Use of IRAP/ACS in dog Sune Jerre

1. Use of IRAP/ACS in dogSune Jerre www.jennyhilldjurklinik.se

2. IRAP- orthogen veterinary GmbhACS= Autologous conditioned Serum • IRAP have been used in horsessince 2008 in Sweden • Studies in People show that injections with ACS will lower Interleukin levels in the joint and is effective in treatment of Osteoarthritis • Studies in horses show that treatment with ACS is Superior in joint treatment compared with hyaluronic acid or cortikosteroids www.jennyhilldjurklinik.se

3. ACS to dogs • Julio Reinecke offeredme IRAP in april 2010 • We decided to threat arthrotic joints with three intraarticular injections 1ml /joint 7-10 days apart • I wanted to try IRAP in Chronic arthrosis in elbows that had been arthroscoped 8 of 10. • I also treid it in three Shoulder and two stifle joints during first year www.jennyhilldjurklinik.se

4. Selection of dogs for IRAP www.jennyhilldjurklinik.se

5. Blood sampling and handling www.jennyhilldjurklinik.se

6. Extraction of ACS-serum www.jennyhilldjurklinik.se

7. IRAP –Orthogen AGACS- Autologous conditioned Serum • IRAP comes from blood incubated in tubes with glasbols in 37 degrees. • IRAP from orthogen 10 ml is incubated 6-9 h. • 50ml syringes is incubated for 20-24 h. • Timeframe important to get Interleukin antibodies • From 10ml blood you get 3ml IRAP-serum • Injection of 1ml intraarticular with 7-10days apart. • 20 joints treated april 2010 – april 2011 www.jennyhilldjurklinik.se

8. During the first year 20 joints where treated • 3 Shoulder joints • 2 Stifle joints after CCL • 15 Elbow joints in 10 dogs. • 1-10 years • 15 dogs treated with 3 injections in each joint www.jennyhilldjurklinik.se

9. Results of first year • Out of three shoulder joints two got perfect and are back to full exercise, one did not response and the dog was eutinised • The dogs with elbow arthrosis often needed some support with NSAID and or Neutrasuiticals two dogs where back to full function without adjunctive treatment www.jennyhilldjurklinik.se

10. Results was promising • Most cases diagnosed with Arthroscopy • Many cases had arthrosis in multiple joints • Synovial fluid got more viscous after each inject. • Dogs got lame free even with grave arthrosis • Treatment often combined with other drugs • Decided to have IRAP as a part of my joint treatment www.jennyhilldjurklinik.se

11. MY way to use IRAP in dogs In this presentation I will show the results after IRAP treatment in 105 joints. Each dog got 3 injections with 7-14 days apart in one to four joints. 4 dogs have been treated two times with 3 injections and more than one year apart. Follow up time is 6 month – 3,5 years www.jennyhilldjurklinik.se

12. My experience of IRAP/ACS • 44 dogs with 67 elbow joints treated so far • 25 dogs with 40 stifle joints treated so far • 9 dogs with shoulder problems treated so far • 5 dogs treated in hip joints often in combination with other joints • 2 dogs treated in the hook • 85 dogs and 125 joints have been treated so far www.jennyhilldjurklinik.se

13. Jennyhill djurklinik • The most commen injury in the stifle joint of dogs is CCL and it often affects Booth hindlegs • We have used IRAP to slow the process of Arthritis after Surgery • We use arthroscopy to diagnose and TTA to treat rupture of CCL www.jennyhilldjurklinik.se

14. Arthroscopy • 30 of 34 dogs treated in the elbow have been arthroscoped prior to treatment 23 in both elbows • 1-10 year of age at treatment • We have suggested IRAP treatment for all dogs with elbow arthrosis www.jennyhilldjurklinik.se

15. IRAP is a blood product that have to be handled steril www.jennyhilldjurklinik.se

16. Use of IRAP in Elbow joints • 34 dogs and 57 joints where treated 3 times with 7-14 days apart • In 6 dogs hip joints or stifle joints where treated at the same time • Follow up time 6 – 40 month • 8 dogs are dead three because of lameness • Results: • 2 dogs did not function • 5 dogs needed multi-treatment and some lameness • 16 dogs had good function but needed supportive treatment • 10 function with out medication www.jennyhilldjurklinik.se

17. Use of IRAP in stifle joints 21 dogs and 36 joints All dogs have had stifle Surgery 15 had stifle surgery to both hindlegs We should probable use IRAP more in profylaxis of Stifle arthrosis • Results: • 2 dogs did not have positive effect • 5 dogs needed other supportive treatment • 8 dogs where back to normal but needed medication • 6 dogs back to normal with out medication www.jennyhilldjurklinik.se

18. Use of IRAP in Shoulder joints • We have used IRAP in older dogs with shoulder instability and after trauma. • Young dogs with shoulder OCD have good prognosis anyway and I have not used IRAP • Results: • 2 dogs did not come back to good function and was eutinised • 5 dogs came back to full function and did not need any further medication. www.jennyhilldjurklinik.se

19. Use of IRAP in Hip joints • We used IRAP in 5 dogs with hip artrosis or Hip dysplasia. • In 3 dogs multiple joints where injected with IRAP • In 2 dogs only Hips where injected • No arthroscopy used • All dogs functioning good but Neutrasuiticals and Nsaid where used • I think a bigger study using IRAP in hip dysplasia after Arthroscopic evaluation are needed www.jennyhilldjurklinik.se

20. Irap www.jennyhilldjurklinik.se

21. Patient material • Large breed dogs are commonly getting arthrosis • In this material dogs weight are between 15 and 80 kg • 34 dogs and 57 joints with elbow arthrosis • 21 dogs and 36 joints with stifle arthrosis • 7 dogs with shoulder DJD • 5 dogs with hip arthrosis • 2 dogs with hook arthrosis www.jennyhilldjurklinik.se

22. IRAP – conclussion • 65 dogs and 107 joints with a follow up between 6 and 40 month. • 11 dogs are dead today 2 because of tumours in the affected limb, 3 because that they did not come back to full function and 6 of unrelated probleme • 12 function with other treatment • 37 good function but need NSAID • 16 perfect function without medication www.jennyhilldjurklinik.se

23. Skalpellen 2 may 2015 • At Jennyhill we currently have treated 170 dogs with ACS and more than 400 joints have been treated • All joints in the extremities have been treated • So far we have not used ACS in back problems • Some times especially in joints of lower extremities I combine with Lederspan (korticosteroids) www.jennyhilldjurklinik.se

24. Primary and secondary arthrosis • Primary arthrosis are probably less commen One example is primary stifflearthrosis in boxer breed and artrosis in cats • Secondary arthrosis : will be the consequence of any joint instability or incongruence. And probably we will end up with some degree of artrosis after all joint operations except Prostesis or panarthodesis www.jennyhilldjurklinik.se

25. When do I use ACS (IRAP) • Acute after cruciate operations and other traumatic joint diseases to prevent further artrosis • All chronic joint problems especially if there are multiple joints affected • We often see Hip artrosis at the time of cruciate surgery and than it is convenient to treat the hip at the same time with IRAP www.jennyhilldjurklinik.se

26. Multimodal treatment of arthrosis • Physiotherapy – exersice • Surgery • Joint diets • Nutritional supplements • Joint injections • Goal of treatments for different patients www.jennyhilldjurklinik.se

27. Questions?? • Sune Jerre • DVM , Specialist in Surgery • E.mail sune.jerre@telia.com www.jennyhilldjurklinik.se