harvey R, Horton H. Successful treatment of perianal fistulas in two dogs with oclacitinib. Vet Dermatol. 2023 Oct;34(5):483-486. doi: 10.1111/vde.13171. Epub 2023 May 15. PMID: 37184056. 

Bottom line — Potentially useful in some cases

Just putting things in perspective …