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  1. #1
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    Default Interesting article on Legend IV vs Adequan IM vs (Pentosan IM pg 2)

    http://www.ctrdvm.com/html/medications.html

    Perhaps many of you already knew this but I was somewhat surprised to read about the effectiveness or in my newly formed opinion now, uneffectiveness (longterm) of Legend, due to its very short acting effect plus it doesn't get into the joint. The latter now has me doubting again if Legend is worth it at all and if IA is just a better way to go.

    Things that surprised me :
    LEGEND
    It does NOT go into any of the joints themselves, but merely attaches to anti-inflammatory receptors on the blood vessel side of the joint capsule. Here it has an even stronger anti-inflammatory than when placed within a joint! As it does not enter the joints, there is no lubrication effect when given intravenously(IV). Remember too, it is only an anti-inflammatory for joint related issues. The duration of its anti-inflammatory effect when given IV is anywhere from 2 to 7 days maximum. Because it works well for these short periods and is a naturally occurring substance I consider it: “The bute for JOINTS that does NOT test.” There is NO long term benefit from Legend
    ADEQUAN
    In several studies Adequan has been shown to go to joints once injected and actually be incorporated into production of new cartilage. The dose of Adequan you give today helps you best eight weeks from now. This is because Adequan works to heal damaged cartilage. The process of healing damaged cartilage takes time, at least eight weeks for a significant defect. Although there is some anti-inflammatory effect right away from an Adequan injection, this is very minor and not reliable for keeping horses sound in competition
    I'm just curious how many of you are (did) combining (combine) both products and how frequent do (did) you inject and do you feel it's worth it combining or are you happy with regular use of just 'one' of the above, which one and how often.

    Thanks!

    PS, PENTOSAN mentioning on pg2
    Last edited by Lieslot; Jul. 20, 2010 at 09:19 PM.



  2. #2
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    Checked out the link. That page makes it unclear if that information is written by Craig T Roberts or those are comments by Gary White - the link for that article is broken.

    Frankly, I'm doubting what is said here about Legend.



  3. #3
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    well it does look to be just a tad heavy on the adequan promo side, so I would prefer to see something a bit more independent... however if legend - I meant to type "legend" (doh - not adequan) does nothing more than reduce inflammation on the receptors (which is vaguely what I recall it to do and be advertised as nothing more or less than that) then it does help the viscosity within the joint. It's that inflammation that breaks down the viscosity of the joint fluid and contributes to long term damage. Typically I've heard Legend is better before the arthritic damage is done and adequan is better later in the disease stages. You know, they do different things and need to be used at different times. I don't think they are or have ever been advertised as interchangeable.

    The linked page sort of reminded me of the spin that states the obvious and then repackages it so you think it's awesome: Green? You don't need GREEN! You need to mix up blue and yellow! Blue and yellow are far superior to green!
    Last edited by DMK; Jul. 20, 2010 at 08:39 AM.
    Definition of "Horse": a 4 legged mammal looking for an inconvenient place and expensive way to die. Any day they choose not to execute the Master Plan is just more time to perfect it. Be Very Afraid.



  4. #4
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    I was surprised too to read that about Legend.

    the link for that article is broken.
    Hmmm weird, does it work when you go
    http://www.ctrdvm.com/, select "equine healthcare" at bottom and then go to the bottom 2 links :
    - more.... about Adequan
    - more.... about Legend

    or these :
    http://www.ctrdvm.com/html/medications_adequan.html
    http://www.ctrdvm.com/html/medications_legend.html



  5. #5
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    I actually found a great improvement when I was giving adequan every two weeks. I think it can't hurt to give bi weekly or once weekly and see if you notice a difference for a month.



  6. #6
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    I don't think anyone would dispute Legend doesn't work.
    I was merely looking at it from a point of longterm effectiveness.

    I guess I wasn't clued up enough and somehow thought if you did a Legend monthly with a (bi-)weekly Adequan that was a great thing. Now I come to wonder if Craig T R. is correct that Legend is only effective for 2 days (if lucky 7 days), unless one can afford to inject their horse every other day, then I'm wondering if it's worth it.
    I can see it making sense prior to competition, but perhaps not so much as part of a maintenance program.

    On the Bayer website I can't see any mentioning on how long it's effective, nor any mentioning of where the substance actually goes in or attached around the joint. As you say they probably don't know. That's okay, I believe it works, I was just wondering if how long and when or why one would use Legend. I had a misconception of the drug in the past I guess, thinking you could use it as a maintenance thing, well you still can, if you can afford to inject more then once a week, else it now seems to me it may be a drop on a hot plate and not worth the money.



  7. #7
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    Here is what I have always heard. Adequan for boney problems, legend for soft tissue. That is the rule I follow.



  8. #8
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    This is because Adequan works to heal damaged cartilage. The process of healing damaged cartilage takes time, at least eight weeks for a significant defect.
    Statements like this drive me absolutely, positively INSANE

    Cartilage DOES NOT HEAL. EVER. That's the problem with articular cartilage...it can not replace itself. Damaged cartilage is replaced with a "hyaline-like" scar tissue that is structurally and functionally inferior to the preexisting cartilage.

    Statements like the one above (and by a vet no less ) indicate that cartilage "heals." It does not. There is no existing medication or surgical treatment that can heal articular cartilage.

    I feel better now.

    Signed,
    Absolut Equestrian
    Obsessive scientist studying articular cartilage repair
    *Absolut Equestrian*

    "The plural of anecdote is not fact...except in the horse industry"



  9. #9
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    where do you get the idea that cartilage does not heal?
    maybe not major tears or severe acute damage, both problems that tend to require surgical intervention, but general wear n tear does get repaired and heal. Very slowly. Lots of studies on the topic and how one might speed up the repair process.



  10. #10
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    I posted the same thing yesterday that I am about to say:

    My horse had OCD surgery in May & was immediately put on the loading dose of Adequan IM. He had HA-Injections 30 days post-op (aka 4 weeks into the Adequan) and again at 60 days (8 weeks into Adequan). The difference in his joint fluid was significant from 30 to 60 days. My vet said "The Adequan is doing it's job! His joint fluid has substantially improved"....which basically, the first time around with the HA injections, he had NO JOINT FLUID... And now he's finally starting to form the fluid he needs to cushion his joints.

    He is also on Cosequin ASU, for additional support.



  11. #11
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    Quote Originally Posted by wendy View Post
    where do you get the idea that cartilage does not heal?
    maybe not major tears or severe acute damage, both problems that tend to require surgical intervention, but general wear n tear does get repaired and heal. Very slowly. Lots of studies on the topic and how one might speed up the repair process.
    Nope. I'm not aware of a single study that shows damaged cartilage in a mature mammal (humans included) is able to heal ad integrum. It is always replaced with scar tissue, never with chondrocytes which produce an extracellular matrix identical to that found in true articular cartilage.
    *Absolut Equestrian*

    "The plural of anecdote is not fact...except in the horse industry"



  12. #12
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    well, since a casual search of the literature turned up hundreds of articles demonstrating cartilage repair in adult mammals I'm not sure what to say in response....



  13. #13
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    Wendy, you have a PM
    *Absolut Equestrian*

    "The plural of anecdote is not fact...except in the horse industry"



  14. #14
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    not that good ol' Wiki is much of a reliable authority, but this statement sums it up reasonably well:

    The aim of an articular cartilage repair treatment is to restore the surface of an articular joint's hyaline cartilage. Over the last decades, surgeons and researchers have been working hard to elaborate surgical cartilage repair interventions. Though these solutions do not perfectly restore articular cartilage, some of the latest technologies start to bring very promising results in repairing cartilage from traumatic injuries or chondropathies. These treatments are especially targeted by patients who suffer from articular cartilage damage. They provide pain relief while at the same time slowing down the progression of damage or considerably delaying joint replacement (knee replacement) surgery.
    Nothing can restore the cartilage to its former "well oiled machine". You can do a lot of therapies, drugs and surgeries to slow the process of deterioration or ease the pain/improve the functionality of the damaged joint surface, but you cannot yet undo the damage done.

    But as soon as someone CAN undo the damage, bjillions will be made.
    Definition of "Horse": a 4 legged mammal looking for an inconvenient place and expensive way to die. Any day they choose not to execute the Master Plan is just more time to perfect it. Be Very Afraid.



  15. #15
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    Quote Originally Posted by wendy View Post
    well, since a casual search of the literature turned up hundreds of articles demonstrating cartilage repair in adult mammals I'm not sure what to say in response....
    Uh, are you sure? I have yet to find ANY article that shows repair in mammals and I work in the field (department of orthopaedics). Like Absolut and DMK say....

    Reed



  16. #16
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    Whatever, I think some of us would like to know where to put our dollars; in Adequan, Legend, IA injections, or other for those teenage horses that have hock DJD.

    I seems that we can't believe anything we read or hear.



  17. #17
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    Quote Originally Posted by RAyers View Post
    Uh, are you sure? I have yet to find ANY article that shows repair in mammals and I work in the field (department of orthopaedics). Like Absolut and DMK say....

    Reed
    Thank you
    *Absolut Equestrian*

    "The plural of anecdote is not fact...except in the horse industry"



  18. #18
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    Quote Originally Posted by ToN Farm View Post
    Whatever, I think some of us would like to know where to put our dollars; in Adequan, Legend, IA injections, or other for those teenage horses that have hock DJD.

    I seems that we can't believe anything we read or hear.
    This is where you have to coordinate with you veterinarian. Adequan is more effective on the cartilage directly while Legend is more to stabilize the joint environment.

    For the previous post that stated, "And now he's finally starting to form the fluid he needs to cushion his joints..." This is an example of how people are misinformed and subsequently believe an incorrect assumption. Joint fluid does NOT cushion joints or joint surfaces. Many biomechanic studies establish that joint fluid has little function during the movement of joints. Hyaline cartilage has little change in viscosity whether there is fluid or not. Its primary function is nutrient delivery and its structure enables it to survive in a high motion joint. Thus, a watery fluid is more indicative of a failing joint support system than cartilage degradation. Yes, they generally go hand-in-hand but not always.

    Reed



  19. #19
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    Remember that arthritis causes waxes and wanes naturally and it can be hard to determine what is helping or how much such as turnout and low grade exersise legend adequan or everything. My cusins horse has some more advanced hock arthritis and he was kept sound and showing with regular hock injections steroid HA and monthly adequan. I like IRAP and IA adequan. I can't really afford legend with the vet doing the IV it costs me about $160 did it monthly for a year did it for me more than anything. My vet did say monthly legend would make the joint injections last longer but they did't work for me.

    Best Luck



  20. #20
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    Quote Originally Posted by TonFarm
    Whatever, I think some of us would like to know where to put our dollars; in Adequan, Legend, IA injections, or other for those teenage horses that have hock DJD.
    So true, this is really why I am out there reading & reading, but with no medical background it's tough and how are we to know which source to trust and which source not to trust.



    I have a question for those who are more knowledgeable on the subject.
    The reason I'd prefer to start with Legend/Adequan is because of the risks of intra articular injections, small yet real, but also because I cannot figure out whether repeated IA steroid injections actually damage cartilage or not?
    Some human or animal articles read that even as much as a single steroid joint injection will damage the integrity of the cartilage and repeated injection will for sure. True or false?

    Example of a human medicine article I came across (http://www.caringmedical.com/sports_..._cortisone.asp)
    In this study, some of the joints were injected only one time. Even after one steroid injection, cartilage remained biochemically and metabolically impaired. Other studies have confirmed similar harmful effects of steroids on joint and cartilage tissue. A cortisone shot can permanently damage joints
    I have to refer to the same vet's article
    http://www.ctrdvm.com/html/jointinjections.html
    Long term comfort of the horse and relief from the arthritis is the primary goal of lower hock joint treatment, NOT continued motion and flexibility of these low motion areas. This is a very important concept to grasp as joint comfort and treatment for joint function are not necessarily the same. Granted, high motion joint treatments such as Adequan, Legend (intravenous hyaluronic acid), intra-articular hyaluronic acid (HA) and low dose, short acting steroids do play some role in creating comfort. However, all of these drugs are aimed primarily at restoration of a more “normal” joint environment. The primary goal being preservation and regeneration of healthy cartilage. In lower hock joints we often take a different approach. As these joints are not necessary from athletic performance, their more reliable comfort becomes the primary goal somewhat at the expense of the cartilage involved. For this purpose, long acting steroids (the most potent anti-inflammatory available) are used.

    As we now know these joints do not play any significant role in the motion of the horse, thus the worst case scenario from such treatment (i.e. continued, progressive joint deterioration and possible increased arthritis production which may be enhanced by steroid injections) may only result in joint fusion. If this were to occur in a high motion joint pasture retirement, at best, would result. In the lower hock joints, however, this results in a pain free performance horse which no longer requires periodic joint injections
    To me this reads that when using long acting steroids you are potentially damaging cartilage. But you'd want that for the lower hocks.
    But what about short acting steroids & stifle injections for exmple or fetlocks (high motion joints), what is the latest research on cartilage improvement or on the contrary cartilage damage, degeneration by repeated IA injections for maintenance purpose.? I bring this up, coz often when one starts to inject hocks & stifles, one ends up doing so yearly, then going onto 6-mthly or even more frequent. Before I fall into this pattern, I want to understand it better.

    Interestingly enough, recent research has down played the significance of long acting steroids in the progression of arthritis in joints (steroid arthropathy). The newest theories support the progressive degeneration regardless of therapies used. Our own clinical experience would somewhat support this as well as many horses appear to progress an fuse despite numerous injections while others apparently never fuse through their entire career even with frequent injections
    HUH, in laymen terms? Is he now saying yes degeneration from IA repeat injections (long action steriods) or no? Or horse dependent?
    Almost seems to read to me that no matter what you do, inject IA or not, the degeneration will continue to happen, so really you are looking at comfort/pain relief. If that's the case, if one has a non-competing horse, why not bute it? I know bute = gastroenteric probs.

    Is it common to inject a joint only with HA and no steroid at all? And as such effective? Perhaps I should have asked this question first, then long acting/short acting steroid, none of it matters anymore, haha .
    Thanks!!!!



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