Arthritis Flashcards
What is arthropathy?
Any joint disease
What is arthrosis?
A joint; “wear and tear” (human term)
What is arthritis?
Inflammation within a joint
What is polyarthritis?
Inflammation within several joints simultaneously
What is an osteophyte?
Outgrowth of bone; forms at synovial or articular margins
Where do enthesiophytes form?
Tendon/ligament attachments
What is a joint mouse?
Mobile fragment within a joint
Loose osteophyte or fragment of cartilage
What is a joint capsule?
Sac that encloses a joint
What does the suffix “-rrhaphy” mean?
To suture in place; to close
What is ankylosis?
Spontaneous fusion of a joint
End stage of joint disease
What is arthrodesis?
Surgical fusion of a joint
Define “arthrotomy”
Incision into a joint
What are the 3 types of joints?
-
Synovial
- Elbow, hip, stifle, SI, vertebral facets
- Fibrous
- Skull, tooth sockets
- Cartilaginous
- Symphyses, growth plates
What is osteoarthritis?
- Aberrant repair of articular cartilage –> degradation of articular cartilage
- Altered subchondral bone metabolism
- Periarticular osteophytosis
- Synovial inflammation (synovitis)
How can you differentiate between inflammatory and non-inflammatory arthritis?
Joint tap
Determine whether highly cellular or not
How is the treatment of inflammatory arthritis different from that of non-inflammatory arthritis?
Inflammatory = medical treatment
Non-inflammatory = surgical treatment
What is the sub-classification of inflammatory arthritis?
- Infectious
- Bacterial (aka, septic), fungal, mycoplasmal, etc.
- Non-infectious (immune-mediated)
- Erosive (e.g., rheumatoid), non-erosive
What causes primary arthritis? What species is it more common in?
- Idiopathic
- Don’t know what the underlying cause is
- Highly unusual in dogs
- Relatively more common in cats
How does secondary arthritis differ from primary arthritis?
- (DJD)
- Developmental (OCD, hip dysplasia)
- Acquired (trauma, neoplasia)
What are the pros and cons to using radiographs as a diagnostic tool in arthritis?
- Pros
- Readily available
- Inexpensive
- Good for confirmation (high specificity)
- Cons
- Bad for ruling out (low sensitivity)
- Correlation with clinical severity is variable
What are some radiographic signs of arthritis?
- Osteophytes
- Effusion
- Increased/decreased joint space
- Soft tissue swelling
- Subchondral sclerosis
What are the arrows pointing to?
Osteophytes
What is the single most important element of medical treatment for osteoarthritis?
What are some other non-surgical treatment options?
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
What are the specific weight management goals/techniques (puppies and adults)?
- 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)
T/F: When treating osteoarthritis, moderate regular exercise is indicated immediately following diagnosis
FALSE
Once inflammation is controlled, moderate regular exercise is indicated
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
What are some symptom-modifying agents used in the non-surgical treatment of OA?
- NSAIDs
- Tramadol
- Gabapentin
- Amantadine
- Corticosteroids (intra-articular injection)
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
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
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
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
What are the mechanisms of action of nutraceuticals?
- Food or part of a food that provides medical benefits
- Cartilage building blocks
- Anti-inflammatory effects
What are some examples of nutraceuticals?
- Glucosamine/chondroitin (Cosequin)
- Omega-3 fatty acids
- Avocado and soybean unsaponifiables
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
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 ^
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
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
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
T/F: Stem cell therapy is wholly benign
FALSE–requires anesthesia
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
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
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
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
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
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
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
- Preferred over ankylosis
- Ankylosis–abnormal adhesion of bones to a joint
- End-stage joint–let it do its thing on its on
What are the 4 principles of arthrodesis?
- Complete removal of ALL articular cartilage
- Cancellous bone graft
- Rigid fixation (usually DCP)
- Standing angle
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
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
