Arthritis Flashcards
(49 cards)
1
Q
What is arthropathy?
A
Any joint disease
2
Q
What is arthrosis?
A
A joint; “wear and tear” (human term)
3
Q
What is arthritis?
A
Inflammation within a joint
4
Q
What is polyarthritis?
A
Inflammation within several joints simultaneously
5
Q
What is an osteophyte?
A
Outgrowth of bone; forms at synovial or articular margins
6
Q
Where do enthesiophytes form?
A
Tendon/ligament attachments
7
Q
What is a joint mouse?
A
Mobile fragment within a joint
Loose osteophyte or fragment of cartilage
8
Q
What is a joint capsule?
A
Sac that encloses a joint
9
Q
What does the suffix “-rrhaphy” mean?
A
To suture in place; to close
10
Q
What is ankylosis?
A
Spontaneous fusion of a joint
End stage of joint disease
11
Q
What is arthrodesis?
A
Surgical fusion of a joint
12
Q
Define “arthrotomy”
A
Incision into a joint
13
Q
What are the 3 types of joints?
A
-
Synovial
- Elbow, hip, stifle, SI, vertebral facets
- Fibrous
- Skull, tooth sockets
- Cartilaginous
- Symphyses, growth plates
14
Q
What is osteoarthritis?
A
- Aberrant repair of articular cartilage –> degradation of articular cartilage
- Altered subchondral bone metabolism
- Periarticular osteophytosis
- Synovial inflammation (synovitis)
15
Q
How can you differentiate between inflammatory and non-inflammatory arthritis?
A
Joint tap
Determine whether highly cellular or not
16
Q
How is the treatment of inflammatory arthritis different from that of non-inflammatory arthritis?
A
Inflammatory = medical treatment
Non-inflammatory = surgical treatment
17
Q
What is the sub-classification of inflammatory arthritis?
A
- Infectious
- Bacterial (aka, septic), fungal, mycoplasmal, etc.
- Non-infectious (immune-mediated)
- Erosive (e.g., rheumatoid), non-erosive
18
Q
What causes primary arthritis? What species is it more common in?
A
- Idiopathic
- Don’t know what the underlying cause is
- Highly unusual in dogs
- Relatively more common in cats
19
Q
How does secondary arthritis differ from primary arthritis?
A
- (DJD)
- Developmental (OCD, hip dysplasia)
- Acquired (trauma, neoplasia)
20
Q
What are the pros and cons to using radiographs as a diagnostic tool in arthritis?
A
- Pros
- Readily available
- Inexpensive
- Good for confirmation (high specificity)
- Cons
- Bad for ruling out (low sensitivity)
- Correlation with clinical severity is variable
21
Q
What are some radiographic signs of arthritis?
A
- Osteophytes
- Effusion
- Increased/decreased joint space
- Soft tissue swelling
- Subchondral sclerosis
22
Q
What are the arrows pointing to?
A
Osteophytes
23
Q
What is the single most important element of medical treatment for osteoarthritis?
What are some other non-surgical treatment options?
A
WEIGHT MANAGEMENT IS THE SINGLE MOST IMPORTANT ELEMENT OF MEDICAL TREATMENT
Other options:
- Exercise moderation
- Physical rehabilitation therapy
- Symptom-modifying agents (analgesics)
- Disease-modifying agents (reparative)
- Nutraceuticals
24
Q
What are the specific weight management goals/techniques (puppies and adults)?
A
- Puppies–delay/prevent radiographic OA
- 25% more food doubles wt. at 6mo
- Calorie restriction decreases OA prevalence
- Avoid free-feeding
- Adults–established OA
- Reduces need for medication/sx
- Decreased BCS –> longer lifespan
- Good to excellent EBM support
- Pharmaceuticals (Slentrol)
25
T/F: When treating osteoarthritis, moderate regular exercise is indicated immediately following diagnosis
FALSE
**Once inflammation is controlled,** moderate regular exercise is indicated
26
What are 6 types of physical rehabilitation therapies for the non-surgical treatment of OA?
* Cold/heat therapy
* Passive ROM exercises (patient is not doing work, everything is done **without** weight-bearing)
* Massage
* Swimming
* Treadmill
* Acupuncture
27
What are some symptom-modifying agents used in the non-surgical treatment of OA?
* NSAIDs
* Tramadol
* Gabapentin
* Amantadine
* Corticosteroids (intra-articular injection)
28
What is the goal of disease-modifying agents in the treatment of OA?
What is an example?
What should you avoid?
* Promote substrate synthesis over breakdown
* Adequan--IM injection
* Chemically similar to heparin--**don't give if patient is also on heparin**
29
What is the mechanism of action for NSAIDs in the treatment of OA?
* Reduce pro-inflammatory mediators by inhibiting cyclooxygenase
* COX-1: responsible for maintaining normal physiologic processes
* COX-2: "inducible form", activated in inflammation
* Cats--glucuronidation
30
What is the mechanism of action for disease modifying agents in the treatment of OA?
* Promote synthesis over breakdown of cartilage
* Building blocks of articular cartilage or fluid
31
What are some examples of disease-modifying agents?
* Polysulfated glycosaminoglycans (PS-GAG)
* Adequan label recommends IM injection
* Pentosane polysulfate--interstitial cystitis
* Hyaluronic acid--synovial fluid
* Heparin analogues
32
What are the mechanisms of action of nutraceuticals?
* Food or part of a food that provides medical benefits
* Cartilage building blocks
* Anti-inflammatory effects
33
What are some examples of nutraceuticals?
* Glucosamine/chondroitin (Cosequin)
* Omega-3 fatty acids
* Avocado and soybean unsaponifiables
34
What are the specific benefits/MoA of glucosamine? Is there any evidence?
* Stimulate proteoglycan synthesis of hyaline cartilage matrix in vitro
* Anti-inflammatory effects
* Preparation variability
* EBM: efficacy uncertain, but safe
35
What is the specific MoA for omega-3 fatty acids? Is there any evidence that they are beneficial?
* Produce less inflammatory mediators
* Quality studies proving ^
36
What are the benefits of avocado and soybean unsaponifiables?
Example?
Evidence?
* Anti-inflammatory, anti-osteoarthritic
* Gasequen (cosequin + unsaponifiables)
* Not a whole lot of evidence but probably won't hurt anything
37
What is the process/theory of autologous platelet therapy? Is there any evidence proving it's beneficial?
* Platelets collected and injected into involved joint
* Pain and wt. bearing improved at 12wks (study by company who makes it)
* Uknown mechanism; debated
38
When is stem cell therapy appropriate? What is the EBM?
* *Might* be appropriate for:
* Non-responsive immune-mediated disease
* When salvage or replacement is not viable
* EBM very iffy in dogs for clinical arthritis
39
T/F: Stem cell therapy is wholly benign
FALSE--requires anesthesia
40
What are the possible side effects of NSAIDs?
* **All have side effects**
* COX-1 inhibition: GI, renal
* COX-1 sparing or COX-2 selective drugs may also cause GI ulceration, renal or hepatic problems
41
What are the side effects of disease-modifying agents? EBM?
* Heparin analogues--**don't use in animals with coagulopathies**
* Adequan--good
* PPS--fair, good EBM support for PS-GAG
42
What is the EBM behind nutraceuticals?
* Glucosamine/chondroitin--efficacy uncertain, but safe
* Omega-3 FAs--good mechanism-wise, but feeding studies have shown ineffectiveness
* **Lots of variation**
43
What does the term "salvage procedure" mean?
* Goal is to preserve life or limb function
* No attempt to cure or fix underlying cause of DJD (or other disease)
* Delayed as long as possible
44
What are the indications for and implications of a salvage procedure in general terms?
* Indicated for severe DJD
* Generally delayed as long as possible
* Outcome keyed to procedure/technique rather than cause
45
What are the differences between joint replacement and partial excision arthroplasty?
* Joint replacement arthroplasty
* Intent: restore/preserve normal joint function
* **Gold standard**
* Artificial implants
* Requires lots of training/expertise/equipment
* Hip, elbow, stifle, shoulder
* Partial excision arthroplasty
* Remodeling of joint **without replacement**
* Less specialized
* Less training
46
Compare and contrast ankylosis to arthrodesis
* Arthrodesis--artificial fusion of a joint
* Preferred over ankylosis
* More rapid fusion
* More complete fusion (true ankylosis is rare)
* Less discomfort over time
* Ankylosis--abnormal adhesion of bones to a joint
* End-stage joint--let it do its thing on its on
47
What are the 4 principles of arthrodesis?
* Complete removal of ALL articular cartilage
* Cancellous bone graft
* Rigid fixation (usually DCP)
* Standing angle
48
What are the guidelines for post-op management of arthrodesis?
* Coaptation (splint or ESF)--6-8wks
* Activity restriction until bony fusion
* Prolonged healing common--3mo minimum
49
What are the expected effects of arthrodesis of a given joint (general terms)?
* High motion joint--"peg leg"
* Low motion joint--minimal effect on gait
* Distal joints in carpus/tarsus
