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  1. #1
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    Default Combining IRAP and HA in an injection?

    Vets are proposing IRAP combined with HA for a horse in my barn who has significant arthritis in multiple joints.

    I've never heard of the two combined and am a touch leary (*edited - prob best if I don't post all the stuff I've been through with this clinic!).

    It is possible I'm being paranoid, but part of me wonders if they are just adding on extra stuff cause they think i'll pay for anything.

    I would be very happy to hear that I am being silly and this combo is standard or even new but promising. Just having some trust issues here!!


    Thanks in advance!!
    Last edited by clivers; Jun. 11, 2013 at 12:33 PM.



  2. #2
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    I will go with your vet is ignorant about the interactions and functions of the two.

    NO, don't combine the two as there can be interaction between the sodium hyaluronate and the Il-1ra.


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  3. #3
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    Reed,
    can you give me a super basic idea of what the interaction does? I'm not challenging, would just love to know more!
    thank you!!



  4. #4
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    I wouldn't do that personally as it would likely be waisteful. Also, significant arthritis tends to not respond to HA very well (compared to other options).

    I've had good luck with prp or prp plus triamicolone for horses that do not respond to steroids alone. I've seen some amazing results with adepose derived stem cells plus prp.



  5. #5
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    We did to regular HA+triamcinolone in February and he felt good initially but it only lasted 6-8 weeks or so



  6. #6
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    Quote Originally Posted by clivers View Post
    We did to regular HA+triamcinolone in February and he felt good initially but it only lasted 6-8 weeks or so
    Which begs the question: if that didn't work sufficiently, why take the weaker of the two drugs and use it?



  7. #7
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    Quote Originally Posted by flyracing View Post
    I wouldn't do that personally as it would likely be waisteful. Also, significant arthritis tends to not respond to HA very well (compared to other options).

    I've had good luck with prp or prp plus triamicolone for horses that do not respond to steroids alone. I've seen some amazing results with adepose derived stem cells plus prp.
    In a joint? There has never been one study or is there any body of evidence that suggests stem cells directly injected into a joint stimulates healing or cartilage generation. There is no support structure/physiology or mechanism to get the cells to differentiate etc.

    HA is an anti-inflammatory in the joint. Not as good as triamcinolone but effective. The reason HA+tri only works as long as it did was the metabolic action of arthritis and the fact only the inflammatory pathways were targeted. Was the assumption that HA will act as synovial fluid?

    As for binding, yes, Il-1ra and HA can bind. In experiments, HA is used to bind up Il-1ra for a delayed release subcutaneous administration (Bendele 2000). However this is not a clinical type application and it is not as simple as putting HA you get in a clinic with Il-1ra in a clinic.



  8. #8
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    I have had very good luck with the IRAP done on my horse's fetlock 2 years ago (knock wood). Sound since. In my case there was no combined treatment with HA, no follow-up treatment with HA, nothing at all injected since. My vet did suggest a flax seed supplement for possible prevention and it is either helping or at least not hurting.

    Also a friend had IRAP in her horse's fetlock longer ago than mine and hers has stayed sound as well.

    I'd go with the IRAP and see how that works for you first; you may want injections down the road but I'd let the IRAP work its magic first. No point paying for 2 things at once and then not really being sure which one of them had an impact.
    It's just grass and water till it hits the ground.


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  9. #9
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    Thanks for posting - I will keep my fingers crossed for a positive result.

    In the interim, I guess I will ask for the IRAP without HA.

    Reed, I'm sorry but I am still confused about the possible interaction between the two. Can you dumb it down a bit more for me? Thanks again!!



  10. #10
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    Quote Originally Posted by clivers View Post
    Thanks for posting - I will keep my fingers crossed for a positive result.

    In the interim, I guess I will ask for the IRAP without HA.

    Reed, I'm sorry but I am still confused about the possible interaction between the two. Can you dumb it down a bit more for me? Thanks again!!

    The idea of interaction is similar to oil and water and salt and water.

    If there is no "interaction" the two components will remain separate and maintain their specific activities (oil and water).

    If there is an "interaction" then the "mixture" becomes something totally different that may or may not work (salt in water).

    There can be synergistic effect (they add to each other) that may or may not help (salt water can be used for cooking but you don't want to drink it directly).



  11. #11
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    Thanks Reed!



  12. #12
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    I had a simular case. Responded to IRAP beautifully. I would give IRAP a try, its the next logical step as IRAP is suggested for horses that don't have long lasting effects from steroid HA injections.


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  13. #13
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    Thanks Fharoah!

    He had his IRAP yesterday (no HA) and will be having 4 days off and resuming hacking on Monday.

    I'll keep you guys posted



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