My 8 y/o OTTB was diagnosed with mild arthritis in both hocks last week after nerve blocks, X-rays, and a thorough soundness exam. He is currently sound on his HR but lame (2/5) on his HL, so my vet recommended corticosteroid (steroid) injections and bio (pro-stride) injections in the HL. I haven’t heard of anyone doing both before, but injections are completely new to me. Trying to gauge what is normal.
Has anyone had their horse injected with both steroids/pro-stride at the same time?
It’s my understanding that the steroid will negate the effect of the biologic, so I’m curious to see what responses you get here!
My vet has done steroid’s with Noltrex. With the pro-stride, the regenerative effects and healing are there but it isn’t a super potent anti inflammatory to knock inflammation out so perhaps that is why. Best to ask the vet since he/she is recommending it.
@TWH_Girl Oh, interesting! How do you like Noltrex? I am hesitant to use anything that isn’t FDA-approved, but it doesn’t mean it isn’t effective.
I definitely plan to ask my vet, but wanted to see what others’ experiences are as well. I don’t want to only hear one side of the story (even if that side is from an educated professional I trust!).
@Simkie Interesting! That makes sense. I was wondering if the steroid was to bring down inflammation and the biologic to assist in the joint’s function. I hope we see 
I liked Noltrex quite a bit. I’ve used it in stifles and coffin joints. We added a little steroid to the stifles as that is his main issue. We have done prostride as well but it wasn’t as dramatic of an impact.
I’ve only ever done one or the other.
I have not heard of that. I’ve only ever heard of one or the other.
I’ve not done them at the same time but offset by a couple months. I was in a way stressful work situation at the time so apologies, I don’t remember how far offset.
Old broodmare has a trashed stifle and we did steroid/HA. Vet suggested waiting a few months, then doing Pro-stride to help the injection “hold” longer. She did well with a standard injection, and was a brand new horse after Pro-stride (as much as one can be a “new” horse with no remaining cartilage and massive bone spur). Granted I am overseas for the time being, so I am unable to determine how well the combo has lasted. But when I left in August, she looked great.
This was my understanding as well. Pro Stride only if no steroid is being used. However, you can use steroid and then Pro Stride after a couple of months to help the original injection hold better. Just not at the same time is what I was told.
Aw, I’m so glad it is working for her! That progression makes sense to me. Thankfully I was able to identify his lameness before severe OA, so I am hoping we can preserve as much cartilage as you can. Thanks for sharing, and no need for apologies. No one here is a sub for my vet, and anything is useful context!!
Thanks—this seems like what is echoed throughout the thread and with a couple trainers I’ve asked. I’ll ask my vet to clarify at our appointment, and then hopefully, we can proceed with just the steroid for now, see how that works, then check in on pro-stride later. Again, this will be reviewed and evaluated by my vet. Since this is my first go around with hind end lameness, and he is prone to abscesses, I would hate to “double inject” him for something that ends up being front end lameness.
Maybe your vet actually meant NOT at the same time when they said it?
But in close proximity to each other? (and that’s what they meant by “and”?)
Clarify for sure!! Could be.
There are plenty of people doctors using biologic therapies that aren’t up on all the ins and outs of them, so it wouldn’t surprise me at all if there are vets in the same boat. It’s good that you’re out asking questions! No one cares as much about your horse (and your wallet!) as you do.
I, personally, wouldn’t use steroid and a biologic together, regardless of what the vet was recommending, based on experience using biologics in my own joints and what my (human) regenerative medicine expert says about them.
I lost my gelding at 28 when his left kee finally gave out. He had a lump on it when I bought him at 7 but never had any problems. It was arthritic and the flexion was declining. A fellow rider said it was “perfect on 3/31.” The BO locked all of them up so he stood in a field for month 4/20, when COVID broke out. No one was allowed on the property - her decision, not mandated - and that put him on a downward spiral.
In 2/2021 the lameness specialist started steroid injections that lasted 5-6 months. We used Adequan or Osphos, both of which were very effective for overall movement. His limp was getting much worse when he got Osphos in 5/22. He felt much stronger walking – I had to work harder to keep up. We all thought he would keep going at least until winter.
I thought his vet was jumping the gun when she said it was time. It was less than a week. He wouldn’t walk away from the barn to hand graze. If he dragged his toe he put his foot down flat. If he picked it up it made an arc and landed on the outside edge. The flexion was gone. I could see his knee was losing its ability to control his hoof. He was still a bundle of energy. I probably could have done more with drugs including joint injections, but I didn’t want to make him into an old man. It was time. 7/20/2022.
The lameness vet spent a lot of time with me reviewing x-rays and an ultrasound during one visit. That level of knowledge was extememly helpful when it came to making decisions. They couldn’t do a standing MRI, and the vet refused any MRI because of the anesthesia risk. My vet did x-rays every few months which she sent to the farrier and the lameness vet for his file.
I was on the start-up team for Pro-Stride APS (before we sold the company)
I would HIGHLY recommend you speak to another vet before allowing APS (or any biologic) and a steroid to be injected into a single joint at the same time/day.
Separate times to inject these products in the same joint, is not out of the realm. However, if indicated, 2wks is typically considered of best practice.
Thank you for this. I spoke with my vet last Friday and she is on board with my preference to start with steroids, then decide our next step based on how he reacts to the single injection. I’ll keep that in mind if we decide to do the biologic!!
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