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Small animal surgery I > Arthritis > Flashcards

Arthritis Flashcards

1
Q

What is arthropathy?

A

Any joint disease

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2
Q

What is arthrosis?

A

A joint; “wear and tear” (human term)

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3
Q

What is arthritis?

A

Inflammation within a joint

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4
Q

What is polyarthritis?

A

Inflammation within several joints simultaneously

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5
Q

What is an osteophyte?

A

Outgrowth of bone; forms at synovial or articular margins

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6
Q

Where do enthesiophytes form?

A

Tendon/ligament attachments

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7
Q

What is a joint mouse?

A

Mobile fragment within a joint

Loose osteophyte or fragment of cartilage

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8
Q

What is a joint capsule?

A

Sac that encloses a joint

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9
Q

What does the suffix “-rrhaphy” mean?

A

To suture in place; to close

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10
Q

What is ankylosis?

A

Spontaneous fusion of a joint

End stage of joint disease

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11
Q

What is arthrodesis?

A

Surgical fusion of a joint

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12
Q

Define “arthrotomy”

A

Incision into a joint

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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
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14
Q

What is osteoarthritis?

A
  • Aberrant repair of articular cartilage –> degradation of articular cartilage
  • Altered subchondral bone metabolism
  • Periarticular osteophytosis
  • Synovial inflammation (synovitis)
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15
Q

How can you differentiate between inflammatory and non-inflammatory arthritis?

A

Joint tap

Determine whether highly cellular or not

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16
Q

How is the treatment of inflammatory arthritis different from that of non-inflammatory arthritis?

A

Inflammatory = medical treatment

Non-inflammatory = surgical treatment

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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
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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
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19
Q

How does secondary arthritis differ from primary arthritis?

A
  • (DJD)
  • Developmental (OCD, hip dysplasia)
  • Acquired (trauma, neoplasia)
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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
Q

T/F: When treating osteoarthritis, moderate regular exercise is indicated immediately following diagnosis

A

FALSE

Once inflammation is controlled, moderate regular exercise is indicated

26
Q

What are 6 types of physical rehabilitation therapies for the non-surgical treatment of OA?

A
  • Cold/heat therapy
  • Passive ROM exercises (patient is not doing work, everything is done without weight-bearing)
  • Massage
  • Swimming
  • Treadmill
  • Acupuncture
27
Q

What are some symptom-modifying agents used in the non-surgical treatment of OA?

A
  • NSAIDs
    • Tramadol
    • Gabapentin
    • Amantadine
    • Corticosteroids (intra-articular injection)
28
Q

What is the goal of disease-modifying agents in the treatment of OA?

What is an example?

What should you avoid?

A
  • Promote substrate synthesis over breakdown
  • Adequan–IM injection
  • Chemically similar to heparin–don’t give if patient is also on heparin
29
Q

What is the mechanism of action for NSAIDs in the treatment of OA?

A
  • 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
Q

What is the mechanism of action for disease modifying agents in the treatment of OA?

A
  • Promote synthesis over breakdown of cartilage
  • Building blocks of articular cartilage or fluid
31
Q

What are some examples of disease-modifying agents?

A
  • Polysulfated glycosaminoglycans (PS-GAG)
    • Adequan label recommends IM injection
  • Pentosane polysulfate–interstitial cystitis
  • Hyaluronic acid–synovial fluid
  • Heparin analogues
32
Q

What are the mechanisms of action of nutraceuticals?

A
  • Food or part of a food that provides medical benefits
    • Cartilage building blocks
    • Anti-inflammatory effects
33
Q

What are some examples of nutraceuticals?

A
  • Glucosamine/chondroitin (Cosequin)
  • Omega-3 fatty acids
  • Avocado and soybean unsaponifiables
34
Q

What are the specific benefits/MoA of glucosamine? Is there any evidence?

A
  • Stimulate proteoglycan synthesis of hyaline cartilage matrix in vitro
  • Anti-inflammatory effects
  • Preparation variability
  • EBM: efficacy uncertain, but safe
35
Q

What is the specific MoA for omega-3 fatty acids? Is there any evidence that they are beneficial?

A
  • Produce less inflammatory mediators
  • Quality studies proving ^
36
Q

What are the benefits of avocado and soybean unsaponifiables?

Example?

Evidence?

A
  • Anti-inflammatory, anti-osteoarthritic
  • Gasequen (cosequin + unsaponifiables)
  • Not a whole lot of evidence but probably won’t hurt anything
37
Q

What is the process/theory of autologous platelet therapy? Is there any evidence proving it’s beneficial?

A
  • Platelets collected and injected into involved joint
  • Pain and wt. bearing improved at 12wks (study by company who makes it)
  • Uknown mechanism; debated
38
Q

When is stem cell therapy appropriate? What is the EBM?

A
  • 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
Q

T/F: Stem cell therapy is wholly benign

A

FALSE–requires anesthesia

40
Q

What are the possible side effects of NSAIDs?

A
  • 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
Q

What are the side effects of disease-modifying agents? EBM?

A
  • Heparin analogues–don’t use in animals with coagulopathies
  • Adequan–good
  • PPS–fair, good EBM support for PS-GAG
42
Q

What is the EBM behind nutraceuticals?

A
  • Glucosamine/chondroitin–efficacy uncertain, but safe
  • Omega-3 FAs–good mechanism-wise, but feeding studies have shown ineffectiveness
  • Lots of variation
43
Q

What does the term “salvage procedure” mean?

A
  • 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
Q

What are the indications for and implications of a salvage procedure in general terms?

A
  • Indicated for severe DJD
  • Generally delayed as long as possible
  • Outcome keyed to procedure/technique rather than cause
45
Q

What are the differences between joint replacement and partial excision arthroplasty?

A
  • 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
Q

Compare and contrast ankylosis to arthrodesis

A
  • 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
Q

What are the 4 principles of arthrodesis?

A
  • Complete removal of ALL articular cartilage
  • Cancellous bone graft
  • Rigid fixation (usually DCP)
  • Standing angle
48
Q

What are the guidelines for post-op management of arthrodesis?

A
  • Coaptation (splint or ESF)–6-8wks
  • Activity restriction until bony fusion
  • Prolonged healing common–3mo minimum
49
Q

What are the expected effects of arthrodesis of a given joint (general terms)?

A
  • High motion joint–“peg leg”
  • Low motion joint–minimal effect on gait
    • Distal joints in carpus/tarsus

Small animal surgery I (25 decks)

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