Arthritis inconsistent symptoms

Feb 5, 2009
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#1
My Shetland pony was diagnosed with arthritis in his left knee 2 years ago after the vet did the flexion test. Pony has PPID (Cushings) & often has lami during the summer months. He has Prascend each day & 1/4 sachet of bute every 2 days. During the last few weeks there have been no signs of lami so I am confident his mobility difficulties are due to the arthritis rather than sore feet/lami. What puzzles me is that some days he moves almost normally e.g trotting a short distance across the field. On other days he is very stiff & reluctant to move although once he gets started on his daily walking exercise his movement usually improves. I can't find a pattern to this behaviour. His better days do not match the days that he has bute & the cold wet weather doesn't seem to affect his arthritis either. Are these inconsistent symptoms normal for arthritis? Has anyone had the same experience with their arthritic horse or pony? I don't find my vet very helpful & a book written by a vet that I have just read doesn't mention symptoms that vary from day to day so am hoping to get some help from someone with first-hand experience :)
 

carthorse

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Jan 6, 2006
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#2
A few things spring to mind on an initial reading
1) flexion tests aren't very reliable, flex hard or wrong& you can very easily skew the result. Was this the only test the vet based his diagnosis on? I'd want x-rays to confirm & see the extent of the damage.
2) summer laminitis is less likely to b PPID induced than autumn bouts, in fact summer is often the best time for PPID horses. Also if you're getting regular bouts I'd question whether you have the PPID under control & whether you're actually doing too much too soon so that the laminitis isn't fully treated and so is recurring rather than a new bout. Have you had hoof x-rays?
3)stiff and reluctant to move but easing on exercise also sounds like mild laminitis to me, as does the on off nature of the lameness that you can't see an obvious pattern to
4) some arthritics struggle less with the cold than they do hard ground, but I would expect more consistency
5) if you don't find your vet helpful then change vet. But be aware they are human & if you don't ask the questions that concern you then how is he or she to know you want help?
6) we aren't vets on here & we can't see your pony, any experiences we share may be way off. You need to talk to your vet & follow their advice, as I said before if you lack faith in your vet then get another.
 

Silvia

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#3
I have arthritis and for me it is certainly normal to have good days and bad days. They don't follow a predictable pattern, although the cold always makes my symptoms worse. I also tend to overdo it on the good days and a bad day follows. Maybe it is the same for horses.
 

Jessey

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#4
Osteo and rheumatoid arthritis can react quite differently, I can't remember which way round it is but one is more effected by cold and negatively by exercise and the other is better with exercise and worse with immobility. Could you just not be seeing the movement level right before the up/down?
My old boy was worse from standing in, better if I wrapped his legs than not but always far better out plodding about more, and notably worse if he'd been laid sternal with his legs tucked under him right before.

I'd also be inclined to check the Prascend dosage if he's still getting lami, or perhaps consider changing management routine in the summer to help avoid it if the dosage is correct.
 
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orbvalley

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#5
I have arthritis in my fingers (don't know what type) some days they're fine other days they're really stiff and sore. No pattern to it ref weather as they can be really painful in hot weather, its just random. Only things that make it worse is overactivity ie holding "tools" for long periods, and equally under activity ie sleeping.
One of my retirees has arthritis, some days he skips about, other days he's stiff and spends more time resting.
just to be clear though - I have no knowledge of lammi and its interference/interaction with arthritus
 
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Feb 5, 2009
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#6
A few things spring to mind on an initial reading
1) flexion tests aren't very reliable, flex hard or wrong& you can very easily skew the result. Was this the only test the vet based his diagnosis on? I'd want x-rays to confirm & see the extent of the damage.
2) summer laminitis is less likely to b PPID induced than autumn bouts, in fact summer is often the best time for PPID horses. Also if you're getting regular bouts I'd question whether you have the PPID under control & whether you're actually doing too much too soon so that the laminitis isn't fully treated and so is recurring rather than a new bout. Have you had hoof x-rays?
3)stiff and reluctant to move but easing on exercise also sounds like mild laminitis to me, as does the on off nature of the lameness that you can't see an obvious pattern to
4) some arthritics struggle less with the cold than they do hard ground, but I would expect more consistency
5) if you don't find your vet helpful then change vet. But be aware they are human & if you don't ask the questions that concern you then how is he or she to know you want help?
6) we aren't vets on here & we can't see your pony, any experiences we share may be way off. You need to talk to your vet & follow their advice, as I said before if you lack faith in your vet then get another.
thanks for your informative & helpful reply. I have spent all summer debating with myself whether the lameness was caused by the lami or the arthritis so your comment about recurring lami is interesting. the vet took the usual 6 monthly blood sample in the middle of October. The ACTH was 66 when it should have been less than 50. She told me to give him 1 tablet a day instead of the 1/2 tablet he had been on for 2 years. Vet took another blood sample yesterday. Result due next week. i have had a big problem with my current vet regarding the lack of advice/help with my pony's condition. In desperation I booked a consultation (£35 for 10 mins!) at the surgery to discuss my concerns. She explained that only a limited amount of advice is provided during a £50 field visit. I asked what a "limited" amount of advice consisted of but she couldn't elaborate. No help there then. I questioned whether my pony did have arthritis & she was confident he did based on the flexion test from 2 years ago. I asked about x-rays & nerve blocks. X rays would be £4-500. Nerve blocks are normally used prior to X rays. I didn't dare ask the cost of that! I said i don't have insurance and am already paying a fortune for prascend & bute. As a pensioner I can't afford all these tests which would at best confirm he has arthritis (which we suspect) or suggest another problem. If he does not have arthritis then what would the vet investigate? And how much would new investigations cost? I also expressed my confusion about exercising him: I was aware that if the lameness is caused by lami then he shouldn't be exercised, if caused by arthritis then he should be exercised. She surprised me by saying that only acute cases of lami should be rested. Chronic laminitics can be exercised. None of the advice I had read or heard over several years explained this so again i was confused. As regards changing vets. I changed to my current vet because I was not happy with my previous vet (same problem - lack of advice & support). I have recently contacted another vet whose prices were even higher than my current vets. In addition he was quite rude during the call & clearly wasn't listening to me when I tried to explain my predicament so another dead end.
I am currently thinking that the lameness is due to mild laminitis & treat/manage accordingly e.g go back to soaking hay & restrict grazing. I think it is worth a try.
 

carthorse

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#7
£4-500 for x-rays? They're taking the p**s!!!! And if she's sure it's in the knee there's no need to nerve block out, that's done to identify where the lameness is coming from so if she needs to do that she shouldn't be confident in telling you it's knee arthritis & should have done more thorough investigations 2 years ago.

I don't know how much you pay for prascend & bute but it may be worth looking on sites like Hyperdrug & Viovet and asking for a prescription.

If a horse is actively laminitic then it MUST be rested. By chronic laminitic I can only assume she means a horse that has had more than one attack but is currently not actively laminitic & is sound, in which case yes exercise is beneficial as long as it's carefully done & the horse is monitored for signs of problems.

I don't think that there's any harm in treating as though there is mild laminitis, given the history that's what I'd do.

Do you have many equine vets in your area? It's easy for me to say change practice but if there aren't the practices there it may not be practical. Could you ask for a different vet within the practice?
 

Jessey

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#8
Have you joined the ECIR group online? You can upload your case history and get lots of advise from professionals and people with heaps of experience with cushings, it's run by Dr Ellenor Kellon. They can give you lots of advise re management, diet, trimming etc.
 

Mary Poppins

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#9
Once a pony has had laminitis, I would always treat them like they had it. So restricted grazing, soaking hay for 8 hours, keeping their weight down, not working on hard surfaces etc. It can so easily reocurr and prevention is better than cure. My friends laminitic pony no longer has grass at all, he is turned out on a dirt field with other laminitics and they all have soaked hay. This is the only way that she can prevent it reoccurring.

Laminitis is quite easy for a vet to diagnose so I don’t understand the confusion in determining if he has this?

If he doesn’t have laminitis, literally anything else could be causing the lameness. The flexion tests are used to diagnose if the horse is lame. The vet will trot the horse up normally first, and then flex each leg for 60 seconds and then watch the horse trot away. If there is lameness, this will be exaggerated after the flexion. My vet has used them extensively to determine the extent of my horses lameness and I think that they are a reliable method to diagnose lameness.

However, the flexion test cannot tell you why the horse is lame. The only way to determine if a horse has arthritis is to nerve block and X-ray. And yes, £400 to £500 is what this will cost. Arthritis is such a general term it can mean anything from slight stiffness to significant bone spurts which press on other parts of the leg and cause real problems. Saying a horse has arthritis doesn’t really mean anything, you need to know where it is, how bad it is and what you can do to help.

What do you do with this pony? Is he a non ridden companion or do you want to work him? For a non ridden companion, if you really did not want to spend the money on further investigations I would concentrate on getting him as comfortable as possible. Talk to the vet about upping the bute (you are not giving him much at all) or look at other drugs. If he is visibly lame in walk in the field, this suggests to me that he is really hurting and needs some help.
 
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horseandgoatmom

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Dec 3, 2014
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#10
I got an xray few weeks ago I have arthritis in my right knee.
I have good and bad days cold days Seem better.
Its stiff in the morning a d frir better by the time I was done with chores.
If I twist funny sometimes it's better and that's why I went to a chiropractor a few weeks ago.
Now hes got me going to an osteopath tomorrow and says he may want to do an mri.
BUT I have altered my diet looked up good and bad foods for arthritis and inflammation made changes and I feel a difference.
No idea what this other doctor will say tomorrow.
I wonder if diet changes can help arthritis in animals???
But it's a bit limited to how to do that bagged feed or ration balsncer have lots of Ingriedents and forage can. Be changed somewhat.
So it's for sure much more complicated than googling good and bad foods for arthritis and inflammation.
 
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Feb 5, 2009
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#11
£4-500 for x-rays? They're taking the p**s!!!! And if she's sure it's in the knee there's no need to nerve block out, that's done to identify where the lameness is coming from so if she needs to do that she shouldn't be confident in telling you it's knee arthritis & should have done more thorough investigations 2 years ago.

I don't know how much you pay for prascend & bute but it may be worth looking on sites like Hyperdrug & Viovet and asking for a prescription.

If a horse is actively laminitic then it MUST be rested. By chronic laminitic I can only assume she means a horse that has had more than one attack but is currently not actively laminitic & is sound, in which case yes exercise is beneficial as long as it's carefully done & the horse is monitored for signs of problems.

I don't think that there's any harm in treating as though there is mild laminitis, given the history that's what I'd do.

Do you have many equine vets in your area? It's easy for me to say change practice but if there aren't the practices there it may not be practical. Could you ask for a different vet within the practice?
Thanks again for your reply. I too was gobsmacked when she told me the price of the x-rays. Apparently that price is for up to 6 x rays carried out in the field using a mobile unit. However this unit requires mains electricity (not exactly "mobile" !)so i would need to rely on the generosity of a friendly neighbour who would allow me to use their electricity. I assumed at least 2 X rays (both knees) would be needed & possibly 2 for front feet. I did contact another vet about charges for X rays. He charges £170 for 2 X rays then £25 per plate thereafter. Sounds better but he would also charge £40 for the field visit PLUS £40 to examine my pony. Then there will be the dreaded 20% VAT to pay. So not that much different.

I do buy Prascend online from Animed. Even with the £20 prescription charge it is still cheaper than buying from the vet. I will buy my next batch of bute online too.

I agree with you about resting an actively laminitic pony so I am applying a bit of commonsense & ignoring what the vet said about exercise.

A couple of days' ago I did move my pony to a small grazing area taped off around one of the field shelters. There is some poor quality grass & the ground is very soft but not muddy. I am also giving him soaked hay again which i did in the summer. He has been moving around & all basic functions are normal e.g eating, pooing, etc. Today the problem seems to be his arthritic left knee because he isn't keen to put a lot of weight on it. Or maybe it's lami in his left foot. It's a guessing game. And it's so frustrating.

No, there aren't many equine vets in my area - the one i currently use & another that I used a few years' ago but wasn't happy with. The lack of vets could be why their prices might be high. i have often considering asking for a 2nd opinion from another vet at my current vets' practice but I am suspicious that the vets might support each other so I would be paying out AGAIN only to be given the same advice.

I take each day as it comes. I observe my pony carefully in the morning & the afternoon & have to decide whether he is able to tolerate any exercise or if he should be left in his paddock to exercise himself.
 
Feb 5, 2009
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#12
Have you joined the ECIR group online? You can upload your case history and get lots of advise from professionals and people with heaps of experience with cushings, it's run by Dr Ellenor Kellon. They can give you lots of advise re management, diet, trimming etc.
thanks for your suggestion. I will have a look for the ECIR group. My pony & I need all the help & advice we can get!
 
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carthorse

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#14
Round here we're clearly very lucky with what we pay for x-rays. I had foot ones done late summer, lots of shots of both fronts from different positions, and I'm sure it was only £160.

It's hard to know what to do for the best when you don't know what the problem is. If it's arthritis he's better moving around a bit, even if only in his paddock, but if it's laminitis he ideally should be on box rest. I guess you can only do what you hope is best.
 
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horseandgoatmom

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#15
Xrays here for Lincoln the baby goat that turned out to have a broken neck were
35.00 ea . That is in their clinic.
Their treatment in office or at the farm is a flat fee 148.00 an hour. And farm call varies to where your farm is.

They vets there are worth their weigh
In gold the hard then 2 soft casts worked
And hes doing fine and thriving.
 
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Jessey

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#16
I assumed at least 2 X rays (both knees) would be needed & possibly 2 for front feet. I did contact another vet about charges for X rays.
Normally for joints they will need 2 or 3 angles to fully assess it, because an xray is 2d and shows things layered over one another, so different angles give a more 3d picture so they can better tell what is going on. For Jess' foot xrays they did 12 plates to assess the 2 front feet to check balance and the navicular bone and related joints. From memory at the hospital in Newmarket they cost 180 for set up and first 2 then 20 a plate, that was part of a full workup which was about 575 in the end including nerve blocks etc. For Bo's hock they did 4 or 5 angles as its a complex joint.
 
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#17
Your poor pony. :(
I have a Fell pony who had chronic laminitis and arthritis.
Chronic laminitis is what you get when an acute episode isn't cured. The pedal bone rotates and/or descends then the inflammation recedes without the bone being returned to it's former position. This means that the hoof grows abnormally causing discomfort which is easy to mistake for another "touch of lami".
The only way to correct this is to x-ray the feet then realign the hoof capsule to the pedal bone and support it while the entire hoof wall grows from the coronet down. If you don't do this, it simply won't get better.

http://www.thelaminitissite.org/chronic-laminitis.html

The laminitis site is an excellent resource for owners, particularly owners whose vets are not experts in laminitis as mine wasn't. It gathers the latest scientific research into laminitis from around the world.
 
Feb 5, 2009
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#18
Normally for joints they will need 2 or 3 angles to fully assess it, because an xray is 2d and shows things layered over one another, so different angles give a more 3d picture so they can better tell what is going on. For Jess' foot xrays they did 12 plates to assess the 2 front feet to check balance and the navicular bone and related joints. From memory at the hospital in Newmarket they cost 180 for set up and first 2 then 20 a plate, that was part of a full workup which was about 575 in the end including nerve blocks etc. For Bo's hock they did 4 or 5 angles as its a complex joint.
OMG!!
 
Feb 5, 2009
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#19
Your poor pony. :(
I have a Fell pony who had chronic laminitis and arthritis.
Chronic laminitis is what you get when an acute episode isn't cured. The pedal bone rotates and/or descends then the inflammation recedes without the bone being returned to it's former position. This means that the hoof grows abnormally causing discomfort which is easy to mistake for another "touch of lami".
The only way to correct this is to x-ray the feet then realign the hoof capsule to the pedal bone and support it while the entire hoof wall grows from the coronet down. If you don't do this, it simply won't get better.

http://www.thelaminitissite.org/chronic-laminitis.html

The laminitis site is an excellent resource for owners, particularly owners whose vets are not experts in laminitis as mine wasn't. It gathers the latest scientific research into laminitis from around the world.
Thanks for the advice. Today my pony is willingly trotting along the road with no sign of arthritis or laminitis. All 4 hooves look better than they have looked for a couple of years e.g no lami rings. Can't make head or tail of it !!
 

carthorse

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#20
Laminitis rings are signs of a past change in diet, not a sign of a current attack. They can occur without laminitis & laminitis can occur without them showing later.

I'm glad he's looking better now, and hope it continues.
 
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