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  Discussion on Legend or Adequan IM for navicular?
Author Message
Member:
Lisam

Posted on Friday, Mar 12, 2004 - 1:42 pm:

Hello Dr. O and everyone, my 17 y/o Apdx QH mare has been diagnosed with navicular. Some history below in case it is useful. My question is whether doing an IM injection of Adequan or Legend might be worthwhile. I saw the discussion of using Adequan in the joint in the article, and the discussion elsewhere of using Adequan or Legend IM for arthritis. I am wondering about using them IM for navicular.

My mare first presented about 6 months ago with RF lameness (head bob at trot, nearly sound at walk) that resolved with RF nerve block. We did a 7-day course of bute and put egg bar shoes on her. She was sound for a bit then RF lame again. Another course of bute, and x-rays. X-rays showed only insignificant changes to the RF navicular bone, but moderate degeneration on the LF. That got her sound again, then she went LF lame. We now have degree pads and silicone pads on her with wide web egg bar shoes (I think I have that right). My vet claims to have had luck with isoxuprine so I took his advice to start that. But ever since she went LF lame the only thing that keeps her sound is 2g bute per day. I am probably going to stop the isox.

My vet wants to inject her joints. He said that we can *try* an IM injection of Adequan or Legend but he doesn't think we will see much benefit. I hate to incur the infection risk of a joint injection before we've tried everything short of it, but if there is no evidence at all for the utility of an IM injection in these circumstances then I won't waste my money. But I am also not sure whether to inject just the LF (current lameness) or both. My vet says that there is not always a correlation between the bad radiograph and the clinical lameness presentation. And she was RF lame at the beginning of this.

Thank you for any help!

Lisa
Moderator:
DrO

Posted on Saturday, Mar 13, 2004 - 8:45 am:

Lisa the meaning of the diagnosis of "Navicular" is practically meaningless and should be replaced with "chronic bilateral heel pain". There are many causes of this condition and injection will only be helpful if arthritis is a component of the problem. If you would like to try alternative treatments to those suggested so far see the article associated with this forum we have other recommendations that have been useful.
DrO
Member:
Lisam

Posted on Monday, Mar 15, 2004 - 9:31 am:

Thanks Dr. O. I always do read the articles before posting, I swear. I hate to waste your time. I guess I am just too dense to fully understand them. I was trying to ask whether, if there is degeneration of the navicular bone, IM injections might be helpful instead of IA. Are you saying that degeneration of the navicular bone is just like any other kind of arthritis in terms of the utility of injections? Thanks again.

Lisa

Moderator:
DrO

Posted on Tuesday, Mar 16, 2004 - 6:32 am:

If the navicular bone is truly degenerated there will be no treatment that is helpful, but I suspect you mean that there are enlarged vascular channels with some remodeling of the shape of the bone. These changes are not a primary cause of disease as they can be seen in sound horses, though when severe are associated with an increase incidence of chronic heel pain. What I am saying is that the actual disease causing the pain may or may not be a primary arthritis so it will be impossible to know if anti-arthritic therapy will be useful. Yes I do think that the studies that apply to the treatment of other forms of arthritis can be extrapolated to arthritis of the joints associated with the navicular bone.
DrO
Member:
Lisam

Posted on Tuesday, Mar 16, 2004 - 10:22 am:

I understand now, and that distinction is enormously helpful to my understanding of which therapies might help. I will be sure to ask my vet about that specifically. Many thanks.

Lisa
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