Hock arthritis treatment pathways

[musk]

Hello, hoping for some advice from those with experience of hock arthritis. My daughter's pony has been diagnosed with arthritis in both hocks after presenting as 2/10 lame and going in for xrays which confirmed arthritis.

We had his hocks injected with steroids but unfortunately this has not made a difference at all and in fact he is now looking lame and uncomfortable in the field whereas before it was only obvious ridden at trot. The arthritis is moderate and pony is 18 years old.

I have a wonderful farrier coming out next week and I will get him to shoe to xrays as I had hoof xrays done at the same time and these revealed NPAs in both hinds - can j expect this to make any significant difference?

I have ordered someBOT hock wraps for him just to hopefully make him more comfortable in the field.

Anything else I can do? Would arthramid be worth trying for him?( paying out of my own pocket not insurance).

He is the most wonderful pony and had never so much shown us any hint of pain before this, his behaviour is always impeccable. In an ideal world I'd love him to be able to come back into work from a selfish pov but in reality making him comfortable in the field is my priority as he deserves at least that after the wonderful year he has given my daughter

 

[Michen]

My horse didn't initially respond to steroids. He did respond once we added tildren- it made a big difference.

In 3 years he's had

June/July 2020- Steroids and Tildren a few weeks apart
February 2021-Steroids
June 2021- Tildren
January 2022- Steroids

(I think- could be wrong, I'd need to pull vet records!)

Not needed anything since that January. Everyone raves about arthrimid but I've had two vets inc a surgeon tell me it's not great for the lower hock joint, only the upper. However I'd defo try it if the alternatives weren't working!

Oh and yes re the NPA! I had a different horse with those. Tried all the fancy shoeing, took the shoes off and they fixed. On my arthritic horse, I keep a very close eye with yearly x rays. They have occasionally been a little "flat" but never negative. His most recent ones were the best ever.

 

[ycbm]

Has he also been scanned for PSD? IME negative hind foot angles are very often associated with PSD and that would account for the failure to respond to injections in the hocks.
.

 

[Widgeon]

Don't panic - there are lots of options available, I'm sure you'll find something that helps your pony. My cob has hock arthritis - one side has fused but the other doesn't seem keen to do so. Thankfully he does respond well to steroids (he needs them every 9 months or so) but he's also had tildren and cartrophen. Because I threw everything at it at once, it's hard to say what helped most, but they are both worth a try. I also took his back shoes off and that has helped too. He has good feet and no additional issues in his hind legs, so the farrier reckoned that reducing concussion and leaving him to move in the way he is most comfortable would help, and she was right.

I did quite a bit of looking into arthramid (although for mine it wasn't the best option) and it's definitely something to think about. I would book a visit from your vet and warn them that you need to talk through the options, then they can come prepared with costs and their best plan for a treatment pathway for your particular pony. Otherwise there is so much out there it can feel a bit like waving a credit card in the dark.

If he is uncomfortable in the field (and the vet thinks it's appropriate) can you put him on a bute a day until you've decided how to tackle the problem? I'm sure the vet would have an opinion on that.

P.S. Good luck, and try not to catastrophise - there are a lot of horses out there with well managed arthritis who are comfortable.

 

[Zoeypxo]

Has the vet blocked to the hocks ?
If not id probably want to scan suspensorys and look at sorting the NPA.

arthramid has worked for me in the lower hock joints BUT my horse blocked to the hocks and responded to steroid prior to this too

 

[Birker2020]

Mine didn't respomd to steroids or a course of three Tildren but did have chemical arthrodesis around 2010 I believe. It made all the difference and we were able to continue competing, hacking, jumping, fun rides for another six or seven years until a suspensory branch injury brought things slowly to an end for jumping at least.

Chemical arthrodesis isn't as popular as it once was and I think Arthramid is a better shout nowadays.

 

[musk]

Thank you very much for all the replies.
I am planning on having the farrier fit wedges with caudal support. I am actually usually very pro barefoot but having tried that to sort issues with my eldest daughter's horse then having wedges fitted with caudal support which after the barefoot option didn't work it completely transformed the other horse so feel like I am most comfortable with that option. (photo of transformation of other daughter's horse- he looks like he has pit weight on but he actually hasn't, it has just totally transformed him)
I will then see how that helps pony and go from there. I was probably being a bit dramatic about him being uncomfortable in field as it was when he was trotting over frozen hard rutted ground. At this moment I dont think it is his suspensories but obviously if he doesn't improve after other treatments I will look into that route.
I dont think I am brave enough to go the Tildren route so think I will try Arthamid first bit maybe discuss the chemical fusion of the joint too!
Lots of ideas and thank you so much for the support

 

[musk]

Sorry forgot to attach photo of eldest's horse and now it says it is too large, grr

 

[olop]

My 23 year old has just been diagnosed with hock arthritis. Mine isn’t lame only on flexion but me and the farrier have both struggled to pick his back feet up which is why I got the vet, my canter is not as good anymore either.

she has started with the “cheapest” option first and he’s currently on Bozwelix (sorry spelling might not be good there!) he’s been on it coming up three weeks now and to be honest I haven’t noticed much difference but looking at reviews it looks like it can take a while to kick in. If it doesn’t work after a while I’ll get her back out to evaluate.

she’s told me to keep him in a fair amount of work (the feet picking is easy once he’s been worked) but I guess if yours is lame it’s not something you can do.

I hope you find something to keep him comfortable, it’s a bit of a minefield as so many products out there claim they can do this and that but it’s finding the time (and money!) to find out what works best!

 

[Widgeon]

I dont think I am brave enough to go the Tildren route so think I will try Arthamid first bit maybe discuss the chemical fusion of the joint too!

Tildren is not very dramatic? It's an IV drip - I think the main side effect is colic so as long as you make the drip really slow and give Buscopan, then walk them afterwards, it's quite straightforward. Mine has had it twice; he got colicy after the first time so second time round we gave buscopan and slowed the drip, and that sorted it. I definitely wouldn't hesitate to do it again.

 

[Widgeon]

she has started with the “cheapest” option first and he’s currently on Bozwelix (sorry spelling might not be good there!) he’s been on it coming up three weeks now and to be honest I haven’t noticed much difference but looking at reviews it looks like it can take a while to kick in. If it doesn’t work after a while I’ll get her back out to evaluate

I'd be really interested to see whether you notice a difference on it - do keep us posted!

 

[Tiddlypom]

My 17yo wonky mare was first diagnosed with hock arthritis in 2017. Initially she had steroid jabs, which were short lasting. In Aug '20 she got arthramid in both hocks and it lasted well over 2 years.

Recently she became uncomfortable again, and 20 days ago she had arthramid AND steroid in both hocks, which is what my vets do routinely now. Last time she couldn't have steroid as well as arthramid in her hocks as she had it in her SI the same day.

The improvement in her in just 20 days on is nothing short of dramatic. Her whole stance and demenour are better. She has been reassessed by the chiro vet who was the first to think that her hocks needed doing again, and she is so pleased with her. Walks, trots and canters freely and easily on the lunge inc transitions. Before the jabs, she was tense and bucking.

Her left hock, which was the most sore, is nearly fused and it was quite tricky to find space to get the needle in, and vet had to check positioning by x ray, but it clearly went in the right place.

My mare is not insured either, plus has a very wonky pelvis after a field accident, but she has been cleared by both vets to be ridden again.

Good luck.

 

[PinkvSantaboots]

My 18 year old Arab had mild hock arthritis he had steroids and arthramid and it took a good 3 weeks for him to be sound, he also had some suspensory damage unfortunately it does often hand in hand with arthritis so I would definitely get them checked before throw everything at the hocks, a quick scan and at least you know what your dealing with and it can all be treated my horse had laser on his.

 

[AandK]

NPA can absolutely make a difference, my older horse had this in his youth and just looked a bit wrong all over as well as being lame behind before we sorted the angles out. Did your horse block to the hocks? Definitely worth addressing the NPA before panicking about the hocks too much.

 

[musk]

Tildren is not very dramatic? It's an IV drip - I think the main side effect is colic so as long as you make the drip really slow and give Buscopan, then walk them afterwards, it's quite straightforward. Mine has had it twice; he got colicy after the first time so second time round we gave buscopan and slowed the drip, and that sorted it. I definitely wouldn't hesitate to do it again.

I think I got scared off by the risk of colic and bone thinning, sorry didn't mean to make it sound like it was dramatic. I'm really glad it was a positive experience for you

 

[musk]

My 23 year old has just been diagnosed with hock arthritis. Mine isn’t lame only on flexion but me and the farrier have both struggled to pick his back feet up which is why I got the vet, my canter is not as good anymore either.

she has started with the “cheapest” option first and he’s currently on Bozwelix (sorry spelling might not be good there!) he’s been on it coming up three weeks now and to be honest I haven’t noticed much difference but looking at reviews it looks like it can take a while to kick in. If it doesn’t work after a while I’ll get her back out to evaluate.

she’s told me to keep him in a fair amount of work (the feet picking is easy once he’s been worked) but I guess if yours is lame it’s not something you can do.

I hope you find something to keep him comfortable, it’s a bit of a minefield as so many products out there claim they can do this and that but it’s finding the time (and money!) to find out what works best!

Interestingly enough, I feed all of mine boswellia serrata (sorry I may have spelled that wrongly) and I ran out for a short while and was busy and distracted so didn't get round to ordering it in again straight away and this is when he presented as lame. He has been back on the boswellia for around 2.5 weeks now I think.

 

[Sossigpoker]

My 8 yo cob was sound in 48 hours after Arthramid! His right hock is pretty advanced and nearly fused so the response has been even better than I hoped for . He's also has Osphos.
As your horse is older, Osphos and Tildren are possibly not going to be that useful as they stop the further degeneration of the joint surface- at that age I imagine the joint surface is already fairly damaged.

I'd discuss Arthmid with your vet and also Cartrophen /Arthropen: this is an intramuscular injection so it treats the whole body , it's basically a super strength joint lubricant, IME great for older horses.
I'd also look into medicating the SI as that I'd usually sore too with hock pain.

 

[ownedbyaconnie]

Steroids and arthramid didn’t work for my mare so we had them fused with ethanol. Worked a treat (with a long extensive rehab plan after).

I’d recommend getting another work up once you fix the hock lameness though as there is often something secondary going on due to compensatory movements.

 

[spacefaer]

My vets say that if steroids don't show a decent improvement then arthramid won't work. We've had a lot of success using both and haven't had to attempt any other treatments, thankfully

 

[Sossigpoker]

My vets say that if steroids don't show a decent improvement then arthramid won't work. We've had a lot of success using both and haven't had to attempt any other treatments, thankfully

That's a silly statement to make since steroids and Arthmid work in totally different ways. Steroids reduce inflammation and encourage the body to create cartilage whilst Arthmid physically fills the painful joint space. So saying that is totally misleading.

Mine had little help from the initial steroid but was sound in 48 hours after Arthmid.

 

[musk]

That's a silly statement to make since steroids and Arthmid work in totally different ways. Steroids reduce inflammation and encourage the body to create cartilage whilst Arthmid physically fills the painful joint space. So saying that is totally misleading.

Mine had little help from the initial steroid but was sound in 48 hours after Arthmid.

You see that is what my vet said too and it annoyed me a bit as I cannot for the life of me see why that would be the case. I cant even really get my head around why steroids are the first port of call for moderate arthritis as I can't see where there is inflammation, I thought the discomfort was coming from the fact bone is rubbing against bone, joint spaces have degenerated but I think I must be misunderstanding something somewhere. For me Arthramid seems like a more sensible solution. (I actually have a degree in anatomy and physiology which is embarrassing as I feel like I have zero knowledge on the topic but to be fair I have never used the specifics in my professional life so maybe I can excuse myself)

 

[musk]

Sorry just to further my thoughts, I thought rheumatoid arthritis is inflammatory but osteoarthritis is degenerative? Can someone help me get my head around this?

 

[SEL]

Sorry just to further my thoughts, I thought rheumatoid arthritis is inflammatory but osteoarthritis is degenerative? Can someone help me get my head around this?

Rheumatoid arthritis is an auto immune condition. I don't think it's that common in horses.

Osteoarthritis is degenerative but steroids early on can often calm down inflammation and stop it progressing. Depends on the cause because if it's their build or way of moving then bringing down the inflammation isn't going to help long term. I have arthritis in my right shoulder from an old injury. Steroids may give me enough relief to use the joint correctly and build up the right muscle but if the lubricant between the bones is deteriorating then arthramid should 'fill the gap' and bring relief.

Steroids in her hocks didn't work for my mare (at all) but arthramid 6 months later with a small dose of steroid to act as a painkiller made a huge difference. I kick myself for not changing vets a year earlier because my old practice were very resistant to the idea.

 

[Sossigpoker]

Steroids also can kick start the body into producing more of the joint lubricate , that's why if it helps , it can help for several months.
Vets try the Steroids first (unless there are contraindications) because they're cheaper than Arthmid but also because after using certain types of Steroids, Arthmid is no longer appropriate to use.

 

[musk]

Thanks both, that is helpful

 

[mavandkaz]

My boy had tildren (for bone pain in many places, not specifically hocks). The actual procedure is fine. He had his split between two sessions and given buscopan incase of colic, but he was perfectly fine and not bothered at all. It did seem to really help his issues but he was also turned away for 9 months. However, my vet refuses to use it again, and would only do a second lot as a last resort. It is nasty stuff, and repeat uses cause kidney issues - my vet ran bloods first to make sure his kidney function was good.
It is not something I would use 'just' for mild hock arthritis.

My lad has since been diagnosed with hock arthritis and we used steroid injections. They didn't seem to help at first, so he was then given a course of metacarbomol which is a muscle relaxant. Basically where he had been compensating for his hocks, he had caused issues elsewhere, and this allowed him to 'reset'.
Agree with others who have PSD and this often goes hand in hand with NPA, and will present similarly to hock pain.

 

[Squeak]

Out of interest those of you who have had good results with treatments, did your horse return to the same level of work as before?

 

[Nicnac]

Mine has Tildren - 3 times now always with Buscopan. Have had hocks injected but Tildren works much better for him along with intramuscular HA injections. His bloods are checked regularly. 6 months between first 2 treatments and 9 months before the 3rd. We are now 6 months on from 3rd treatment and he is in brilliant form. Sound as a pound (), done his first XC session of the year and regularly jumping and BD. He will be 16 this year.

 

[Sossigpoker]

Out of interest those of you who have had good results with treatments, did your horse return to the same level of work as before?

Yes! Mine was doing hacking and light schooling but now he's doing more intensive schooling and has started some small jumps. 3 months after Arthramid and Osphos he's looking and feeling better than ever before.
My vet feels that the right hock is a form of juvenile arthritis but now that he's sound to just crack on and don't treat him any differently from any other horse. I.e he's only 9 , he doesn't need to take it easy , he's capable of doing what I'd like him to do (I wouldn't jump much over 2 ft and he should be up for that)

 

[Zoeypxo]

Out of interest those of you who have had good results with treatments, did your horse return to the same level of work as before?

yes my vet says i can do anything just be mindful of some arena surfaces and xc when the ground is too hard.
Had an unlucky tendon injury so out of work again now but unrelated to the hocks