Beginners guide to joint injections

[reen2020]

Hi all

After a loss of performance workup and (improvement on) bute trial vet is coming out next week to X ray with a view to likely some joint injections, we are suspecting one hock at minimum and potentially coffin joints but tbd how X rays go.

Having been lucky enough to not have needed these before personally, I am only peripherally aware of offerings (steroids, arthramid?) and what to expect. I'd like to go in with some level of information as part of my thinking is also around how much I am comfortable with doing to maintain a ridden career.

Would appreciate any info on a) what's out there and what people have found effective/ at what intervals of administration? and b) more philosophically, thoughts on where people draw the line, e.g. with medicating multiple joints multiple times a year (appreciate this is a personal thing and every case is different).

Thank you!

 

[lme]

Arthramid is regenerative. I'd use it over steroids. We've used it on hocks (every 18 months) and coffin joints with success.

 

[Slightlyconfused]

Arthramid is regenerative. I'd use it over steroids. We've used it on hocks (every 18 months) and coffin joints with success.

This. Just had a stifle done with arthramid on mine.

 

[GypsGal1718]

Audrey de clue ( a leading sports medicine vet) talks about how injections are a quick fix and usually there is a bigger problem going on, not necessarily in the limbs. By all means do what makes your horse most comfortable but please do look further to see if you can find the issue. Sorry this isn’t the answer you wanted to hear but best of luck.

 

[lannerch]

The steroids used today usually triamcinoline enhance cartilage unlike the old fashioned steroids that gave steroid joint injections a bad name . I would give whatever your vet advised not what here or Facebook or any where else suggests as the vet knows your horses case best.

 

[YourValentine]

Calling Arthramid regenerative isn't strictly true. It certainly slows progression of arthritis and acts as a joint lubricant but doesn't repair arthritic damage/changes.

Steroids are just anti-inflammatory which has a painkilling effect making the joints more comfortable but doesn't slow the progression of arthritis.

No idea if done here, but for hocks you can chemically fuse the lower joints (ones that don't move much) and support with painkillers while this happens. Arthritis of these joints would naturally lead to their fusion, so it's speeding up what's happening but it's painful and there are side effects of giving painkillers long term.


Ethically where do I sit? I'd never chemically fuse joints, if the arthritis is that advanced that its the onky option I'd suspect issues elsewhere and accept its retirement time.

Arthramid & steroids I would definitely try, but expect to have to reduce the horses work load to accommodate hocks that are no longer 100% and be very vigilant for signs of pain/loss of performance. If they were needed more frequently than every 8-12months I would seriously consider retirement or them just becoming a hack.
They're my thoughts anyway.

Also, they don't always work. Or medicating known joint issues can highlight other problems.

 

[santas_spotty_pony]

Arthramid is safer than steroids as steroids always hold a risk for Laminitis. Arthramid cushions the joint - my Vet described it as being a bit like the filler people use in botox! It is mire expensive than steroids.

All join injections hold the slight risk of infection which is why box rest is prescribed for at 24 hours after injection, but this is quite rare I am told.

 

[poiuytrewq]

How much more expensive is Arthamid than steroids?

 

[HopOnTrot]

my Vet described it as being a bit like the filler people use in botox!

Botox and fillers are different, it is injecting a filler it is not injecting Botox, which is a paralysing neurotoxin.

 

[Zoeypxo]

How much more expensive is Arthamid than steroids?

Double the price

 

[thatsnotmyname]

I’ve just had 2 syringes of arthramid - £1k

 

[Smogul]

I would give whatever your vet advised not what here or Facebook or any where else suggests as the vet knows your horses case best.

Definitely. Also, remember that if you do decide to retire the horse, it will still need pain relief and exercise of some kind. Arthritis does not go away.

 

[sbloom]

Audrey de clue ( a leading sports medicine vet) talks about how injections are a quick fix and usually there is a bigger problem going on, not necessarily in the limbs. By all means do what makes your horse most comfortable but please do look further to see if you can find the issue. Sorry this isn’t the answer you wanted to hear but best of luck.

From this saddle fitter's perspective I'm in complete agreement.

I think that current best understanding (which after all is pretty much all we can wish for!) is that joint degeneration, even most injuries, are the result of repetitive strain, and that means incorrect movement. These compensatory movement patterns affect the whole body, hence medicating joints isn't a fix as there are so often issues that show up elsewhere, and then we get into the primary/secondary debate which in so many cases is meaningless as the underlying cause is still being ignored. Using it for pain relief for a window in which to start changing the way the horse moves makes sense to me, injecting as a matter of course every few months etc seems last resort and not something that would sit easy with me if I owned myself these days.

Most post treatment rehab programmes concentrated on strength and fitness and do not look at HOW the horse moves, instead polework and treadmills so often simply increase loading on already compromised bodies. Postural change has to come first, we just don't realise how unnatural and harmful it is to the horse to carry a rider, and don't do enough to equip them to do so with minimal compromise, nor to keep on top of this with regular ongoing groundwork etc.

 

[CallMeKate]

Very pertinent discussion for me. My 18 year old Irish had hock injections 10 months ago (steroids only as vet doesn't do hyaluronic acid injections....research doesn't support their efficacy apparently)....anyway he has just had minimal pottering about for much of the last year. He LOVES to be ridden, he is just a grump when he is never worked. But last time I rode i noticed he was dragging his hind, leaving scuffs in the sand on both hinds even in a straight line. I have booked the vet for more hock injections....but the more I think about it the more I realise that I can't wave a magic wand and make the arthritis go away. He hasn't had his knees xrayed but the Vet said he had fluid on both knees last visit. Just so sad. I have spent a few hours reading all I can re. arthritis, joint injections, supplements etc. He is on two joint supplements and daily previcox...and still sore. Oh dear. The reality of our situation is dawning on me.

 

[PinkvSantaboots]

Very pertinent discussion for me. My 18 year old Irish had hock injections 10 months ago (steroids only as vet doesn't do hyaluronic acid injections....research doesn't support their efficacy apparently)....anyway he has just had minimal pottering about for much of the last year. He LOVES to be ridden, he is just a grump when he is never worked. But last time I rode i noticed he was dragging his hind, leaving scuffs in the sand on both hinds even in a straight line. I have booked the vet for more hock injections....but the more I think about it the more I realise that I can't wave a magic wand and make the arthritis go away. He hasn't had his knees xrayed but the Vet said he had fluid on both knees last visit. Just so sad. I have spent a few hours reading all I can re. arthritis, joint injections, supplements etc. He is on two joint supplements and daily previcox...and still sore. Oh dear. The reality of our situation is dawning on me.

Try Arthramid gel it's much better than steroid it's more expensive but worth it if it lasts.

Both my horses had it in there hocks both still being ridden at 19 and 20.

 

[CallMeKate]

My Vet (I'm in NZ) doesn't do arthramid! Not sure exactly why, but we had the discussion last year. When making the appointment today the vet nurse said 'we do steriods and pentosan'...pentosan needs monthly injections so not an option. I might push the point and try and find an alternative route to arthramid...but it will mean a two and a half hour drive to the Massey Uni vet hospital...and that will need a referral...from my vet! There are very limited options in NZ as such a shortage of equine vets....I have to wait until October 8th until he can come and visit anyway, so plenty of time to make enquiries.

 

[minesadouble]

I bought a Schoolmistress pony for my daughter who had had her hocks medicated with steroid. When it was wearing off we had them medicated again with steroid.
At the start of this year we decided to go down the Arthramid route and it has worked brilliantly. It took a while to kick in and at first I was a bit concerned it hadn't worked. Now however she is like a new pony.
It has worked brilliantly for her and I wouldn't hesitate to use it again. I personally think that for her the results are better than the Steroid as well as longer lasting and kinder to the joint.
She was medicated in January and is currently showing no signs of discomfort at all after a very busy Summer.