I use Hyvisc and do not have any problems with flares, but I always use steroids with it. I think you are only using 10mg Kenalog in the joint. We use Kenalog too, and it’s 50mg in the 5cc vial, so 10mg/mL.
I use a ton of Adequan in horses (And Legend which is IV sodium hyaluronate). It has its place for sure. I use it as an adjunct in my athletes to maintain joint health, and I think it helps increase longevity of my joint injections. Most of my performance horses are getting injected every 6 months to a year in their problem joints. If a horse has a performance issue due to joint soreness, I don’t put the horse on Adequan to alleviate the joint soreness, as I don’t think it fully will work in that capacity. For me, I’m always going to find where that horse is sore and inject it. I’m very aggressive with my treatment plan when my performance horses are having issues. I want to eliminate that inflammatory event in the joint and protect the joint from those nasty inflammatory by-products that destroy the cartilage. Sometimes I’ll have horses starting out a little stiff but not having any performance issues. Those type horses are perfect to put on Adequan without injecting any joints yet. It helps eliminate that stiffness as they start work...similar to People being stiff after waking up and taking a while to work out the aches and pains by moving around some.