Q Our family pet is a black Lab named Chuck. He is 8 years old and is relatively healthy. His only apparent problem is worsening arthritis in his elbows. We are giving him anti-inflammatories, and other supplements, but his elbows seem to be getting worse. A friend suggested stem cell therapy. What do you think of that? Are there any new surgeries that may help?
A: Elbows are a common trouble spot for many breeds, not the least of which are Labs. They are prone to elbow dysplasia, which includes a number of developmental abnormalities. These may occur singly, or in combination. Unfortunately, the benefits of the common surgical procedures seem to be short term, at best, and elbow replacement surgery is still not a mainstream option.
So, when surgery is no longer an option, arthritis, due to elbow dysplasia, is a condition that must be medically managed. This management includes nutritional supplements, nonsteroidal antiinflammatories (NSAIDS), exercise moderation and a host of other modalities, such as Laser therapy.
While these techniques may slow the progression of arthritis, or provide temporary relief from arthritic pain, none reverse, or arrest, it’s course. I (Henri Bianucci) know we can’t stand to see our pets suffer, so, for many, this situation is frustrating, and unacceptable.
Our frustration, and desire to help, leads us to embrace unproven options in the hopes of finding the magic bullet. At this time, stem cell therapy remains an unproven technique.
There are studies that have demonstrated improved joint function for up to a year, but the studies have been of small populations.
Most people imagine that stem cells placed into an arthritic joint, morph into cartilage cells, and line the joint with a new cartilage surface. This is not true. Their primary action is to reduce pain by modulating the pathways to inflammation.
Many may also imagine that stem cells are a noninvasive approach. Again, not true. Stem cells are concentrated from the patients own adipose (fat) tissue. Generally, the source fat is taken from the abdominal cavity. Acquiring the fat is a full surgical procedure, which requires general anesthesia.
Degenerative joint disease is often a disease of older patients, which may have concurrent health problems. This may render them poor candidates for anesthesia or surgery. Stem cell therapy is, therefore not a benign process. The whole procedure is expensive, invasive and the benefits are temporary.
It is an appealing concept to concentrate cells from one’s own body and deploy them to a problem area, stimulating and enhancing a healing response.
As with stem cells, platelet rich plasma (PRP) is also derived from the patient itself. Specifically, it is a concentrated fraction of blood that is rich in platelets. In addition to being the first cells to a site of tissue injury to stop the bleeding, they also deliver a host of growth factors, and have natural antihistamines, as well as antibacterial and antifungal properties. Numerous studies have demonstrated that PRP accelerates the healing of bone, ligaments, and tendons.
As for arthritic joints, PRP has been shown to stimulate cartilage formation, decrease pain and reduce inflammation. Studies have demonstrated that PRP therapy can actually slow the progression of arthritis and improve joint function.
Multiple human studies have produced similar findings and demonstrated significant joint pain reduction. As with stem cells, the benefits may be transient, on the order of a few months, but unlike stem cell therapy, PRP can be performed without surgery, or general anesthesia. It is non-invasive, and is approximately a tenth of the cost of stem cell therapy. The entire process takes about an hour.
There is still no magic bullet against arthritis, but PRP may represent a significant, new management modality. Using elements, derived from the patients own body, to direct and enhance a healing response, seems to be the wave of the future in human and animal health.
As these techniques are developed, and become available to the veterinary profession, practitioners and clients should engage them with care. Their risks, and benefits, should be weighed, and their application should always be evidence based. We feel that PRP meets this standard and is a safe, affordable and effective advancement in osteoarthritis management.
Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to firstname.lastname@example.org.