IRAP--Experiences? Worth the cost? Other things to try first?

[Natalie]

I’ll try to keep the background short so this doesn’t turn into a monster post. I have a 20 year old Appaloosa gelding who is my heart horse–I first “met” him 16 years ago (he wasn’t mine). Eventually I had to take a break from horses and he ended up with a different owner. I tracked him down close to a year ago when he was offered for retirement from a h/j barn, as he wasn’t sound enough to continue in their lesson program. I jumped and took him because given his age and the price he was being offered at I knew there was a good chance he could end up in a less-than-ideal situation. I took the plunge knowing that his soundness could improve…or not. Either way, he has a soft landing with me for the rest of his life.

This horse has less than ideal front-end conformation which requires decent farrier work–which he obviously hadn’t had for close to a decade when I picked him up. His heels were very, very contracted, toes were long, he had chronic deep thrush and horribly unbalanced feet. Radiographs taken last fall showed some high and low ringbone, some rotation in the coffin bone, and thin soles. Plan at that point was to correct what we could and see what happens with his comfort level, basically.

When he came off the trailer he was 3/5 on the lameness scale, just for context.

Fast forward to today–he’s a 1/5 under saddle only as long as he’s in front shoes with pads (he’s perfectly happy in either pour-ins or leather) and on a daily dose of Equioxx. He trots sound in-hand on blacktop and on the lunge line in decent footing even without the Equioxx . We just did a lameness exam with nerve blocks to further isolate the cause of his residual lameness and it’s mainly in the coffin joints, with one being worse than the other. Xrays done last week didn’t show any progress on the ringbone (yay!), improved sole depth (it’s now normal) and no major concerns with the navicular bone, the vet feels confident we’re dealing with ringbone and some coffin joint synovitis, so she initially recommended injecting both front coffins.

BUT–the images also showed no change in the coffin rotation. It’s not severe; 3-5 degrees from the white line with no sinking. However, vet said she would have expected it to have improved after close to a year of correct trimming, so we both decided against the joint injections until we tested for Cushings and IR. Obviously the great fear was that the steroids could throw him into a laminitic episode, and we both agreed that it wasn’t worth the risk without knowing more, given that he’s not in chronic pain as managed now without the injections.

So…today, test results for both Cushings and IR came back negative. However, given the evidence of laminitis in his past, the vet is still a little wary of doing a traditional joint injection, as am I. She suggested IRAP, saying he was a good candidate and that she’s had really good success with it, including with clients into their 20’s. But, she did make it clear that there’s a chance it wouldn’t work, and even if it did it would likely need to be redone annually. At $1,500(ish) a pop, I told her this was basically out of my horse care budget given all the variables at play (she was completely understanding and said it was out of the financial realm for her personally too, which made me feel less guilty).

However, I’m starting to reconsider it now…I’m going into one of my “it’s only money” modes.:lol: Mind you, I’m obviously not expecting this guy to return to the level of work he could do 10 years ago (jump around a 2’9" local AA course), but it would be nice to be able to bop around a 2" hunter course a handful of times a year, go to some lower-level dressage shows, and play around at hunter paces (flat courses) without seeing that slightly “hitch” at the trot. Vet agreed that all of that was entirely doable if he had a great response from joint injections or IRAP, as he’s in overall great shape, clearly likes having a job, and comes up sounder the more he goes (there’s no soft tissue issues). He’s basically cleared for all that minus the jumping…right now she said an occasional crossrail or the like is fine but more would obviously be unfair to him. The point is, jumping or not, if I can have him go basically 100% sound for a few more years I would love to.

Outside of the Equioxx, he’s on MSM. I did a round of Adequan earlier in the year but didn’t see a noticeable difference. Vet suggested pulling the Equioxx ahead of a lesson or whatnot and switching to bute (he tolerates NSAIDS well) to see if that puts him sound, since it’s stronger. I asked about Pentosan and she said she’d be happy to write me a prescription but can’t offer support if there’s any issues since it isn’t FDA approved, which made me slightly wary, even though I know anecdotally tons of people use it. But obviously, IRAP is a much bigger gun.

So, those of you who’ve done it–how long did it last and how much of an improvement did you see? Should I give the Pentosan or anything else a go first? His feet are also still not 100% there in terms of balance…radiographs showed that he’s still a bit high on the outside wall, so my farrier will be working with those to improve his feet further. I’m hoping that that alone will also help a bit. Basically, I’m willing to try most reasonable things but also trying to not burn money (hence why I’m not doing Cosequin or other spendy joint supps). Once again, any advice is much appreciated!!

[2tempe]

OP - Did IRAP on my then 11 yr old mare’s stifle some years ago. It did work very well, though I think not quite as long as steroid injections might have- though that’s clearly not a measurable thing. . And yes it was pricey! That said, only you can decide if its worth it…think about spending the $ and not getting the desired results? Think about only getting half the results you want?

Re the Pentosan, no input other than my opinion that the general injections don’t seem to fix things. Maybe they keep the horse more comfortable in work and maybe slow down a process but doubt it would be your solution.

Here’s the other thing: with NSAIDS, general injections, etc, it doesn’t take long to get to $100/month. That’s $1200/year, almost the cost of the IRAP. :yes: Spend some time reading about IRAP and coffin joints, (google is your friend) - that may give you a better sense as to range of results people have seen.

[Simkie]

I’ve also had very positive results with IRAP in the stifle. Did not have to repeat, but the issue was a soft tissue one that the IRAP healed, vs a bony problem that will never resolve. But, given that many, many, many “coffin joint” problems are actually soft tissue issues in the hoof capsule, maybe you could get similar results. (Have you considered MRI of the feet? That might be the best path forward, if you can spend the $$$.)

Ask your vet about ProStride? It is similar to IRAP but only one injection (instead of a series) and less expensive.

[IPEsq]

I’ve seen IRAP be successful in coffin joints. It was a different scenario in terms of what was going on, age and conformation of horse. And I’m not sure I’d set a goal of jumping this horse. But you could get somewhere towards your goal with it. As for need to repeat and how often, I think that’s highly variable.

[tpup]

I had success with IRAP on my old Appy that had BAD hock arthritis. It worked GREAT. Sadly he passed from unrelated colic but I would have definitely continued with it.

[Natalie]

Thanks everyone for the feedback so far. My vet did not mention Prostride…a quick look at the practice’s website doesn’t list it, only IRAP and PRP, so they might not offer it. I’ll ask her, however. I also forgot to add that she also talked about Osphos, but she isn’t much of a fan, as she’s anecdotally seen “catastrophic fractures” in two horses they’ve used it on in their practice. Obviously not a sample size large enough to draw clinical conclusions from, but enough to be a little wary about it as well.

I agree that jumping more than what he’s ok with now might not be in his future–I just set it as “maybe” goal since that height is obviously pretty small, I’m imagining jumping that height literally, once a month if that, and on a super limited basis. Mostly, I’d like to do it because he’s fun to jump, he clearly enjoys it (you can tell flatwork does not get him excited…toss some cavalettis in and the interest level immediately shoots up haha), and he’s naturally balanced and sure-footed (not ringbone typical tripping and stumbling). But obviously, at the end of the day, I want to do right by him, hence all the research and agonizing.

The point about adding up the cost of NSAIDs is a good one too–I’m not sure he’d be able to go Equioxx free entirely, but if I could roll back dependence on it and bute that’s a net positive for his overall health as well. He’s not young but not so old that I’m in the “anything goes as long as he’s comfortable” camp either.

[Lusoluv]

A lot of vets (and human Drs. including my husband’s ortho) are recommending IRAP, PRP, stem cell therapy. There is a pretty high profit margin, relatively low risk and the argument that “it can’t hurt and might really help”. Yet the stats are barely 50/50 success rate and usually needs more than one round. Sorry, that doesn’t make financial sense unless you’re loaded and won’t miss the $1200+ if it does absolutely nothing…which is highly likely. I’ve known several horse owners who’ve used IRAP/PRP for soft tissue injuries with absolutely no results. Time and traditional therapy ended up being the best bet.

[IPEsq]

@Lusoluv

Yet the stats are barely 50/50 success rate

Where are you getting this? What is your definition of “success”?