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Preeti: SA Surgery > Arthritis and OCD Objectives > Flashcards

Arthritis and OCD Objectives Flashcards

1
Q

Any joint disease is known as an

A

arthropathy

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2
Q

Broad term for degenerative and other diseases of the joint

A

Arthrosis

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3
Q

Inflammation within a joint

A

Arthritis

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4
Q

Inflammation in several joints simultaneously

A

Polyarthritis

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5
Q

Term for surgical closure of the joint capsule

A

Capsulorrhapy

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6
Q

Surgical tightening of fascia, joint capsule, tendon

or

surgical pleating and folding of tissue to realign organs and provide

extra support,e.g. chronically stretched joint capsule.

A

Imbrication

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7
Q

Surgical repair or shaping of a joint

A

Arthroplasty

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8
Q

a bony outgrowth associated with the degeneration of cartilage at joints

A

Osteophyte

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9
Q

abnormal bony projections at the attachment of a tendon or ligament

A

Enthesophytes

(They are not to be confused with osteophytes, which are abnormal bony projections in joint spaces)

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10
Q

a loose fragment (as of cartilage) within a synovial space

A

Joint mouse

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11
Q

abnormal stiffening and immobility of a joint due to fusion of the bones

or

spontaneous fusion of a joint (when osteophytes come together)

as an end result of chronic joint disease

A

Ankylosis

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12
Q

Surgical fusion of a joint

A

Arthrodesis

(better than ankylosis which occurs on its own)

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13
Q

Incision into a joint

A

arthrotomy

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14
Q

What are the 3 categories of joints?

A

Synovial

Cartilagenous

Fibrous

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15
Q

What category of joints are being referred to when talking

about arthritis?

A

Synovial joints

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16
Q

What is the difference between inflammatory and non-inflammatory

arthritis?

A

Inflammatory means that the primary cause of the arthritis is inflammation

Non-inflammatory means that inflammation is a secondary effect of the primary cause of the arthritis

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17
Q

What are the primary sub‐classifications of inflammatory arthritis?

A
  1. Infectious
    1. bacterial (septic)
    2. fungal
    3. mycoplasmal
  2. Non-Infectious (Immune-mediated)
    1. Erosive (rheumatoid)
    2. Non-erosive
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18
Q

What are the primary sub‐classifications of NON - inflammatory arthritis?

A
  1. Primary (Idiopathic) Osteoarthritis
  2. Secondary Osteoarthritis (DJD)
    1. Developmental (OCD, Hip Dysplasia)
    2. Acquired (trauma, neoplasia)
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19
Q

Which is more common (primary vs. secondary arthritis)

in dogs? In cats?

A

Primary is more common in CATS

Secondary is more common in DOGS

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20
Q

How do you differentiate between inflammatory and non-inflammatory

arthritis?

A

JOINT TAP!

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21
Q

What are the radiographic findings associated with arthritis?

A

Osteophytes

Soft tissue swelling

Joint inflammation or effusion

Subchondral sclerosis

Increased or decreased joint space

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22
Q

What are the limitations of radiographs for diagnosis of arthritis?

A

Rads are highly specific, but minimally sensitive for diagnosis of arthritis

If you don’t see it, you CANNOT say for sure it is not there,

especially in the elbow

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23
Q

What are the 6 categories of nonsurgical treatment for osteoarthritis?

A

Weight management

Exercise moderation

Physical rehabilitation

Symptom-modifying agents (analgesics)

Disease-modifying agents (reparatives)

Neutraceuticals (food or food products that provide medical benefits)

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24
Q

What is the most effective nonsurgical treatment for osteoarthritis?

A

WEIGHT MANAGEMENT

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25
Q

What is the MOA of NSAIDs?

A

Reduce pro-inflammatory mediators by inhibiting cyclooxygenase

(COX-1 Inhibition)

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26
Q

Why should you never give cats NSAIDs and what do you prescribe

for analgesia instead?

A

Cats are poor at glucoronidation (in the liver) which is how NSAIDs are broken down.

Give Onsior (Robenacoxib) instead - metabolized by the kidney

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27
Q

What is absolutely contraindicated if treating an animals with NSAIDs?

A

STEROIDS!

28
Q

What is the general mechanism of action for reparatives?

A

To promote synthesis over breakdown or by

providing articular cartilage or fluid building blocks

29
Q

What is the MOA for the following neutraceutical?

Glucosamine/Chondroitin

(Cosequin)

A

Stimulate proteoglycan synthesis of

hyaline cartilage matrix in vitro

30
Q

What is the MOA for the following neutraceutical?

Omega 3 Fatty Acids

(EPA, DHA)

A

Compete with arachidonic acid as a substrate for COX

Results in production of less proinflammatory mediators

(decreased need for NSAIDs)

Basically, Omega-3 sorostitutes are whores because they love to compete for some COX

31
Q

What is the MOA for the following neutraceutical?

Avocado and Soybean Unsaponifiables (ASU)

(Dasuquin)

A

Decrease inflammatory mediators and

increase cartilage matrix synthesis

32
Q

What are the common side effects of NSAIDs?

A

For COX-1 inhibitors: GI and Kidney side effects

For COX-2 selective drugs: GI, Kidney, and Liver side effects

33
Q

What is a side effect to be cautious of when using

Avocado and Soybean Unsaponifiables (ASU)?

A

Has induced arthritis in some animals!

34
Q

What is the level of EBM support for reparatives

like PS-GAG and PPS?

A

GOOD EBM support

EBM for PS-GAG is best

35
Q

What is the level of EBM support for Glucosamine/Chondroitin?

A

EBM states efficacy is uncertain, but it is safe

36
Q

What is the level of EBM support for Omega-3 Fatty Acids?

A

GOOD EBM for Omega-3’s

(and rarely cause GI probs)

37
Q

What is the level of EBM support for weight management?

A

Good to EXCELLENT EBM support

38
Q

What is a salvage procedure?

A

A procedure in which the goal is to

preserve life/limb function,

but there is NO ATTEMPT to cure or fix the problem

(in this case, the cause of DJD)

39
Q

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

A

A Joint Replacement Arthroplasty is a surgical procedure in which parts of an arthritic or damaged joint are removed and replaced with a prosthesis

A Partial Excision Arthroplasty is where the joint is remodeled but nothing is removed

40
Q

What is the difference between ankylosis and arthrodesis?

A

Ankylosis is the body’s attempt to stabilize/fix a joint by growing bony osteophytes which eventually fuse together.

Arthrodesis the surgical method of doing the same thing, usually done to ameliorate the pain caused by the arthritic joint.

41
Q

What are the the principles of arthrodesis?

A

Complete removal of ALL articular cartilage

Cancellous bone graft

Rigid fixation at standing angle (usually DCP)

42
Q

What are the guidelines for postoperative management of arthrodesis?

A

Coaptation for 6 - 8 weeks

Activity restriction until bony fusion

Prolonged healing for 3 months minimum

43
Q

What is the expected effect of arthrodesis of a given joint in general terms?

A

For high motion joints: “Peg Leg” gait

For low motion joints: Minimal effect on gait

44
Q

Define osteochondrosis

A

DEFECT IN ENDOCHONDRAL OSSIFICATION

(self-limiting developmental derangement of normal bone growth, primarily involving the centers of ossification in the epiphysis. [1, 2] It usually begins in childhood as a degenerative or necrotic condition. Bydefinition, osteochondrosis is an aseptic ischemic necrosis.)

45
Q

Describe the basic pattern of long bone growth

A

Starts from epiphyseael center of ossification→

Travels outward in an “ossification wave”→

Anastomoses form: perichondral plexus and epiphyseal bone supply

46
Q

_____% of long bone growth occurs at the physis

A

80%

47
Q

Endochondral ossification occurs at the ______

A

epiphysis

48
Q

Endochondral ossification is usually complete by

_____ months of age

A

6 months

49
Q

The epiphysis contributes _____% of bone growth

A

20%

50
Q

An error or interruption in the anastomoses process leads to

_____ epiphyseal cartilage due to

cartilage ______ downstream

A

thicker

necrosis

51
Q

Describe the pathophysiology of osteochondrosis

A

Disruptions in anastomoses→ cartilage necrosis downstream→

cartilage cannot ossify→ thickened cartilage→

acts as a “stress riser” (rising from inside the bone to the surface)→

necrotic cleft between cartilage and bone→

focused stress over cleft→

fracture of cartilage and defect in joint surface

52
Q

How does a fissure between the thickened cartilage and subchondral bone trigger degenerative joint disease?

A

Fissure/fractured cartilage causes a defect in the joint surface

which accelerates DJD

53
Q

What does the term

“multifactorial” mean when applied to the etiology of OCD?

A

Need both genetic and non-genetic factors for OCD to present:

  1. Genetics:
    1. Dogs, male, large/giant breeds
  2. Non-Genetic Factors:
    1. High Ca/Vit D (promote errors in endochondral ossification)
    2. Energy
    3. Trauma
54
Q

What is the gender and breed disposition of OCD?

A

Males, large/giant breed dogs, Great Danes

55
Q

What is the significance of heritability in OCD?

A

Heritability is 10 - 45%, so should NOT BREED these animals

56
Q

What is the relationship between

dietary calcium and vitamin D levels and OCD?

A

HIGH Ca/Vit D promotes errors in endochondral ossification

57
Q

How does dietary energy relate to the development of OCD?

A

Dietary energy:

Promotes development of bone and muscle

Increases stress on developing cartilage with RAPID growth

58
Q

What is the difference between

microtrauma and macrotrauma as related to OCD?

A

Microtrauma= normal weightbearing stress

But in OCD, abnormal weakened cartilage is more prone to injury, and lesions occur even with normal stresses

Macrotrauma= athletic, high impact stress

In OCD, may cause subclinical to become clinical

59
Q

What does the phrase “developmental orthopedic disease” signify?

A

It means that the disease is heritable!

60
Q

What is a “biphasic age distribution” (referring to age at presentation)

and why it is present with OCD?

A

Means that two age groups can typically present with the disease.

In OCD, can present in young animals due to inflammatory arthritis

or in older animals due to secondary DJD

61
Q

Describe a typical patient with OCD

(this applies to OCD manifesting in all joints)

A

Male, large or giant breed dog

Either 4 - 8 months or middle-aged to old

Limb lameness, pain on joint manipulation, bilateral issues

62
Q

What are the locations where OCD is commonly found in dogs?

A

Shoulder- humeral head (caudolateral)

Elbow- humeral condyle (medial)

Hock (Ankle)- talar ridge (medial or lateral)

Stifle- femoral condyle (medial or lateral)

63
Q

Describe the radiographic findings compatible with OCD

A

For the shoulder- flattened caudal humeral head =OCD

May see joint mouse (loose cartilage flap)

64
Q

What are the potential preventive measures recommended with OCD?

A

Energy, calcium, and vitamin D restriction

Exercise restriction

65
Q

Describe a patient for which conservative treatment of OCD

might be acceptable

A

Small lesion

Young patient (<6m)

Clinically silent, or only mild lameness

Poor surgical outcome

66
Q

List the components of conservative management for OCD

A

Energy, calcium, and vitamin D restriction

Exercise restriction

Weight control

NSAIDs

67
Q

Describe the most common surgical treatment for OCD and the

difference in the type of cartilage that forms as the defect heals

A

Sx = Fragment removal and subchondral bone debridement

Articular cartilage is replaced by fibrocartilage

Preeti: SA Surgery (10 decks)

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