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Y3 MOD Orthopaedics > Arthritides in domestic species > Flashcards

Arthritides in domestic species Flashcards

1
Q

What are arthritidies?

A

Conditions causing pain and dysfunction related to joints

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2
Q

What is arthritis?

What are 3 examples of included conditions?

A

Inflammation/degeneration of the joint

- Includes: osteoarthritis, immune-mediated arthritis, infective arthritis

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3
Q

What is a Diarthrodial joint

A

A specialised joint consisting of a synovial cavity allowing articulation between two or more bones

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4
Q

What are some examples of Diarthrodial joints?

A
  • Ball and socket (e.g. coxofemoral)
  • Hinge or ginglymus (e.g. elbow)
  • Gliding (e.g. tarsometatarsal)
  • Pivot (e.g. atlantooccipital)
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5
Q

Why are joint diseases important to animals and their owners?

A
  • Cause of pain and suffering: welfare/duty of care
  • Costs to client
  • Loss of function/athletic use
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6
Q

What are the effects on clients when their pet has a joint disease?

A
  • Animals living longer/emotional attachment
  • Drug costs e.g. NSAID use
  • Milk/productivity losses to farmer
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7
Q

What is the most common cause of euthanasia with horse insurance claims

A

Joint disease

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8
Q

What is the most common type of joint disease?

A

Degenerative joint disease

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9
Q

What type of motion is provided by diarthrodial joints?

A

Frictionless, pain-free motion

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10
Q

What are the overall components of a normal synovial joint

A
  • Diarthrodial joints
  • Hyaline cartilage covered bones
  • Synovial fluid
  • Fibrous joint capsule
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11
Q

Articular cartilage has a close relationship with … within the synovial joint

A

Subchondral bone

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12
Q

What is synovial fluid made of?

A

Ultrafiltrate of plasma plus protein (hyaluronic acid)

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13
Q

Describe the components of the fibrous joint capsule

A
  • Synovial membrane
  • Nerves and blood vessels
  • Supportive ligaments/tendons e.g. collateral, muscular
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14
Q

What is osteoarthritis?

A

Degenerative condition ultimately leading to cartilage breakdown and loss of function (end-stage)

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15
Q

Describe the structure of articular cartilage

A

Highly specialised tissue: predominately extracellular matrix with a low density of articular chondrocytes

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16
Q

What is the function of chondrocytes?

A

Maintenance of the matrix

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17
Q

What are the components of the matrix?

A

Collagens (80-90% type II), proteoglycans and water

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18
Q

What are the functions of collagens and proteoglycans within the matrix?

A
  • Collagens confer shear resistance

- Hydrated proteoglycans provide compression

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19
Q

Osteoarthritis is thought of as a disease of which part of the synovial joint?

A

Articular cartilage

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20
Q

Which tissues contribute to the disease progression/clinical signs of osteoarthritis?

A
  • Articular cartilage
  • Subchondral bone
  • Synovial membrane
  • Joint capsule
  • Ligaments
  • Fat pad
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21
Q

What are some possible predisposing factors for osteoarthritis?

A
  • Exercise/ trauma/ biomechanics
  • Developmental orthopaedic disease
  • Obesity
  • Genetics
  • Sepsis
  • Repeat medications
  • Ageing
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22
Q

What processes occur within a joint with osteoarthritis?

A
  • Neoangiogenesis
  • Neurogenesis
  • Synovial fibrosis and inflammation
  • Osteophyte formation
  • Subchondral bone remodelling
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23
Q

What questions should be asked when obtaining the history of a patient with osteoarthritis?

A
  • Age, signalment, use, breeding
  • Level of exercise
  • Determine onset and progression of disease
  • Response to medication
  • Other medical issues (e.g. immune mediated)
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24
Q

Describe the clinical exam of a patient with osteoarthritis?

A

General physical examination:
• TPR, thoracic auscultation etc
• Assessment of body condition, conformation, muscling
Lameness examination:
• Observation, palpation, manipulation and movement
• Pain, thickening, effusion, range of motion

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25
Q

Name some radiographic signs of osteoarthritis

A
  • Soft tissue swelling
  • Osteophytosis
  • Enthesiophytosis
  • Subchondral bone sclerosis
  • Intra-articular mineralisation (e.g. meniscus)
  • Fragmentation/joint mice
  • Collapsed joint space
  • Subchondral bone cysts
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26
Q

What are the 4 aims of osteoarthritis therapy?

A
  • Provide analgesia
  • Control articular inflammation
  • Limit damage to articular tissues
  • Promote healing of damaged cartilage – the Holy Grail!
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27
Q

What are some considerations/factors for the efficacy of treatments for osteoarthritis

A
  • Heterogeneity of the disease
  • Poor correlation between imaging and disease process
  • Lack of reliable indicators of disease process
  • Inter-animal variation
  • High expectations/demands of owners
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28
Q

What are the conservative methods for managing a patient with osteoarthritis?

A
  • Rest/restricted activity
  • Weight loss
  • Exercise
29
Q

Which drugs can be used to medically manage osteoarthritis?

A
  • NSAIDs
  • Corticosteroids
  • Hyaluronic acid
  • Pentosan polysulphate
  • Bisphosphonates
  • Nutraceuticals
30
Q

What are the main benefits of NSAIDs?

A

Anti-inflammatory, anti-pyretic, analgesic

31
Q

Anti-inflammatory and analgesic effects of NSAIDs is via ?

A

Cycloxygenase (COX) inhibition

32
Q

Name some NSAIDs used in SA practice

A
  • Carprofen (Rimadyl)
  • Meloxicam (Metacam)
  • Phenylbutazone
  • Paracetomol/codeine (Pardale V)
  • Firocoxib (Previcox)
33
Q

Name some NSAIDs used in equine practice

A
  • Phenylbutazone (Equipalazone)
  • Flunixin (Finadyne)
  • Firocoxib (Equiox)
  • Carprofen (Rimadyl)
  • Ketoprofen (Ketofen)
34
Q

How do corticosteroids work in the body?

A
  • Bind to cytoplasmic and nuclear receptors
  • Inhibit cytokines (eg. IL-1)
  • Altered signalling pathways and gene expression
35
Q

What are the pros/cons of corticosteroid use?

A
  • Variability in efficacy and duration of action
  • Cheap and effective
  • Potential steroid-induced arthropathy reported (repeat usage)
36
Q

Hyaluronic acid is a normal component of?

A

Synovial fluid and articular cartilage

37
Q

What are the actions of hyaluronic acid?

A
  • Chondroprotection (reduces chondrocyte apoptosis)
  • Anti-inflammatory
  • Stimulate proteoglycan synthesis
  • Mechanical effect (improves viscosity)
  • Limits subchondral bone changes
  • Analgesia (bind to stretch receptors)
38
Q

Pentosan polysulphate is marked as a DMOAD, what does that stand for?

A

Disease modifying osteoarthritis drug

39
Q

What are the actions of Pentosan polysulphate?

A
  • Enhances proteoglycan synthesis
  • Reduction in articular cartilage fibrillation
  • Fibrinolytic: improves joint perfusion
  • Improves synovial fluid viscosity
  • Increases release of free radical scavengers
40
Q

Describe the actions of bisphosphonates

A

Bisphosphonates are potent inhibitors of bone resorption:

  • Inhibition of osteoclasts
  • May also inhibit collagenase release in chondrocytes/ synovial cells
41
Q

What are neutraceuticals?

A

Dietary products which provides medical or health benefits, including the prevention and treatment of disease

42
Q

How can osteoarthritis be surgically treated?

A
  • Arthroscopy
  • Joint replacement: hip/elbow
  • Arthrodesis
43
Q

What is arthroscopy?

A
  • Assess damage
  • Debride cartilage defects
  • Flushing inflammatory mediators
44
Q

What is arthrodesis?

A
  • Destruction of cartilage

- Bone-bone primary healing

45
Q

What are the main features of immune mediated joint disease?

A
  • Usually present as polyarthritis and can be erosive or non-erosive (erosive = poor prognosis)
  • Predominately idiopathic
  • Most relate to abnormal activity of immune cells and antigen-presentation
46
Q

Describe the pathophysiological events involved in immune mediated joint disease

A
  • Early changes occur in synovium
  • > Chronic antigenic stimulation
  • > Antibodies to infective agents or macromolecule modification leading to inappropriate immune response
  • Development of immune-complexes that get deposited or expressed within the joint creating a strong and prolonged inflammatory reaction
47
Q

How is immune mediated polyarthritis diagnosed?

A
  • Multiple limb joint pain/swelling, generalised stiffness, shifting lameness, neck pain, lethargy, PUO
  • Variable and intermittent in character
  • Secondary OA and fibrosis/joint deformities with chronic cases
48
Q

Which test is used to manage immune mediated polyarthritis?

A

Synoviocentesis

49
Q

During the clinical exam/diagnostics, what characteristic involvements of other systems is seen with immune mediated polyarthritis?

A
  • Haematology/ biochemistry, thoracic/ abdominal x-ray
  • Anaemia, leucopenia, thrombocytopenia, raised globulins, low albumin
  • Urinalysis: proteinuria
50
Q

What can be seen with diagnostic imaging in immune mediated polyarthritis?

A
  • Early: non-specific joint effusion

- Late: erosive versus non-erosive; OA

51
Q

What is the treatment of choice for immune mediated polyarthritis?

A

Corticosteroids

52
Q

Infective arthritis is also known as?

A

Synovial sepsis

53
Q

What is the causative agent of synovial sepsis?

A

Inflammatory arthropathy due to an infective organism

- Usually bacteria but occasionally fungi, mycoplasma, rickettsia, protozoa and viruses

54
Q

What are the causes of infective arthritis/synovial sepsis?

A
  • Haematogenous
  • Trauma/wound
  • Iatrogenic
55
Q

Describe Haematogenous infective arthritis

A
  • Often separate focus of infection identified e.g. umbilicus, pneumonia, diarrhoea, septicaemia
  • More common (but not exclusively) in neonates (due to failure of passive transfer)
56
Q

How can trauma/wounds be the cause of infective arthritis?

A
  • Often seen in horses (esp. distal limb wounds due to sparse soft tissue coverage)
  • Cat bites e.g. Pasteurella multocida
  • Adjacent infection (e.g. complicated sole ulcer leading to septic arthritis of DIPJ in cattle)
57
Q

What are iatrogenic causes of infective arthritis?

A

e.g. post-joint/fracture surgery or following intra-articular injection (often Staphlococcus spp.); more common in small animal surgery

58
Q

Describe the pathophysiology of infective arthritis/synovial sepsis

A

Marked inflammatory response:

  • Vasodilation and influx of neutrophils
  • Release of inflammatory cytokines/enzymes
  • Fibrin clots trap bacteria
  • Cartilage destruction and extension to subchondral bone -> osteomyelitis
59
Q

Why does the formation of fibrin clots in the pathophysiology of infective arthritis/synovial sepsis have a negative effect?

A
  • Protects bacteria – prolonging the problem

* Reduces synovial nutrient exchange which has a negative effect on synovial function

60
Q

What are the clinical signs of infective arthritis/synovial sepsis

A
  • Acute onset, severe lameness
  • Stiffness/lying down/pyrexia
  • Wound near/over joint
  • Pain on palpation/ articular swelling
61
Q

What are 3 differential dignoses for infective arthritis/synovial sepsis ?

A
  • Traumatic joint injury (ligament/fracture)
  • Osteochondrosis
  • Bursitis/hygroma/cellulitis
62
Q

Which technique is used to truly diagnose infective arthritis/synovial sepsis ?

A

Synoviocentesis

63
Q

Describe the features of normal synovial fluid

A
  • Pale yellow, high viscosity
  • w.b.c <1x109/l and total protein <20g/l
  • <10% neutrophils
64
Q

Describe the features of septic synovial fluid

A
  • Serosanguinous/ turbid/ reduced viscosity
  • w.b.c.>10-20x109/l and total protein >30-40g/l - Significant increase in WBC and protein
  • > 90% neutrophils
65
Q

What are the 3 principles of treatment for infective arthritis/synovial sepsis?

A
  1. Treat underlying cause/infective agent (don’t always know the agent though)
  2. Systemic and local antimicrobials
  3. Remove inflammatory mediators (joint lavage)
66
Q

What is the cause of Lyme disease?

A

Tick-borne spirochaete Borrelia burgdorferi

67
Q

What are the features of Lyme disease?

A

• Multisystemic, inflammatory disorder

  • Dogs present with inflammatory, non-erosive arthropathy with shifting lameness and swollen joints
  • Also reported in horses (low grade pyrexia, stiffness, joint swelling, lethargy, skin lesions)
68
Q

Describe what would be seen on Synoviocentesis for a case of Lyme disease?

A
  • Increased cell count with 80-90% PMNs

- Rare to culture B.burgdorferi (PCR or serology)

69
Q

How is Lyme disease treated?

A

doxycycline (30 days+)

Y3 MOD Orthopaedics (7 decks)

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