Is there hope for coffin joint arthritis in a 5 Y/O?

[ambitiousAmmy]

I have a 5 y/o OTTB who just went very lame in his front right- a few months after a questionable hoof trim that we have been trying to correct. The vet came out to do radiographs and these were some of her notes:

“there is mild coffin joint arthritis. There is mild lipping of the extensor process of the coffin bone.”

I am very concerned as he is only 5 and I have been using him to jump up to 3 ft (hoping to go higher soon). The vet will be out later this week to inject the joints and we will be looking into wedges but I am trying to be realistic. Is there any kind of a good prognosis for this type of injury? Or any supplements etc that could help to slow it down?

I’ve attached the radiograph for reference

[tipzythegreat]

I would say definitely if it is “just” mild arthritis you can expect to keep him going. Was the coffin joint nerve blocked? My concern would be that many creatures get along fine with mild arthritis and aren’t suddenly VERY lame. Arthritis doesn’t pop up over night. I’d be inclined to think something else may also be bothering your guy. It could be that mild lipping is causing more issues than the arthritis.

Injections are really the big guns when it comes to treatment. I would personally try corrective shoeing and oral supplements first. While injections DO provide HUGE relief in the right situation, at 5 years old, I’d try and do everything as conservatively as possible. Injections can only be done so often and for so long. They can also cause the arthritis to progress more quickly. Unless your vet thinks the injection is for inflammation and not so much meant to be a maintenance thing

I’d also recommend trying corrective shoeing BEFORE the injection. If the arthritis is the problem, the injection is very likely going to help, sure. But I don’t know that you’ll get a good gauge of how much the shoeing is helping if you inject it first. If you throw 5 things at him and he comes sound and feels great… well, you don’t know which of those things actually helped.

Depending on his reaction to conservative treatments I would say that will give you an idea of what kind of longevity you’ll get. I would think he should be limited jumping – jumping not very much and not very high. But again that will depend on his reaction to treatment. If you can get him on an oral supplement and he is comfortable with wedges… see what you vet thinks. Adequan claims to “stop arthritis from worsening” or something like that.

It’s all going to depend on your management and his specific case. A good farrier may be all you need. Or, he may need injections every six months to stay sound just to flat.

BUT you have MANY options ahead of you!!!

[ambitiousAmmy]

I agree with you that I don’t think the arthritis is the big problem. For a little background he has been at a barn in another state and I had not seen him in two months- when I went out to check on him he was missing his front right shoe and was unable to walk across any rough services so I’m hoping the “very” lame part came more from hoof sensitivity.

I really trust this vet so I’m assuming she meant injections more for inflammation and I am having him shipped to me so that I can keep a better eye on him. Just more not sure where to start in tackling this and what reasonable expectations for his performance should be!

[joiedevie99]

Personally, I’d just let things settle for a bit. It’s possible the sudden lameness is a hoof bruise and the mild arthritis is an incidental finding. While you’re letting things settle, I’d take some hoof balance x-rays and get his shoeing perfect. After 3 or 4 weeks, I’d have the vet out to jog and flex him and see where things stand. If he’s still clearly lame on it, I’d want an ultrasound or MRI to see if there is soft tissue damage.

What often happens is that people inject a joint because they find mild arthritis on the x-ray. The horse goes better - for a while. Then 3 months later, the lameness is back. And the original soft tissue injury has been getting worse that whole time because the steroids dispersed around the joint and made it feel better, and the arthritis was always an incidental finding. In a 5 year old that I had high hopes for, I wouldn’t take the risk.

Now… I’d probably still inject the joint either way to deal with the inflammation - but I’d proceed very differently if there is an accompanying soft tissue injury (stall rest/rehab) or not (gradual build up back into work after a week). If it’s soft tissue, I’d probably choose something in the IRAP, PRP or Pro-Stride family rather than the traditional HA/Steroids.

[ambitiousAmmy]

Ok I think that will be my plan! I will go forward with the injections and am reaching out to experienced farriers to get an assessment set up.

@joiedevie99 I’ll take your advice and let him sit for awhile. He has been living in mud for the last two months so I made sure to find a place with good, dry turnout and I’ll see if that helps.

Thank you guys for your help!! Updates to follow😊

[tipzythegreat]

I would also wait on the injection.

What I’m reading is your horse has had some sort of uneven feet for who knows how long (which could have caused a soft tissue injury)… or he is foot sore. I think the coffin bone arthritis might just be coincidental. I mean – was he sore to start and had to work out of it when you were riding him two months ago?

If the answer is no, I think you’ve got an acute injury here.

The mud definitely could have aggravated soft tissue. Is there any swelling or thickening in the area? Any heat at all?

I would get him back, keep him in a dry lot as you said, and have a farrier check him out for foot soreness.

The injection may not even help, as it could be treating the wrong thing. EXACTLY as @joiedevie99 … “What often happens is that people inject a joint because they find mild arthritis on the x-ray. The horse goes better - for a while. Then 3 months later, the lameness is back. And the original soft tissue injury has been getting worse that whole time because the steroids dispersed around the joint and made it feel better, and the arthritis was always an incidental finding. In a 5 year old that I had high hopes for, I wouldn’t take the risk.”

If he isn’t foot sore, I’d get him on stall rest and get another vet to do an exam.

Please do keep us updated!

[ambitiousAmmy]

Just wanted to update you guys- he has made it safe and sound and is settling in nicely. I gave him a week of stall rest and then another week of no riding. Got on him yesterday and just walked and trotted a little and he feels great! I plan on doing light walking/ trotting for the next week or two to make sure I’m not aggravating a soft tissue injury but I am feeling cautiously optimistic😊