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EBCM Lecture > DJD 2: Treatment > Flashcards

DJD 2: Treatment Flashcards

1
Q

We can minimize joint injury by early recognition of…

A

Inflammation of the joint
Traumatic Injury
Developmental Orthopedic Disease
Injections

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2
Q

What are the goals when treating DJD?

A

Decrease inflammation
Alleviate pain
Lubricate the Joint
Restor Normal Environment/Halt Disease
Improve Cartilage Repair

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3
Q

What challenges should be considered when treating DJD?

A

Specific Joint
Stage of Lesion
Current and intended use of horse
Age of Horse
Treatment Cost
Response to Therapy
Regulations

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4
Q

What are some conservative things that can be done when medically managing DJD?

A

Exercise modification
weight reduction
antinflammaory drugs
slow acting, disease modifying antioa agents
supportive care

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5
Q

How do you protect the chondrocyte?

A

Support structures and functions
normalize matrix synthesis
decrease matrix degradation
Disease modifying OA drugs

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6
Q

What are some oral medications that help with OA?

A

Chonfrotin, glucosamine, MSM and SAU

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7
Q

What are some injectible medications for DJD (IM) ?

A

Hylauronic acid and polysulfonated glycosaminoglycan

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8
Q

Why are NSAIDS helpful?

A

Cyclooxygenase inhibitor
-Decrease pain and stiffness, supress inflammation,

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9
Q

What are some side effects of NSAIDs?

A

Gastric Ulceration, Right Dorsal Colitis, Renal Papillary Necrosis

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10
Q

List some NSAIDs commonly used in horses?

A

Phenylbutazone, Flunixin Meglumine, Ketoprofen, Fibrocoxib, Diclofenac Sodium, Acetaminophen

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11
Q

What are some Glycosaminoglycans and how do they work?

A

Chondroitin sulfate, glucosamine - oral supplements, not FDA regulated and dont know how they work
PSGAG - Adequan IM - bovine trachea, stimulates HA production, synthesis of proteoglycan and collagen, inhibit metalloproteases

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12
Q

What are some intraarticular medications?

A

Corticosteroids, sodium hyaluronate, PSGAG, Regenerative Medicine (PRP, IRAP, ALpha2EQ, Pro-stride, VetStem, BM Stem Cell, Peripheral Blood Stem Cells

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13
Q

What are some benefits and disadvantages of steroids?

A

Benefit: Decease MMP, Decrease IL-1 and TNF, Decrease fibrin, pain relief, potent, economical

Dis: Pain relief too good, laminitis, MPA (Depo) - damage chondrocyte, articular, matrix, steroid)

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14
Q

What are some commonly used IA steroids?

A

Betamethasone, Triamcinolone Acetonide, Methyprednisolone Acetate

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15
Q

What are the maximum doses for the main steroids used IA in horses?

A

Betamethasone <30mg
Triamcinolone <18mg
Methylprednisolone <200mg

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16
Q

Tell me about Triamcinolone Acetonide:

A

Half-life 1-5 days
6-9mb/joint
18mg total
Brands: Vetalog and Kenalog
Lowers protein and increase HA

17
Q

Tell me about Bethamethasone:

A

Potent
Medium duration
6-9mg/joint
18mg total

18
Q

Tell me about Methylprednisolone Acetate:

A

Depo-medrol
Long acting
40-60mg/joint
120mg total
Damage proteoglycans
Use low motion joints

19
Q

What is post injection flare?

A

Acute inflammatory response (heat, pain, swelling and lameness) in 8-24 hours of injection
-Treat like infection and send to surgeon

20
Q

Why are infections so bad when they are in a joint injected with steroids or PGA?

A

Immune suppression makes them get out of hand fast

21
Q

What are some types of Hyaluronic Acid?

A

Legend (IV) or Legend IA, Hyvisc, Hyalovet (AI)

22
Q

What does HA do?

A

Lubricates, excludes particles and antinflammatory

23
Q

What is special about Legend?

A

Streptococcal cell wall

24
Q

What is Adequan?

A

Polysulfonated Glycosaminoglycan (PSGAG)
-stimulate HA production, more proteoglycan synthesis and collagen from chondrocytes
-Inhibits metalloproteases

25
Q

What are some negative effects of PSGAG?

A

Increased activated throboplastin, prothrombin, thrombocytopenia, MIC increase for antibiotics

26
Q

What is Polyglycan?

A

Mix HA, Chondroitin and glucosamine
-Medical device
-Not FDA approved (joint lavage)

27
Q

Which steroid is the practitioners favorite?

A

Triamcinolone Acetonide

28
Q

What is PRP?

A

Platelet rich plasma

29
Q

What does IRAP stand for?

A

Interleukin-1 Receptor Antagonist
-compete with interlukin 1 to decrease joint inflammation

30
Q

How much sterile blood do you need for IRAP? Should you use a donor?

A

60ml, no

31
Q

What is prostride?

A

Autologous Protein solution
Release growth factor and protein, improve lameness may be better than IRAP

32
Q

What is beneficial about PRP?

A

Antinflammatory proteins, neutrophils, good pain and inflammmation

33
Q

Is alpha2EQ approved?

A

No - high molecular weight protien in blood

34
Q

Are stem cell based therapies approved yet?

A

no
-use fat
-flat
-3D - spheroid
-Periphearl blood - off shelf - europe

EBCM Lecture (24 decks)

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