2015-06-09 Use of IRAP/ACS in dog Sune Jerre

23-04-18 www.jennyhilldjurklinik.se 1

Use of IRAP/ACS in dogSune Jerre

Use of IRAP/ACS in dogSune Jerre

IRAP- orthogen veterinary GmbhACS= Autologous conditioned Serum

IRAP- orthogen veterinary GmbhACS= Autologous conditioned Serum

• IRAP have been used in horses since 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


ACS to dogsACS to dogs

• Julio Reinecke offered me 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


Selection of dogs for IRAPSelection of dogs for IRAP


Blood sampling and handling Blood sampling and handling


Extraction of ACS-serumExtraction of ACS-serum


IRAP –Orthogen AGACS- Autologous conditioned Serum

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


During the first year 20 joints where treatedDuring 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


Results of first yearResults 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


Results was promisingResults 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


MY way to use IRAP in dogsMY 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


My experience of IRAP/ACSMy 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


Jennyhill djurklinikJennyhill 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


Arthroscopy 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

IRAP is a blood product that have to be handled steril

IRAP is a blood product that have to be handled steril


Use of IRAP in Elbow joints 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

Use of IRAP in stifle jointsUse 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

23-04-18www.jennyhilldjurklinik.se

17

• 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

Use of IRAP in Shoulder jointsUse 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.


Use of IRAP in Hip jointsUse 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


Irap Irap


Patient materialPatient 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


IRAP – conclussion 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

23-04-18 www.jennyh illdjurklinik.se

Skalpellen 2 may 2015Skalpellen 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)


Primary and secondary arthrosisPrimary 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


When do I use ACS (IRAP)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


Multimodal treatment of arthrosisMultimodal treatment of arthrosis

• Physiotherapy – exersice

• Surgery

• Joint diets

• Nutritional supplements

• Joint injections

• Goal of treatments for different patients


Questions??Questions??


• Sune Jerre• DVM , Specialist in

Surgery• E.mail

[email protected]

Documents

2015-06-09 Use of IRAP/ACS in dog Sune Jerre