Arthramid? Prostride? Steroids?

[tipzythegreat]

My horse got traditional steroid injections (Vetalog and Depo Medrol) of November 2023. After 5 months he slowed down and I did Adequan. He felt great post steroids and post adequan. But now he’s slowing down again.

So it’s time to inject. Historically I did IRAP for many years, but I saw much better results with the steroids and Adequan. He was a lot more powerful and willing to push with his backend.

WWYD? Arthramid is a lot more expensive, but it sounds like it may last longer. However, the steroid and adequan combo worked pretty darn good for us. My vet also has ProStride, but I’m afraid that may be a bit more like IRAP and not really be worth it. Also trying to not spend $2k on injections, so open to a combination.

FWIW: My horse is 17 and in regular medium work 3-4x a week. We work on the bridle and do some lateral movements and pole work. We don’t really jump around, but we try small things here and there.

[TWH_Girl]

What joints are the injections for? I’m assuming hocks if you’re using Depo. What joint it is makes a difference in terms of recommendations IMO.

In general, I find steroids effective but short acting. You could try a different steroid such as Vetalog or betamethasone. I’ve not been wowed by ProStride (stifles and coffin joints). I’ve used Arthrmid and Noltrex in stifles but they are thicker substances and sometimes not appropriate for use in fusing lower hocks because of decreased joint space.

I would recommend Equioxx at this point for longer term management.

All injections are a crap shoot I think.

[Demerara_Stables]

The joint matters. I’ve had incredible (1 year+) results with prostride in my mare’s stifles, but didn’t do hocks with it per my vet’s suggestion. She said in her experience it doesn’t work as well in high motion joints.

[tipzythegreat]

Sorry guys – HOCKS AND STIFLES! How could I forget to include that? DOH!

Vetalog is what he got in November and I was wow’ed by it. I’ve never been wow’ed by IRAP.

[Demerara_Stables]

I do think that each horse is an individual but anecdotally I have had amazing results with pro stride in both of Dora’s stifles, it lasts right about a year for her in the more problematic stifle and longer in the other.

[TWH_Girl]

@tipzythegreat thanks! Given what you described, I would go with Arthramid in the stifles as my first option and ProSrride as a second. I feel like if IRAP didn’t work well, I’m not sure ProStride would as its anti inflammatory effect is less than IRAP.

For hocks, I’d probably stick with steroid and HA or just steroid alone.

Please keep us posted on what you decide and how it goes.

[TWH_Girl]

There’s also Alpha Eq as a biologic option if your vet offers that. I’ve never used it so can’t comment.

[atr]

For hocks, I’d use vetalog.

[outerbanks77]

@TWH_Girl

@tipzythegreat thanks! Given what you described, I would go with Arthramid in the stifles as my first option and ProSrride as a second. I feel like if IRAP didn’t work well, I’m not sure ProStride would as its anti inflammatory effect is less than IRAP.

For hocks, I’d probably stick with steroid and HA or just steroid alone.

Please keep us posted on what you decide and how it goes.

I just had this conversation with my vet, and this is consistent with what he recommended. We were talking hocks, and he said he could do ProStride if I wanted, but he feels good about maintaining hocks on a water soluble steroid (I forget the name). He did say Arthramid or Noltrex could make sense for a high-motion joint, but for hocks, not so much.

[IPEsq]

Probably for hocks, I would stick with steroids. I would choose triamcinolone over Depo Medrol for repeated use. Depo Medrol is not kind to joint cartilage.

For stifles, I prefer Pro Stride or IRAP.

[SolarFlare]

@outerbanks77

He did say Arthramid or Noltrex could make sense for a high-motion joint, but for hocks, not so much.

I switched over to Noltrex for lower hocks (previously using HA with a bit of steroid) and have had great success. With HA, hocks needed to be done every year. With Noltrex we get nearly 2 years.

Noltrex was originally recommended for high-motion joints but then they extended the recommendation to low-motion joints as well after more research.

It’s not too much more to use Noltrex for lower hocks, as one dose is split (1/2 dose per side).

[tipzythegreat]

Thanks for the feedback everyone.

I asked if it’s OK to do Arthramid and steroid injections at the same appointment. I am also leaning towards Arthramid stifles and steroid hocks – for cost reasons and because his stifles have seen a lot more steroid than the hocks.

I will ask about triamcinolone, thank you @IPEsq

My vet did not offer Alpha EQ @TWH_Girl – but she may have it. She said she had several different types but liked Arthramid best.

I’m glad I asked all of you. I was feeling guilty not doing Arthramid in the hocks – but he does get all 4 joints injected.
For anyone curious, here is a price breakdown for doing hocks and stifles by my vet (MI Based). These prices do NOT include barn call or sedation.

Traditional steroid with HA:

• Hocks: $640
• Stifles: $450
  = $1090, single barn call

IRAP: collection and processing $605, a second visit would then be required for injection

• Hocks: $220
• Stifles: $110
  = $935, plus 2 barn calls.

Prostride: collection and processing $600 done at the same appointment

• Hocks: $220
• Stifles: $110
  = $930, single barn call

Arthramid:

• Hocks: $1285 (if we split 3 syringes)
• Stifles: $820 (1 syringe each stifle)

Also re: Prostride vs IRAP she said this, "“Prostride and IRAP are similar and different. Both are processed from the horse’s blood and have anti inflammatory proteins. Prostride is processed that day in the barn, where IRAP must incubate for 24 hours before getting processed.
Prostride is a combination of IRAP along with antiinflammatory cytokines/proteins. Prostride tends to be more potent/more concentrated compared to IRAP with its effects. Prostride also has some moderate regenerative effects.
IRAP provides more volume of product, but Prostride can be stretched to probably do 6 joints in a session.”

When I asked if it was worth it, since I didn’t get amazing results from IRAP she said,

"I think you would hopefully see better results with the Prostride compared to IRAP, since the prostride is more concentrated and has a higher level of antiinflammatory proteins. "

[NaturallyHappy]

Is there any concern for using steroids in a joint on a 17 year old horse??? I’ve not done joint injections …

[Demerara_Stables]

My vet’s only concern with older horses is checking to make sure they’re not metabolic.

[Demerara_Stables]

@tipzythegreat

Prostride can be stretched to probably do 6 joints in a session.

IME this is variable - I could only get two stifles with nothing left over from prostride

[fivestrideline]

@tipzythegreat

Prostride is a combination of IRAP along with antiinflammatory cytokines/proteins. Prostride tends to be more potent/more concentrated compared to IRAP with its effects. Prostride also has some moderate regenerative effects.

You know, I got the opposite feedback from my vet. They said that IRAP has more of the “good stuff” than ProStride, and better results. It is more expensive, and usually done 3 times (per one blood draw) vs 1 with the ProStride, so perhaps that is the deal. I don’t know why you’d only do IRAP once.

However, I was inquiring about a younger horse with soft tissue issues in the stifle vs arthritis/bony issues. Maybe that’s the reason for the opposing views.

[TWH_Girl]

@fivestrideline

ou know, I got the opposite feedback from my vet. They said that IRAP has more of the “good stuff” than ProStride, and better results. It is more expensive, and usually done 3 times (per one blood draw) vs 1 with the ProStride, so perhaps that is the deal. I don’t know why you’d only do IRAP once.

This is also the feedback I received. My only hesitation with IRAP is the frequency of injections but I like the idea of having left over product for injections in the future. You can do that with the Alpha 2 Eq as well.

[DMK]

I did pro stride after playing around with periodic stifle or hock injections (hylartin+steroid) and regular adequan. Pro stride definitely was the better outcome over a longer time. I don’t think it has a bigger oomph factor like steroids, but more sustained over a longer period. Also, I had enough for both hocks and one stifle off one draw (typically he only slips in the left stifle and I was only planning on hocks but added the 1 problem stifle because why not). I did him in November and then finished up fitting him to move up to advanced level in combined driving, which is by any measure a hard job. We did our first CDE in January and finished our 4th in April with a few clinics interspersed and he still felt really good when I started back with ridden dressage lessons in May (3rd level). That’s a lot of hard work, and while I don’t think he felt better at any one event than he did with steroid injections, but he felt a lot better at the end of the season than he normally has.

[tipzythegreat]

@fivestrideline

They said that IRAP has more of the “good stuff” than ProStride, and better results

INTERESTING! I suppose it comes down to varying experiences and opinions, I would think. Either way I’m a bit hesitant since IRAP wasn’t a huge value for me, but I did do IRAP for a long time because I knew it was “better” for joint health. I’ve heard from another vet that IRAP is old technology. So I think it really depends on the vet’s opinion.

The ONLY thing with left over IRAP @TWH_Girl is that it has a frozen shelf life. When I started IRAP that wasn’t the case, but now my vet won’t inject it if it’s over a year old. Which doesn’t do you much good if you’re doing yearly injections and/or small sites.

Thanks @DMK. My horse burned through the steroids quickly, but it was a huge improvement. I’m not necessarily needing a huge improvement – I just want him as comfortable for as long as possible and to promote his ultimate longevity. On a budget, lol. But I know long term steroids aren’t ideal.

RE: metabolic issues and age @Demerara_Stables and @NaturallyHappy for my horse I can’t imagine there’s any concerns. He’s been with the same vet and in my care for 8+ years now. He’s very fit and healthy and honestly in great shape for his age. My vet has said before that she, “Knows my horse as well as she knows her own”. (Seriously accident prone) But that, of course, could change as he enters his later teens

For a horse that hasn’t received regular lameness evaluations or hasn’t been in work or has underlying metabolic conditions, I would think they could still inject but with caution. I would think it’s mostly teenage horses getting injections, as their age and workload starts to bother them.

[NaturallyHappy]

Yes, this is my concern…hence the question. I do know it can be a risk for some. I’m glad both you and your vet are on top of it!