20.9.3: Multi-limb lameness Flashcards
Immune-mediated causes of multiple limb lameness
- Generalised osteoarthritis
- Septic arthritis
- Immune-mediated arthritis
- Panosteitis
Non-immune-mediated causes of multiple limb lameness
- Pulmonary osteopathy
- Metaphyseal osteopathy
- Rickets
- Nutritional hyperparathyroidism
- Osteogenesis imperfecta
Signalment and history with generalised osteoarthritis
- Seen in the older dog
- Primarily arises in breeds which suffer concurent developmental disease e.g. elbow dysplasia, hip dysplasia, or acquired disease e.g. cruciate rupture
Signalment and history associated with septic arthritis
- In the younger animal = multiple joints
- In the older animal = single joint
- May occur after surgery or following haematogenous spread
What is the most common cause of multiple limb lameness?
Immune-mediated arthritis
Signalment of panosteitis
- Inflammatory condition in multiple long bones
- Most common in young male (2 y.o.) GSDs
Aetiopathogenesis of pulmonary osteopathy
- A paraneoplastic syndrome resulting in inflammation and periosteal new bone to the distal limb
- Underlying lesion is a mass or masses, usually in the chest but occasionally the abdomen
- Cause not clearly determined but may arise from vagal stimulation arising from arteriovenous shunting
Signalment and prognosis for metaphyseal osteopathy
- Inflammatory condition seen in young dogs
- There are characteristic radiographic changes
- Prognosis is guarded
Signalment and radiographic findings with nutritional hyperparathyroidism
- All meat diet in the young animal
- Poorly mineralised bones with multiple folding fractures and collapse of the vertebrae
What history questions should you ask in the case of an animal presenting for multiple limb lameness?
- Age - young dogs more prone to vaccine associated polyarthritis, panosteitis. Viral causes e.g. calici virus in cat.
- Breed - Sharpei fever (amyloidosis), sulphonamide induced polyarthritis in Dobermann
- Recent vaccine or drug administration?
- Any recent tick exposure? Borellia infection may not become apparent for 2-5 months
- Recent travel / import from abroad?
- Any history of respiratory/ GI disease?
Diagnostic options in the animal presenting for multiple limb lameness
- Radiography: of all affected joints but also other body systems e.g. lungs if suspicious
- Arthrocentesis: look for elevated cell count, presence of neutrophils
- Serology
- Echocardiography and blood culture is suspect polyarthritis secondary to endocarditis
- CSF tap if suspect concurrent immune-mediated meningitis (rare)
- Liver, kidney, muscle, skin biopsies if suspect more widespread immune mediated disease
What tubes should you collect a sample of synovial fluid into? What aspects of this fluid will you asses?
Collect into EDTA and plain tubes
When must you consider joint taps?
In the investigation of the PUO animal
What findings would you expect from the synovial fluid sample of an animal with immune-mediated disease?
- Increased WBCC
- Predominantly neutrophils (even if the bacteria aren’t visible)
- Would expect the same findings for septic polyarthritis or vector-borne disease e.g. Lyme’s disease
Types of Immune Mediated Polyarthritis (IMPA)
IMPA can be divided into erosive and non-erosive forms.
Non-erosive idiopathic forms are further subdivided:
Clinical presentation of IMPA
- Generalised lameness in multiple joints
- May be worse in one limb but animal has poor movement generally with short stride lengths
- Any synovial joint can be affected including the axial skeleton
- Joints must be visually or palpably swollen and painful on manipulation
- May be accompanying muscle pain
- Animal may be systemically unwell with pyrexia
Which dog breed would you avoid giving sulphonamides to?
Dobermanns - due to risk of idiopathic immune-mediated polyarthritis
Characteristics of SLE when seen with immune-mediated polyarthritis and how to diagnose it
- Multisystem involvement with anaemia, leukopaenia, thrombocytopaenia, myositis, meningitis, glomerulonephritis
- ANF positive + 3 organ systems involved = positive diagnosis (ANF alone is not specific for SLE)
- Prognosis is poor
Which animals does Type III IMPA typically affect?
Young puppies with gastroenteritis
True/false: presence of a murmur + mutli-limb lameness is enough to confirm polyarthritis and endocarditis is present.
False
Need to confirm that the murmur has recently developed and is getting worse
Clinical signs and diagnosis of endocarditis and polyarthritis
= an erosive form of polyarthritis
Clinical signs
* Intermittent pyrexia
* Lethargy
* Weight loss
* Rapidly developing cardiac murmur (often diastolic with aortic and mitral valves most commonly affected)
* Associated thromboembolism may lead to renal failure
Diagnosis
* Commonly occurs with anaemia and leucocytosis
* Diagnosed by echo + blood culture (at least 3 samples taken at periods of pyrexia)
Treatment of non-immune-mediated polyarthritis
- If underlying cause can be identified, treat this
- e.g. antibiotics for septic arthritis, endocarditis
Treatment of immune mediated polyarthritis
- Treatment of underlying cause in Types II, III and IV may resolve signs
- Often immunosuppression required
- Management involves frequent monitoring esp of liver enzymes, WBC and platelet level
- Side effects of treatment are common
Immunosuppressive agents that can be used to treat immune mediated polyarthritis
- Prednisolone
- Azathioprine (not in cats!)
- Chlorambucil
- Methotrexate
- Ciclosporin, cyclophosphamide, levamisole all used to minimise side effects
What other treatment should you offer the animal who is on immunosuppressive treatment for immune-mediated polyarthritis?
Analgesia
* No NSAIDs if on steroids
* Paracetamol, opioids
* Bedinvetmab (Librela)
- Weight reduction and hydrotherapy
- Surgery e.g. arthrodesis and joint replacements
- Sometimes PTS most appropriate
What diagnostic tests could you consider if concerned about a myopathy?
- Clinical exam
- Biochemistry: CK, electrolytes, lactate, pyruvate
- Thyroxine (hypoT4)
- Serology: ACh receptor antibody for myasthenia gravis
- Serology: Neospora, Toxoplasma
- Muscle biopsy
What drug could you use to treat a suspected protozoal infection like Neospora?
Clindamycin
Signalment and presentation of sesamoiditis
Sesamoiditis: inflammation with associated fragmentation of the sesamoid bones
Signalment
* Seen esp in greyhounds; also in labs and young dogs
Presentation
* Profound acute lameness with pin point pain on applying pressure over the affected sesamoid and flexing and extending the metacarpo- or metatarso- phalangeal joints
* Lameness may resolve with rest only to reoccur with exercise
Treatment of sesamoiditis
- Rest and analgesia (NSAIDs) for 3-4 weeks
- If no success, local instillation of depo steroid preparation (methyl prednisolone) followed by similar period of rest
- If still no success, surgical excision of affected sesamoid
Presentation and treatment of torn nail
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2
3
Treatment of onchodystrophy
Neoplastic conditions of the nail bed
Treatment of pad lacerations
Causes and treatment of pad loss
Pathogenesis and treatment of corns
