Arthramid ethics

Taliesan

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This is a really interesting thread for me at the moment.

I have a 7 year old horse that I have hardly ridden, as I've always known something wasn't quite right with him since the day I bought him as an unstarted 3 year old. I've spent the last 3 years just walking him in hand - we probably do about 20 miles a week minimum.

Due to a series of events I ended up getting the vet out to check him over. Although not 'lame' he is just 'not quite right'. Anyway, turns out he has significant arthritis in his left hock but only on the outside of the joint. The bones on the inside look great (as does his right hock, no problems there at all). The vets suspect he was kicked when he was a yearling and that is what has caused the issue.

We will be investigating the top of his tendon as well, just to make sure there is no damage there, but the way I am approaching this is "what is the best treatment plan for my horse to enjoy his life to the fullest".

Now, that may well involve hock injections, perhaps some treatment of the tendon as well if that is causing him additional discomfort. Whether we go for arthramid or something else I am not too sure yet, as I will be guided by the vet on this.

However, my horse gets his joy in life from doing things. He loves going out with me and exploring new places. The few times I have ridden him (briefly for about 5 minutes at a time) he thought it was great fun and a novel experience. The whole point of me removing the discomfort from his joint is so he can enjoy his life pain free. He has no concept of how long, or short, life is. He only knows how good, or not, life is.

I am not treating him so I can go out and do XYZ. I had so many dreams and hopes of what me and Apollo would do together - and it looks like none of them may happen now. Which is fine, I have come to terms with that.

However, does that mean I am going to do nothing with him because he's got arthritis and it has been treated? No. Absolutely not.

For me it is a very tricky ethical tightrope of length of life versus quality of life. What is worth more is something that is unique to every horse, as well as every human. For Apollo, his fulfilment comes from being active and going on adventures together. I will, of course, be mindful of his hock and be careful to tread that fine line of his enjoyment versus longevity. It might be that other horses get their joy from going out and about jumping round courses of 1m. I can't possibly comment or pass judgement on this though as I don't know those horses like I know my own.

I would hope that anybody who gets their horse treated does so because the treatment plan is in the best interests of the horse for their overall life fulfilment - not because that treatment plan is in the best interests of the human who wants to use the horse to achieve a specific thing.

When we start treating horses so they can do what we want them to do, and that treatment is not done with the interests of the horse first and foremost, then this is where, for me, it starts to enter an ethical grey area.
 

Muddy unicorn

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For the average age of a horse to be diagnosed with arthritis to be six, then for every 15 year old diagnosed, there would need to be three 3 year olds, for every 21 year old there would need to be three yearlings, and that very clearly is not happening.

[/QUOTE]

There are different types of average - you’re using mean, I suspect the claim is using mode 🤷‍♀️
 

SEL

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@Taliesan that's a lovely post and very much how I feel. Arthramid in hocks was a game changer for my mare but unfortunately the knock on effects of other issues meant we only ever returned to light hacking and she's since retired from that. We walk out in hand. I still kick myself for not pushing the vets more at an earlier stage.

My littlest cob came back from the vets with a long list of issues and I would have happily retired her too. But she wants to hack, gets cross if she hasn't at least been to her favourite field for a couple of days and thinks getting off the box somewhere new is the best thing ever. So I work within her limitations. Which apparently includes bogging off across a newly cut hay field leaving her 17.2 companion eating dust. I won't Bute to make her work but I will often help her out when her antics have left her a bit stiff
 

scats

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My mare had arthramid for very mild arthritis. She was hacking, doing low level schooling and occasional prelim dressage.
I stepped her down to just hacking but this year she has started doing low level schooling again 1-2 times a week as she is feeling better than ever. She had arthramid in July 2022 and none since.
All increases in work are vet and vet Chiro approved.

I know people who medicate horses to continue to compete them in SJ and eventing but I was surprised when my vet told me that a huge portion of his daily work is medicating competition horses.
I would like to think that a need for arthramid or medicating joints would makes people consider reducing a horses workload with longevity in mind, but I suppose there are people out there who don’t really think long term.
 

SEL

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It's a replacement cartilage, is how I prefer to see it. If it can be done again in future at intervals of 6 months or greater, so jumping doesn't shorten the horse's working life, then I wouldn't see any problem with it. If it's not repeatable I'd say that was maybe different.

Does anyone know how repeatable it is?
.
I think initially they weren't sure if it was repeatable but now it's considered ok so long as there is space to inject. I know plenty on #2 and one on round #3 (hocks). All riding club level although a physio who works with dressage horses tells me it's pretty routine at the expensive end of the market.

The one on round #3 is 20 and retired to hacking. I think she was hoping for a better result but age takes its toll....
 

twiggy2

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I'd be interested to understand why some posters only have an issue if the horse is competing and not low level hacking?
Me too, if the horse is pain free and willing to work then great, get on with it and if that means a horse lives a life it enjoys for a shorter period of time then so be it.
So many, in fact I would say the vast majority of horse owners do not have the facilities or finances to give a horse a good or in most cases even an adequate retired life even shorter term, there are not enough homes out there for the horses needing them and that's only going to get worse, so keep them working and busy and in a home, horses needs can increase with retirement qith regard to space, attention, company, static herds etc and its not easy in today's society.
Personally I have never medicated to ride and I don't know if I would or not, it would depend on the circumstances I suppose.
I would and have however medicated my dogs in the past so they can continue to live their very active lives.
 

Sossigpoker

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This is a really interesting thread for me at the moment.

I have a 7 year old horse that I have hardly ridden, as I've always known something wasn't quite right with him since the day I bought him as an unstarted 3 year old. I've spent the last 3 years just walking him in hand - we probably do about 20 miles a week minimum.

Due to a series of events I ended up getting the vet out to check him over. Although not 'lame' he is just 'not quite right'. Anyway, turns out he has significant arthritis in his left hock but only on the outside of the joint. The bones on the inside look great (as does his right hock, no problems there at all). The vets suspect he was kicked when he was a yearling and that is what has caused the issue.

We will be investigating the top of his tendon as well, just to make sure there is no damage there, but the way I am approaching this is "what is the best treatment plan for my horse to enjoy his life to the fullest".

Now, that may well involve hock injections, perhaps some treatment of the tendon as well if that is causing him additional discomfort. Whether we go for arthramid or something else I am not too sure yet, as I will be guided by the vet on this.

However, my horse gets his joy in life from doing things. He loves going out with me and exploring new places. The few times I have ridden him (briefly for about 5 minutes at a time) he thought it was great fun and a novel experience. The whole point of me removing the discomfort from his joint is so he can enjoy his life pain free. He has no concept of how long, or short, life is. He only knows how good, or not, life is.

I am not treating him so I can go out and do XYZ. I had so many dreams and hopes of what me and Apollo would do together - and it looks like none of them may happen now. Which is fine, I have come to terms with that.

However, does that mean I am going to do nothing with him because he's got arthritis and it has been treated? No. Absolutely not.

For me it is a very tricky ethical tightrope of length of life versus quality of life. What is worth more is something that is unique to every horse, as well as every human. For Apollo, his fulfilment comes from being active and going on adventures together. I will, of course, be mindful of his hock and be careful to tread that fine line of his enjoyment versus longevity. It might be that other horses get their joy from going out and about jumping round courses of 1m. I can't possibly comment or pass judgement on this though as I don't know those horses like I know my own.

I would hope that anybody who gets their horse treated does so because the treatment plan is in the best interests of the horse for their overall life fulfilment - not because that treatment plan is in the best interests of the human who wants to use the horse to achieve a specific thing.

When we start treating horses so they can do what we want them to do, and that treatment is not done with the interests of the horse first and foremost, then this is where, for me, it starts to enter an ethical grey area.
This is similar to mine. Right hock almost fused by age 7.
He's an Irish Cob, I call him an "Irish survivor " as he was mentally so scarred when coming from Ireland even at age 4 or so. So his breeding is likely to be fairly accidental /haphazard. Although I'm sure he will have been trashed on hard ground, vet thinks it's juvenile arthritis so how right hock never developed properly, rather than an injury.
I and insurance spent over £6K so far getting him sorted. Yes I did this so I could ride him but also because he wasn't comfortable. He was never head nodding lame but he wasn't forward, he dragged his toes and was tired all the time.
By getting him sound and fit for me to ride I've also improved his general wellbeing as regular work keeps him supple and much happier in himself.
 

Taliesan

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@Taliesan that's a lovely post and very much how I feel. Arthramid in hocks was a game changer for my mare but unfortunately the knock on effects of other issues meant we only ever returned to light hacking and she's since retired from that. We walk out in hand. I still kick myself for not pushing the vets more at an earlier stage.

My littlest cob came back from the vets with a long list of issues and I would have happily retired her too. But she wants to hack, gets cross if she hasn't at least been to her favourite field for a couple of days and thinks getting off the box somewhere new is the best thing ever. So I work within her limitations. Which apparently includes bogging off across a newly cut hay field leaving her 17.2 companion eating dust. I won't Bute to make her work but I will often help her out when her antics have left her a bit stiff

I am really glad that arthramid was a game changer for you mare but sorry to hear that the other issues came to a head. Your little cob sounds like she's a lot of fun to be around and, much like Apollo, her joy in life comes from doing things. In that scenario the bute is helping keep her comfortable because of the things she has chosen to do - it isn't like you made the conscious decision to gallop her up a field, because it is what you wanted to do, knowing that she'd need a bute the following day. (Although, technically, the end result is the same for your mare. It is a bute after a blast up a field. What is different is the ethics of the person behind it and what their individual morals lead them to believe is right versus not right.)

Everyone has different morals, ethics and viewpoints. What I might see as unethical could be totally ethical to someone else. Much like the posters above saying that low level hacking is more ethical than competing for a horse that had been medicated. To me, as long as that is what the horse wants to do (which is the really important bit) then I see no issue.

Where this gets more grey is how we can accurately determine what a horse wants to do?

How many people involved with horses know their animals well enough to be able to distinguish between genuine forwardness because the horse is excited and stress based forwardness because the horse is worried? For example, I see so many people say "but my horse loves jumping" but all I can see are tense and anxious horses rushing at jumps because they are worried.

I can tell when Apollo is a bit worried about where we are walking compared to where he is excited about where we are walking. In both scenarios he speeds up and seems 'forward' but his body and face tell two completely different stories depending on how he is feeling about the situation.

I've also come across a lot of people seeing things in their horses (such as "but he loves X") because it is what they want to see and it is the answer they desire. To look at a situation critically, which includes being critical of ourselves, is really hard and often rather unpleasant. Not many people want, or indeed are able, to look at themselves in that light.

This leads back into the situation of the human seeing what they want to see and is what they are doing really in the best interests of the horse? The human might say it is - but how often is that genuinely true if we really look very deeply at ourselves and our own motives?

This is where I end up thinking myself round in circles about the whole ethics of riding horses in general. I know I can trust myself to do right by both of my boys. But then, doesn't every person think the same way? Or at least tell themselves that.

At the end of the day, for Apollo, yes, I will medicate him and possibly ride him as a result of that. However, when I do ride him it will only be done if the act of riding is something he consents to, me sitting on his back causes him no physical harm and that the ridden activity genuinely enriches his life.
 

Sossigpoker

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For the average age of a horse to be diagnosed with arthritis to be six, then for every 15 year old diagnosed, there would need to be three 3 year olds, for every 21 year old there would need to be three yearlings, and that very clearly is not happening.

There are different types of average - you’re using mean, I suspect the claim is using mode 🤷‍♀️
[/QUOTE]
Absolutely. I doubt the vets are doing statistical modelling on the topic , they are just noticing that the most common (i.e a form of average) age of horse they treat for arthritis is very young (around 6 or so). When mine was diagnosed around age 7 I was upset because I thought arthritis is an old horse's disease. That's when they said that most horses they treat are young and especially in hocks it's not just an old horse problem. These are performance specialists but my own regular vet has said very much the same

Quite sad really.
 

Sossigpoker

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I am really glad that arthramid was a game changer for you mare but sorry to hear that the other issues came to a head. Your little cob sounds like she's a lot of fun to be around and, much like Apollo, her joy in life comes from doing things. In that scenario the bute is helping keep her comfortable because of the things she has chosen to do - it isn't like you made the conscious decision to gallop her up a field, because it is what you wanted to do, knowing that she'd need a bute the following day. (Although, technically, the end result is the same for your mare. It is a bute after a blast up a field. What is different is the ethics of the person behind it and what their individual morals lead them to believe is right versus not right.)

Everyone has different morals, ethics and viewpoints. What I might see as unethical could be totally ethical to someone else. Much like the posters above saying that low level hacking is more ethical than competing for a horse that had been medicated. To me, as long as that is what the horse wants to do (which is the really important bit) then I see no issue.

Where this gets more grey is how we can accurately determine what a horse wants to do?

How many people involved with horses know their animals well enough to be able to distinguish between genuine forwardness because the horse is excited and stress based forwardness because the horse is worried? For example, I see so many people say "but my horse loves jumping" but all I can see are tense and anxious horses rushing at jumps because they are worried.

I can tell when Apollo is a bit worried about where we are walking compared to where he is excited about where we are walking. In both scenarios he speeds up and seems 'forward' but his body and face tell two completely different stories depending on how he is feeling about the situation.

I've also come across a lot of people seeing things in their horses (such as "but he loves X") because it is what they want to see and it is the answer they desire. To look at a situation critically, which includes being critical of ourselves, is really hard and often rather unpleasant. Not many people want, or indeed are able, to look at themselves in that light.

This leads back into the situation of the human seeing what they want to see and is what they are doing really in the best interests of the horse? The human might say it is - but how often is that genuinely true if we really look very deeply at ourselves and our own motives?

This is where I end up thinking myself round in circles about the whole ethics of riding horses in general. I know I can trust myself to do right by both of my boys. But then, doesn't every person think the same way? Or at least tell themselves that.

At the end of the day, for Apollo, yes, I will medicate him and possibly ride him as a result of that. However, when I do ride him it will only be done if the act of riding is something he consents to, me sitting on his back causes him no physical harm and that the ridden activity genuinely enriches his life.
I'm more and more aware of the fact that we ride horses for our own benefit ,.no horse asks to be ridden. They just obey us.
There may become a day where I will no longer consider it morally acceptable to ride my horse/any horse. I already view a lot of competitive riding in this light.
 

Birker2020

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I'd be interested to understand why some posters only have an issue if the horse is competing and not low level hacking?

If the horse is pain free and happy to be out competing, why would it bother you?
Assuming, as the product works by lubricating the joint, it doesn't accelerate any further break down of the joint itself.
I know. I don't get this either.
And if a horse has hock injections and the vet says its okay to jump again, or it has chemical arthrodesis and can continue to jump, I don't get this either.
I had my horse done with chemical arthodesis and was back competing again.
 

Tiddlypom

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Danilon/bute are an anti inflammatories given precisely to alleviate pain and stiffness. If the horse wasn't 'stiff', aka in pain, the Danilon/bute would be of little use or benefit.

But anyhows, Arthramid is injected into specific joints, it doesn't have a systemic effect, which bute does.
 

Goldenstar

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I put arthimid into the hocks of my cob as soon as I bought him
He passed a five stage vetting but was hugely fat and very unfit
Within three day I knew it had helped
I am very relaxed about using arthrimid and use for all the horses I have atm they are mature horses with mileage
I don’t see the ethical concerns with it’s an inert gel that helps the joint run smoothly some recently told me it’s coming for humans I would have it in my knees in a heartbeat
It may well be it’s decided it’s the safest intervention for the horse described by OP
Arthimid is less damaging to the joint than steroid for example
It’s a great intervention on horses very little or no lameness
 

Abacus

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I don't follow the logic that says we can use this or any treatment but then can't bring the horse back to work, or the same level of work. Why not, if s/he is pain free?

Every day we have a horse and ride it, we have made the decision to risk shortening their life or making them unsound (wear and tear, or in some cases immediately through injury). I don't see that the situation changes after applying a treatment: if the work doesn't cause immediate pain, it is up to each individual to decide whether they want to work the horse back at the same level, or whether they feel that the chance of having a sound horse for longer is worth reducing the work.

If our only interest was in reducing wear and tear, and keeping the horse as sound as possible for as long as possible, we either wouldn't ride at all, or would just pootle about mostly in walk all the time (I realise many people don't, and that's fair enough).
 

ycbm

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You can speak to the specialists at Donnington Grove and tell them they don't know what they're talking about ?

I'd certainly like to hear for myself the exact words that they used, and see the records for horse age for arthritis treatments for all UK vets.

I do not believe that 6 can possibly be either the arithmetic mean (average) or the value that occurs most (mode) as the age of treatment for arthritis in UK horses in general.
.
 

TPO

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I don't follow the logic that says we can use this or any treatment but then can't bring the horse back to work, or the same level of work. Why not, if s/he is pain free?

Every day we have a horse and ride it, we have made the decision to risk shortening their life or making them unsound (wear and tear, or in some cases immediately through injury). I don't see that the situation changes after applying a treatment: if the work doesn't cause immediate pain, it is up to each individual to decide whether they want to work the horse back at the same level, or whether they feel that the chance of having a sound horse for longer is worth reducing the work.

If our only interest was in reducing wear and tear, and keeping the horse as sound as possible for as long as possible, we either wouldn't ride at all, or would just pootle about mostly in walk all the time (I realise many people don't, and that's fair enough).
I guess my completed unfounded opinion/beliefs are because if a horse is "broken" doing X then the foot should be taken off the pedal.

Like you, and another poster, have said you can always treat and keep doing X, step up to Y & Z, and potentially shorten the horse's "useful" life and/or decrease the in between periods where it is pain free before requiring more and more regular interventions.

To me the difference between "every day riding" of a sound horse and a horse needing medical treatment is because in the latter the horse is in pain [for definite].

That brings me back to the rabbit hole because is it ethical that "we" can keep riding/jumping/progressing/doing what "we" want [at the expense of the horse's wellbeing/longevity] for "our" enjoyment.
 

ihatework

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I guess my completed unfounded opinion/beliefs are because if a horse is "broken" doing X then the foot should be taken off the pedal.

Like you, and another poster, have said you can always treat and keep doing X, step up to Y & Z, and potentially shorten the horse's "useful" life and/or decrease the in between periods where it is pain free before requiring more and more regular interventions.

To me the difference between "every day riding" of a sound horse and a horse needing medical treatment is because in the latter the horse is in pain [for definite].

That brings me back to the rabbit hole because is it ethical that "we" can keep riding/jumping/progressing/doing what "we" want [at the expense of the horse's wellbeing/longevity] for "our" enjoyment.

Firstly, I don’t disagree but I think it’s so nuanced that it’s difficult to take a strong position on it in general.

Is a horse ‘broken’ due to the work it’s been doing or is it ‘broken’ despite the work? How does one tell? Might it be more ‘broken’ if it were not working? Sometimes broken horses are actually best maintained by working them, ease back and all the wheels fall off.

Jumping 1m is an arbitrary figure. It’s a complete exertion for some, a comfortable level for some and child’s play blindfolded for others.

Quality of life. How do we define it? We can’t ask the horse. Some will probably think retirement in a field is amazing, others will hate every last minute. Some will go out hacking with their ears pricked and a smile on their face, others even if sound as a pound and passaging around the arena in glee, will turn into nappy horrors at the mere thought.

I suppose my ultimate position is that quality trumps quantity of life. The humans in charge of the horse needs to try and stay as impartial from their own ‘wants/needs’ as possible and try and genuinely evaluate what work the horse enjoys and is happy doing. Then if they need medical support to do that I have few qualms provided it’s legal. The human has to be ever mindful to keep monitoring and if the balance changes then the expectation from the horse needs to change to.

As for arthramid - this is one of the positive interventions on the market … there are far far more controversial / unethical practices that should be scrutinised before arthramid
 

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I'd certainly like to hear for myself the exact words that they used, and see the records for horse age for arthritis treatments for all UK vets.

I do not believe that 6 can possibly be either the arithmetic mean (average) or the value that occurs most (mode) as the age of treatment for arthritis in UK horses in general.
.

I'd like to see this too - @Sossigpoker do you know if they've published that finding? I've run a quick PubMed search for "osteoarthritis" and any Donnington Grove affiliation, but nothing's coming back. I would be genuinely interested to find it, if it's out there.
 

Sossigpoker

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I'd like to see this too - @Sossigpoker do you know if they've published that finding? I've run a quick PubMed search for "osteoarthritis" and any Donnington Grove affiliation, but nothing's coming back. I would be genuinely interested to find it, if it's out there.
No idea. This was a conversation between a few of their vets and myself.
Ask any performance vet if they're doing more and more younger horses. Or go to any competition yard and ask if anyone has had any injections....although they'd never tell you!
Some yards put Arthmid into hocks as preventative when they're around 5 !
 

BMA2

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I used it on a fetlock on a 20 ish year old horse (at the time hack and hunter). Massive difference...he strode out down hills and for 6 weeks I struggled to hold him. He. Was. Wild. It was that much of a difference.

I had a repeat jab at 10 months and it didn't make a jot of difference so I didn't bother again maintained him on bute from then on
 

tb gal

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Are people mixing up what various treatments achieve? Cortisone is an anti inflammatory that reduces swelling in a
Joint and thus makes the horse comfortable to perform. Arthremid is an artificial gel that replaces missing cartlidge and with hocks at least ethanol can remove cartlidge to speed the less mobile small joints in the hock to fuse thus the horse returns to soundness. I would think masking lameness say with psinkillers would be unethical but I can’t see therapeutic treatment to allow a horse to continue a competitive life or just be comfortable as being unethical . Surely not treating using modern treatments would be far worse?
 

ownedbyaconnie

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Arthramid sadly didn't seem to take with my mare but I think it's brilliant. The worst thing humans/animals etc can do as they get older is stop. How many times do you hear about an elderly person fit as a fiddle, having a fall and then deteriorating massively. I'd rather inject a hock and carry on with schooling/hacking to keep the horse supple than stop completely? Plus by taking away the pain in the affected area, the horse can stop compensating elsewhere and causing further issues.
 

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No idea. This was a conversation between a few of their vets and myself.
Ask any performance vet if they're doing more and more younger horses. Or go to any competition yard and ask if anyone has had any injections....although they'd never tell you!
Some yards put Arthmid into hocks as preventative when they're around 5 !

I was under the impression that steroids into hocks are routinely used on younger competition horses (again this is from conversations with our vets), but I hadn't heard of arthramid being used in this way (of course that's not to say it isn't happening).

Also - surely it will skew the figures if steroids and/or arthramid are being used on young horses as, essentially, a preventative? So if the average age of six is including all those horses, then I'm not sure it can be said that "six is the average age to have arthritis" - it's just the average age to start steroids/arthramid.

Not trying to argue with you, I just think this is potentially really interesting data on a) prevalence of arthritis, and b) use of steroids and/or arthramid as a preventative.
 

ownedbyaconnie

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I was under the impression that steroids into hocks are routinely used on younger competition horses (again this is from conversations with our vets), but I hadn't heard of arthramid being used in this way (of course that's not to say it isn't happening).

Also - surely it will skew the figures if steroids and/or arthramid are being used on young horses as, essentially, a preventative? So if the average age of six is including all those horses, then I'm not sure it can be said that "six is the average age to have arthritis" - it's just the average age to start steroids/arthramid.

Not trying to argue with you, I just think this is potentially really interesting data on a) prevalence of arthritis, and b) use of steroids and/or arthramid as a preventative.
Also I wonder if the fact we as a community are more aware of issues, quicker to call vets out, vets have better diagnostic equipment etc. means we are spotting things like this younger than before.
 

Sossigpoker

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I was under the impression that steroids into hocks are routinely used on younger competition horses (again this is from conversations with our vets), but I hadn't heard of arthramid being used in this way (of course that's not to say it isn't happening).

Also - surely it will skew the figures if steroids and/or arthramid are being used on young horses as, essentially, a preventative? So if the average age of six is including all those horses, then I'm not sure it can be said that "six is the average age to have arthritis" - it's just the average age to start steroids/arthramid.

Not trying to argue with you, I just think this is potentially really interesting data on a) prevalence of arthritis, and b) use of steroids and/or arthramid as a preventative.
I'm not aware of steroids being used as a preventative as some types of steroids actually cause damage to the joint surface. I know my vets routinely do hocks with Arthmid at the start of hunting and eventing seasons- I had to wait a few weeks to get my cob done as they'd actually run out and had to order more.
 

SantaVera

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I'm more and more aware of the fact that we ride horses for our own benefit ,.no horse asks to be ridden. They just obey us.
There may become a day where I will no longer consider it morally acceptable to ride my horse/any horse. I already view a lot of competitive riding in this light.
Me too
 

ihatework

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I'm not aware of steroids being used as a preventative as some types of steroids actually cause damage to the joint surface. I know my vets routinely do hocks with Arthmid at the start of hunting and eventing seasons- I had to wait a few weeks to get my cob done as they'd actually run out and had to order more.

There did seem to be a bit of a thing for it at one point, maybe not as a preventative as such, but more a ‘let’s see if this helps’ kind of approach. Thankfully that seems to be reducing, in part due to the availability of better support options such as arthramid.
 
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