Noltrex for stifles - or maybe something else? Can't use steriods

[Dori]

So my 20 year old gelding has been getting steroid injections in his stifles every 6 months for several years now and always did well with it. That worked great until he contracted EPM about a year ago and now can’t have steroids (due to suppressing the immune system, not good with an EPM horse).

I tried the ProStride last spring (May) and I’m not sure how well that worked due to some bad luck and multiple factors at play. The vet who did the ProStride also recommended Prascend for possible Cushings. About a month afterwards my boy was feeling more forward and eager, but not sure if that was the ProStride or the Cushings meds kicking in. Then I got hurt and had surgery, leased out my horse, and lost track of how he was feeling for a while. I got him back in October about 5 months after the ProStride and he felt terrible. But was this because of bad riding when leased out, my own bad riding coming back from surgery, trouble finding a good farrier resulting in unbalanced feet, or something else? We also retreated for EPM and he seemed to improve some… so way too many factors to know if the ProStride did in fact work or not.

Anyway, my new vet recommended Noltrex but hasn’t used it yet in a lot of horses. Or I could go back to my old vet for more ProStride. Prices are similar enough. Any suggestions? The horse is not visibly lame but flexes unsound on both stifles and has no impulsion, tends to be heavy on the forehand and doesn’t want to use his hindquarters. Steroid injections in the stifles always made him feel like a million bucks but that’s not an option anymore.

[Railbird]

If he is 20 and steroid joint injections are no longer effective to the point where he is flexing off on both stifles and avoids using his hind end, I would probably consider whether whatever happened while he was leased out was really something to come back from or just natural aging. Is he comfortable just puttering around? Could he do a daily previcox?

[NaturallyHappy]

Have you tried anything like Lubrisyn or Adequan?

[BroncoMo]

I was going to suggest Arthramid but looks like (with very little research on my end) that Noltrex is the same thing, or similar.

I’ve done ProStride once on an old broodmare who has a terrible spur in a sniffle as well as it being bone on bone. It made huge difference for her. She is also on gabapentin for that stifle, as well as high dosage pergolide. My vet had no issues with doing steroid/HA injections, but just wanted to see if ProStride would help prolong the usefulness of the injection. I may see if we can do just ProStride next time because she did so well with it.

[SolarFlare]

There are quite a few other threads on Noltrex in general if you want to search. I’ve been using it for years in a variety of joints, and last year started using it for a stifle on my horse who has mild arthritis.

It has worked well for us. Follow the suggested rehab from the manufacturer to make sure you get longer-lasting results. Depending on how many compartments you need done, it can get pricey (I had to do all three, and it’s one dose of Noltrex per compartment).

[TWH_Girl]

Noltrex and Arthramid are both hydrogels and act as a lubricant to cushion the joint. Prostride
isolates the horses own anti-inflammatory proteins- the downside is that as a horse ages, they have less and less anti-inflammatory proteins and often the regenerative therapies as not as helpful as they are on younger horses since what you are reinjecting isn’t as potent.

I would not hesitate to use Noltrex in stifles. I have used it in stifles twice as well as coffin joints recently- also great response. The stifles needed retreating after a few months and we used half dose (one syringe per stifle) some months later and that helped. I think the hydrogels are a great options for older horses with chronic arthritis issues.

[stargzng386]

I would also add in estrone that actually works better than steroid injections on my horse who has some stifle arthritis.

[Dori]

Yes we tried Adequan and it did nothing at all, and he’s never responded to Equioxx though he does feel better on Bute.

[AmyGrace]

I have consulted with an equine orthopedic surgeon for my severely arthritic mare, she has advanced OA/DJD in her left knee ( carpus ),
Initially, he suggested the Noltrex.

Upon reading his detailed report, he outlined many options for arthritis and a biologic therapy called RenoVo is one of them. RenoVo is just starting to be studied in arthritis in joints, it has proved effective in soft tissues and wound healing. Grace has an appointment in a few weeks to get an intra-articular injection of RenoVo and I am optimistic.

[ladipus]

First …has he had any recent metabolic bloodwork done ? …such as insulin, glucose and acth ?? What dose of Prascend is he on ? His PPID(Cushings might not be controlled at the moment ) what’s his diet now ? What was the diet & management when leased out ? Is he on grass ? Does he get tested low sugar hay or soaked hay ?? X-rays of feet ?? This sounds to me possibly more like metabolic related issues that I would rule out first.
As for the Pro Stride …I can’t say that I’ve noticed it make much difference for the horses that I’ve given it to …which has been for hocks /stifles and a fetlock …I used it because mine are IR and can’t have steroids because of laminitis risk.

I’ve had the best luck doing Adequan & Legend on my 20yr old Tb gelding…I find doing that series of 1 dose every 4 days for 28 days twice per year works great as well as the loading dose of Legend-1 dose weekly for 3 doses also Pentosan works better for some than Adequan …things that can also help your boy might be something like Jiagulon-an adaptogen herb that’s very beneficial in improving circulation, immune system, respiratory and metabolic…also have you tried Equioxx ?? Other things to try would also be giving Marine derived fish oil supplements such as Mad Barn W3 or KER EO3 as well as Equithrive …also Omega Alpha Antiflamm and Sinew X are great too as well as Uckele Hemp Joint

[Dori]

Ok so the vet was out today for a re-check exam and this is what we came up with. He still has residual neurologic symptoms from EPM which will probably never go away, but the big limiting factor right now is his right stifle. We think the Prostride did help but wasn’t as effective as the steroid injections into the stifle. I didn’t think it worked well at first, but Prostride takes months to reach peak effectiveness, and a slight EPM relapse was confusing the issue. We’ve re-treated for EPM for the past 2 months and my horse feels much better even though we’ve done nothing to treat the stifle since the Prostride injection in the spring.

So the plan is to repeat the Prostride in the next month or two (whenever I get today’s bill payed off and can afford it). Then in the fall do the Noltrex. Repeat Prostride every spring and Noltrex every fall so he’s getting something injected in to that joint twice a year. And he will stay on EPM meds at the twice weekly maintenance dose and get vitamin E supplements for the rest of his life. We also pulled blood to run a metabolic panel and test to see if the half pill of Prascend for Cushings is an appropriate dose. As he did not respond to Adequan in the past we won’t pursue anything like that.

This horse is 20 (possibly older) but he’s my best friend and just a blast to ride. Plus he’s 100% trustworthy, and since I have some health issues myself that’s really important to me. I don’t think I could ever replace him. So we will do everything my budget allows to make my boy sound and healthy for as long as possible. I am also looking for a new farrier to get his feet in better shape, but that’s been tough as all the good farriers aren’t taking new clients in my area. And for the person who asked above, Equioxx doesn’t seem to do anything for him. Bute works well but I worry about GI problems, particularly since he’s already on EPM meds and that can cause GI upset.

[TWH_Girl]

This sounds very reasonable to me. My older guys stifles are tough to manage I have to stay on it. Whatever it takes within your budget so long as horse responds…I do plenty for my guy!

I don’t ever feel like it’s ever mentioned, but Equioxx doesn’t help stifle pain very much IMO and my sports med vet agrees. Bute is helpful but horse won’t eat it. I wish there were a few other easy one pill options similar to equioxx.

Good luck with your boy!! And post an update after the prostride.

[Misheyla]

Hi Amy,

I just made an account so I could reply to your post and ask you some questions! My 16 year old mare has fairly severe arthritis in her right knee. I have done the initial x-rays and have also done 2 x corticosteroid with HA injections. The first injection made a huge difference, the second one did nothing, and almost seemed to make things worse (that could just be coincidence, of course.) My Vet suggested Noltrex but doesn’t seem too convinced that it will work. My horse is just a putter around, trail girl and I haven’t actually ridden her more than once in the last 6 months due to her being so sore and stiff. She’s also on Previcox once daily and that doesn’t seem to be doing anything. What country are you in? I am in Canada so I am not sure if RenoVo is used here but am going to look into it!