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Surgery > Arthritis and OCD > Flashcards

Arthritis and OCD Flashcards

1
Q

Arthorpathy

A

any joint disease

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2
Q

Arthrosis

A

a joint; “wear and tear” degeneration- human term

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3
Q

arthritis

A

inflammation within a joint

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4
Q

polyarthritis

A

inflammation in SEVERAL joints at the same time

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5
Q

osteophyte

A

forms at synovial or articular margins

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6
Q

enthesiophyte

A

forms at tendon/ligament attachment

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7
Q

joint mouse

A

mobile fragment within a joint; loose osteophyte; fragment of cartilage

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8
Q

joint capsule

A

the sac the encloses a joint

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9
Q

rrhaphy

A

to suture in place; to close

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10
Q

imbrication

A

surgical tightening

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11
Q

-plasty

A

surgical repair or shaping of

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12
Q

Ankylosis

A

spontaneous fusion of a joint; end stage of joint disease

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13
Q

arthrodesis

A

surgical fusion of a joint

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14
Q

arthrotomy

A

incision into a joint

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15
Q

Types of joints

A

synovial- elbow, hip, stifle, SI, veterbral facts; fibrous- skull tooth sockets; cartilaginous- symphyses, growth plates

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16
Q

What is the most common classification of arthritis?

A

Secondary non-infectious

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17
Q

Who gets primary non-inflammatory arthritis?

A

Hunting dogs, and CATS

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18
Q

Osteoarthritis

A

Syn- OA, osteoarthrosis, DJD aberrant repair of articular cartilage- degradation of articular cartilage altered subchondral bone metabolism periarticular osteophytoisis synovial inflammation (synovitis

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19
Q

How do you tell the difference between inflammatory and non-inflammatory?

A

JOINT TAP

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20
Q
A

Secondary arthritis with osteophytes

21
Q

What would you see on rads for arthritis?

A
  • osteophytes
  • effusion
  • ST swelling
  • subchondral sclerosis
  • increased/ decreased joint space

Remember, just because you don’t see anything on RADS, doesn’t mean it’s not there- but if you do see something then it’s there (high specificity, low sensitivity)

Correlation with clinical disease is variable

22
Q

What is the medical treatment for osteoarthritis?

A
  • WEIGHT MANAGEMENT- the most important; helps with puppies to prevent/delay rad changes; adults with established OA- reduces medical need for surgery
  • Excerise moderation- maintain muscle strength and joint flexibility wihout increasing pain
  • physical rehabiliation therapy- passive ROM
  • sympton- moderifying agents (analgesics and NSAIDS)
  • disease-modifiying agents (reparative)
  • Nutraceuticals
23
Q

What is the most effective non-surgical treatment for OA?

A

WEIGHT MANAGMENT

24
Q

NSAIDS for OA

A

NSAIDs reduce pro-inflammatory mediators by inhibiting cyclooxygenase

COX-1 inhibition: GI, renal side effects

COX-1 sparing or COX-2 selective drugs may also cause GI, renal or hepatic problems

All have side effects Cats – glucuronidation Onsior (robenacoxib)

25
Q

Disease-Modifying Agents

A

Promote synthesis over breakdown

Building blocks of articular cartilage or fluid

Polysulfated glycosaminoglycan (PS-GAG) Adequan label recommends IM injection (SQ)

Pentosan polysulfate – interstitial cystitis Hyaluronic acid – synovial fluid
Good EBM support for PS-GAG and PPS Heparin analogues

26
Q

Neutraceuticals

A

Food or part of a food that provides medical benefit

Cartilage building blocks Anti-inflammatory effects

Glucosamine/chondroitin
Omega-3 fatty acids
Avocado and soybean unsaponifiables Others

27
Q

Omega-3 Fatty Acids

A

Eicosapentanoic acid (EPA) Docosahexanoic acid (DHA)

Compete with arachidonic acid (AA, O-6 FA) as a substrate for COX

Produce less proinflammatory mediators May decrease need for NSAIDS
Rarely cause GI problems
EBM – good*

28
Q

Avocado/Soybean ASUs

A

Avocado and soybean oil unsaponifiables Dasuquin
Anti-inflammatory, anti-osteoarthritic Decrease inflammatory mediators Increase cartilage matrix synthesis Based upon in vitro models Experimentally protective

29
Q

Autologous Platelet Therapy

A

Platelets collected and injected into involved joint

JAVMA November 2013: Pain and weight bearing improved at 12 weeks

Mechanism unknown Some debate over

30
Q

Stem Cell Therapy

A

Lots of studies in horses and humans

EBM very iffy in dogs for clinical arthritis

May be appropriate for some cases Non-responsive immune-mediated disease When salvage or replacement is not viable

Less expensive than joint replacement(?) Not wholly benign – requires anesthesia

31
Q

which Cox receptor do you only want to block?

A

COX-1

32
Q

Surgical Treatment – Salvage

A

Indicated when severe DJD is present Generally delayed as long as possible Goal: preserve life/limb function
No attempt to cure or fix cause of DJD

Outcome keyed to procedure/technique rather than cause

Joint replacement arthroplasty
Partial joint excision arthroplasty Arthrodesis (also technically an arthroplasty) Amputation (NOT an arthroplasty)

33
Q

What joints can you do a joint replacement arthroplasty with?

A

HIP, STIFLE, ELBOW, SHOULDER

34
Q

What are the principles of arthrodesis?

A
  • complete removal of all articular cartilage
  • cancellous bone graft
  • rigid fixation (usually DCP)
  • fusion at a standing angle
35
Q

Definition of OCD

A
  • defect in endochrondral ossificaiton
  • endochondral ossification: the process by which epiphyseal cartilage becomes bone
  • starts from the epihyseal center of ossification
  • travels outward- “ossification wave”
36
Q

Endochondral ossification

A
  • cartilage blood supply: perichondral plexus
  • ossification wave- anastomoses form
    • perichondral plexus
    • epihyseal bone supply
37
Q

What is the pathophysiology of OCD(osteochrondritis dissecans)?

A
  • Disruptions in anastomoses lead to cartilage necrosis
  • necrosis of cartilage “blocks” ossification wave(like objects in a light beam)
  • necrotic epiphyseal cartilage cannot ossify
  • this is what is meant by “failure of ossification”
  • small defects may ossify by other means
    • “intramembranous ossification”
    • lesion resolves- not a clinicial problem
  • Failure to ossify- thickened cartilage
  • thickened cartilage acts as “stress riser”
  • necrosis- cleft between cartilage and bone
  • focused stresses over cleft- fracture of cartilage
38
Q

where does 80% of long bone growth come from?

A

physis

39
Q

When does endochondral ossificaiton occur?

A

6 months

40
Q

Osteochondritis Dissecans

A

Osteochondrosis vs. Osteochondritis Necrotic cartilage induces repair Inflammation is the first stage of repair Defect in joint surface accelerates DJD

Pain of clinical disease
Initially: result of inflammation due to necrosis Later: result of degenerative joint disease This is the basis of the “biphasic presentation”

41
Q

Etiology of OCD

A

Genetics/heredity

Nongenetic/environmental factors

Nutrition
Vitamin D/Calcium Energy

Trauma

Both genetic and nongenetic factors must be present for disease to manifest

Genes alone not responsible for disease Genes dictate susceptibility to other factors Gender – males predisposed

Breed – large, giant breeds Heritability 10-45%
DON’T BREED

Vitamin D and Calcium

High Ca/Vit D promotes errors in endochondral ossification in great danes

Direct causation of OCD not established High Ca/Vit D linked to other ortho diseases

Energy
Promotes development of bone and muscle Increases stress on developing cartilage

Microtrauma – normal weightbearing stress Abnormal cartilage more prone to injury Lesions occur even with normal stresses

Macrotrauma – athletic, high-impact stress May cause subclinical to become clinical
No direct evidence in dogs
Shown to be a factor in human OCD

42
Q

What is the most common trauma that causes OCD?

A

microtrauma

43
Q

What is the typical signalment of OCD?

A

male large/giant breed dog

44
Q

What are the most common joints affected with OCD?

A

Shoulder – caudolateral humeral head

Elbow – medial humeral condyle
Hock – medial or lateral talar ridge
Stifle – medial or lateral femoral condyle

45
Q
A

OCD- flattened caudal humeral head

46
Q

What are preventive measures for OCD?

A

Preventive measures (i.e., no clinical signs)

Diet: energy, calcium, vitamin D restriction

Exercise restriction
Evidence – dogs vs. humans
Difficulty – confinement vs. eliminating high-impact

47
Q

Indications and treatment for conservative OCD Lesions

A

Indications
Small lesion
Young patient (ossification incomplete < 6 mos) Clinically silent or mild lameness
Poor surgical outcome – site-dependent

Diet/exercise restriction Weight control
+/- NSAID or other therapies

48
Q

Surgical Treatment for OCD

A

Fragment removal and subchondral bone debridement – usually arthroscopic

Replacement of articular cartilage with fibrocartilage – imperfect

Osteochondral transplants (OATS)

Various synthetic/semisynthetic implants in humans

Surgery (11 decks)

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