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Locomotor > DJD (bolt) > Flashcards

DJD (bolt) Flashcards

1
Q

Terminology used for DJD?

A

OA
DJD
Osteoarthrosis
Arthrosis

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2
Q

What is the purpose of the menisci?

A

Compensate for incongruency of joint (stifle)

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3
Q

2 types of synoviocytes?

A

A (modified epithelial cells)

B (metabolically active, produce hyaluronic acid)

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4
Q

What is the ECM of hyaline cartilage mainly composed of?

A

Secreted by chondrocytes

  • type 2 collagen
  • GAGs(aggrecan)
  • water
  • very small amount of elastic and reticular fibres and chondrocytes
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5
Q

Are immune mediated joint disease seen in endorse?

A

Nooo

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6
Q

What is DJD?

A
  • multi factorial disorder of joints
  • degeneration of articular cartilage
  • bone changes (OA)
  • lysis and new bone formation
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7
Q

Common conditions causing DJD?

A 
> trauma
- acute
- repetitive 
> infectious inflam 
- septic 
> non-infectious inflam (VERY COMMON HORSES) 
> developmental dz 
- dysplasia
- angular /flexural limb deformity 
- OCD
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8
Q

What is bone spavin?

A

DJD of the TMT/DIT

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9
Q

Outline the pathophysiology of DJD LOOOK UP

A

> failure of homeostasis of articular cartilage
- cartilage breakdown products
- matrix metalloproteinases (MMP2,3,4… Etc)
- catabolic cytokines
synovial membrane
- PGs, LTs
- neuropeptides and cytokines
subchondral bone
- altered load absorption: cartilage damage
- inflammatory mediators (IL-1, TNFa)

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10
Q

How is pain caused with DJD?

A

No pain fibres in the articular cartilage

  • pain fibres in synovium (joint capsule)
  • pain fibres in subchondral bone (exposure bad)
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11
Q

How do soft tissues affect pathophysiology of DJD?

A

> synoviocytes release mediators and enzymes (PGs, cytokines, MMPs)

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12
Q

Do radiographic signs correlate well with clinical signs?

A

No

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13
Q

Is intra-articular medication cheap?

A

No!

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14
Q

What should be looked at in PE for DJD?

A 
> weight BCS 
> lameness exam 
- identify and loacalise 
- scoring
- palap and manipulatio nof joint
- pain, heat, swelling, crepitus
- reduced ROM
- joint effusion
> muscular atrophy
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15
Q

Further Dxx for joint dz?

A 
> imaging
- rads
- ultrasound 
- MRI/CT
> nerve blocks
> synovial fluid analysis (rare in horses, usually normal, unless suspect iatrogenic sepsis) 
> arthroscopy (rarely for 1* DJD investigation, only to debride etc) 
- synovial biopsy possible
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16
Q

Why may intra-articular analgesia be more specific? Why are there limitations to intra-articular analgesia in the distal limb?

A

Close proximity of DIP joint, navicular bursa and distal recess of digital synovial sheath
- more specific than peripheral nerve blocks otherwise

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17
Q

Osteophytes

A
  • see rads
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18
Q

Soft tissues

A

eg. meniscal tear and protrusions, can become 2* mineralised, effusions

19
Q

Subchondral bone sclerosis

A

thickened radiodensity

20
Q

Tx goals for DJD?

A
  • pain
  • stop inflammatory process (all DJD comes from inflam)
  • V production inflam mediators
  • chondroprotection (“disease modification” arrest or slow down cartilage degeneration, usually not drugs, (called Neutroceuticals but NOT as no nutritional value) supplement type things)
  • OA can not be cured, just managed *
21
Q

Tx strategies LOOK UP

A 
>maintenance
- weight loss  
- excercise mod/physio
- stratgetic analgesia
> control flare ups 
- initial analgesia (5-10d) 
- gradual resume excercise 
- swimming/hydrotherapy 
- joint supplements ("neutraceuticals" / for disease modificiation) 
> salvage/new tx options
22
Q

Potential medical Tx of DJD in large animals?

A
  • NSAIDs
  • intraarticular steroids
  • analgesia
  • GAGs
  • sodium hyaluronate
  • supplemetns
    > chondroitin sulphate
    > glucosamine
  • IL1 receptor antagonist protein
  • Tiludronate “Tildren” (bisphospohate)
23
Q

Most common medication for orthopeadic problems? Side effects?

A 
>NSAIDs 
- inexpensive 
- efficient 
- mechanism = inhibition of COX, prevent PG 
> side effects 
- GI ulceration 
- nephritis
- PLE
- negative influence of bone and cartilage metabolism?!!
24
Q

Look at lecture for table of NSAIDs

A

-

25
Q

Why is ketoprofen good? Bad?

A
  • good for foals, COX specific

- $$$$$

26
Q

Most potent anti inflam Tx?

A

Intra articular corticosteroids
- inflam cells and humoral mediators
> mechanism
- inhibits PG synthessis by blocking PLA and COX pathways
- inhibit synthesis of cartilage degrading cytokines (IL1, TNFa)
- inhibit cartilage degrading enzymes themselves (MMP, aggrecanase)

27
Q

Potential side effects of coritcosteroids ?

A 
> negative effects on cartilage healing? (Not seen clinically, very effective!) 
> ^ risk of iatrogenic joint infection 
- immunosuppressive 
> laminitis 
- check max doses
28
Q

Which 2 drugs are used most commonly for Tx DJD in horses?

A
  • Triamcinolone acetinonide

- methylprednisolone acetate

29
Q

When is the term OA used?

A

Only when radiographic signs of underlying bone involvement

30
Q

What GAG products are available for horses? What is it’s mechanism and recommedned dose?

A

> “Adequan” Polysulfated GAG
- extract from bovine lung and trachea $$$
- mechanism: MMP inhibition, HA production stimulator, matrix synthesis stimulator
- IA injection
- ^ risk of sepsis or non septic inflam (flare)
- licensing?
- Dose: 500mg IM q4d for 28d
“Cartrophen” Pentosan Polysulphate
- extract from beechwood hemicellulose
- mechanism: stimulates cartilage matrix and HA synth, MMP and inflam inhibition, mobilises thrombi and fibrin in synovium, lipids and cholesterol in vessels, inhibits platelet aggregation and clotting, ^ plasma lipase levels
- Dose: 3mg/kg SC 4x q5-7d

31
Q

What is sodium hyaluronate and how can it be administered? What effects do supplements have?

A
  • major structural componenet (articular cartilage matrix synthesis by chondrocytes, synovium synthesis by btype B synoviocytes)
    -> viscoelasticity, concentration, polymerisation, boundary lubrication
    -> anti-inflammatory function (steric hinderance, chemotactic response)
    > IA/IV/PO
  • may supplement depeleted HA or stimulate endogenous HA synthesis (unknown)
32
Q

What is the difference between cheap and expensive HA supplements?

A

Molecular weight in kDa - bigger the better

33
Q

What effects can supplements have on DJD?

A

= neutraceuticals (feed additives)

  • dz modification
  • mechanism: stim cartilage matrix synthesis, MMP inhibition, reduce inflam mediators
  • often administered without vet prescription
34
Q

Egs. of matrix GAGs? Are these commonly used?

A

> glucosamine
- bioavailability variable
chondroitin sulphate
- molecular weight: SMALLER the better!!
- degradation in GI mucosa
glucosamine/chondroitin sulphate combo may be better?
most horses will be on some kind of supplement!!

35
Q

WHere is chondroitin sulphate found naturally?

A
  • Green-lipped mussell extract!!!
  • Perna canaliculus (edible shellfish in NZ)
    + anti-inflam via leukotriene pathway
    + fatty amino acids
    + minerals
    + vitamins
36
Q

What is MSM?

A 
Methylsulphonylmethane
> sulphur source 
- collagen 
- matrix metabolism 
> derived from DMSO 
> Mechanism (no convincing efficacy data, no effect on inflam) 
- analgesic (human studies)
37
Q

What is Devil’s claw?

A
  • harpagophytum Procumbens (Iridoid Glycosides)
  • decreses inflam mediators in people but no science in horses
  • used in traditional african medicine (arthritis, fever, skin conditions, GI dz)
  • not cheap but good alternative if allergic to bute
38
Q

What is IRAP? How is it used?

A

= IL1-R antagonist protein
- IL1 key inflam mediator in OA
- stimultes cartilage degrading enzymes (MMPs, aggrecanases)
> IRAP diectly blocks IL1, v inflam but no controlled large scale studie sin horses
- therapeutic sucess in cases refractory to steroids
> autologous conditioned serum (ACS) used byu culturing patient blood in special syringe with chromium sulphate soaked glass beads
-> upregulation of IRAP and other anti-inflam mediators
- IA administration
- serum can be stored frozen

39
Q

What is Tildren? What drug is similar?

A 
Tiludronate (Non-nitrogenous Biphosphonate) 
- inhibits bone resorption by osteoclast apoptosis 
- anti-inflam 
> Europe LIC for horses 
- distal tarsal OA 
- navicular dz
- ?clinical efficacy
- side effects.. colic? 
> DOse:  1mg/kg IV CRI over 30 mins 
- may require NSAID premed ??
> ~=Osphos (IM version)
40
Q

What surgical tx are possible for DJD?

A

> Excision arthroplasty (SA)
Arthrodesis
- horse pastern, distal tarsus, fetlock, carpus (often slavage procedure)
Total joint replacement (SA)

41
Q

What is high ring bone?

A

DJD of the pastern (DIP)

42
Q

Tx high ring bone? Prog?

A

Arthrodesis (40% return to work in FL, 70% HL)

43
Q

Which steroids are best for high motion joints? Which for low motion?

A

> TMA high motion (fetlock)
Methylprednisolone low motion or 2nd line
- can cause reaction @ injection site (hock/back)

Locomotor (29 decks)

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