DL/DS Swollen Joints Flashcards
Pattern spotting :
3mo foal, v lame LF, multiple swollen joints - hot, effusive and painful, 3w prior foal tx with short course Abx for cough/fever/^RR
- suspect septic arthritits (pyrexic complaint previously, acute onset)
> arthrocentesis, joint fluid analysis, C+S - leukocyte count >30,000 cells/uL >90% neutrophils and elevated TP >2.5g/dl
- culture results may be negative (use blood culture medium or synovial biopsy to ^ accuracy)
> radiograpohy repeated weekly - normal initially
- lysis few days after onset
- presence of osteomyelittis afects Px and Tx
Logical approach:
3mo foal, v lame LF, multiple swollen joints - hot, effusive and painful, 3w prior foal tx with short course Abx for cough/fever/^RR
> young animal systemic problem - 3mo, multiple swollen joints > acute problem serious nature - hot, effusive, painful joints, very lame > possible infectious hx - resp infection >> PLAN - biochem/haem to r/o systemic problem - arthrocentesis, joint fluid abnalysis, C+S, radiography
Tx septic arthritis foals?
> emergency!
- tx BS Abx while waiting for C+S(cephalosporin or panicillin/aminoglycoside combo eg. pen and gent) IV or IA
- joint lavage
- resample joint fluid q48hrs
management
- minimising joint movement helps reduce damage but passive movment may minimise fibrin adhesion
- box rest and supportive bandaging, physiotherapy
Px septic arthritits foals?
- Prompt recogniition, aggressive Tx and local ABx = improved px
- multiple istes of involvement = ^ risk of poor future atheltic performance
> define and refine:
- sudden onset lameness 10 landraceX gilts large commercial unit, msot lame single HL, bilateral sweeling tarsus, one animal recumbent.
- all animals from group brought in 9d ago @110kg breeding replacemenet
- pigs housed in a yard system on solid floors
- group of pigs, likely infectiou s
- replacement gilts underweight, unlikely to be DJD
- pigs show different clinical signs: disease is progressive
- solid floor: risk of trauma? multiple pigs affected concurrently though.
> DXx
- sudden onset lameness 10 landraceX gilts large commercial unit, msot lame single HL, bilateral sweeling tarsus, one animal recumbent.
- all animals from group brought in 9d ago @110kg breeding replacemenet
- pigs housed in a yard system on solid floors
- isolate new pigs and incontact
- synovial fluid sample and cultre
- temperature if raised suspect infection
- cull most severely infected (recumbent) PM
- rads and ultrasound not possible $$$$$
- Ab assay on bloods for common diseases
Ddx:
- sudden onset lameness 10 landraceX gilts large commercial unit, msot lame single HL, bilateral sweeling tarsus, one animal recumbent.
- all animals from group brought in 9d ago @110kg breeding replacemenet
- pigs housed in a yard system on solid floors
- mycoplasma hyosynoviae infection
- DJD
- Erysipelas infection
- Glassers disease
- Trauma
> See ppt for good table
Tx mycoplasma hyosynoviae?
- lincamycin/tiamulin
- prevention: in feed medication, lower stress, resp spread control
> Dxx:
- 2yo TB racehorse
- acute onset, mod LF lame after gallop, heat and effusion @ carpus, + response to felxion of carpus
- rads (both limbs, bilateral dz common)
- joint block
- arthroscopy
What would be seen on rads concurretnly with a carpal chip fx?
- joint effusion
- osteophyte formation poss
Pathogenesis of carpal chip fx?
- cumulative microdamage d/t repetitive loading
- loss of smooth articular surface, OCD fragments -> synovitis, effusion and pain
- chronic release of MMPs, enzymes and catalytic enzymes may -> DJD and OA
- OA and fibrosis of joint capsulle restrict ROM and perfomrance
Tx carpal chip fx?
- standing arthroscopic sx to remove chip and debride joint
- +- lavage
- skin sutures
- NSAIDS
pX CARPAL CHIP FX?
- most common fx in racehorses (2nd most common intercarpal joints)
- px excellent
- px worsens with chronicity and loss of cartilage
Most common site of carpal chip fx?
- craniodistal intermediate carpal bone
Dxx:
- 5yo DSH cat
- 4wk hx lethargy, not going outside esp morning
- acute lameness LH, swollen hot effusive left tarsus and swollen R tarsus and carpus
- radiographs
Differnetials for cat 4 week hx lethargy, acute LH lame, swollen hot carpus and tarsi, joint effusion L tarsus
+ large amounts new bone formation at tarsus
- joint ankylosis?
> next steps?
- periosteal proliferative polyarthritis
- feline chronic progressive polyarthritis
- septic arthrittis (bacterial normally one limb)
- OA/ osteosarc/ Osteomyelitis
> next steps - analgesia (NSAIDs, corticosteroids CI d/t infection as ddx)
- arthrocentesis (cell count, cyto, culture - decide inflammatory? -> septic? may need serology)
- ham/biochem in case systemic
Price for full joint investigation in a cat?
> £600
What is periosteal proliferative arthritis? Tx? Px?
- idiopathic inflammatory arthritis
- linked to FeLV, FIV, FeSFV
> Tx: prednisolone @ immunosuppressive doses, + cyclophosphamide - monitor response w/ WBC cytology for 2* infections (+- Abx)
- Physio to improve ROM
> Px guarded - poor - euthanasia on humane grounds if joint deformity severe
Use and Is azathioprine CI for anythign?
CATS! (commonly used as 2* tx for IMPA in dogs)
- BM suppression -> non-responsive severe fatal leucopenia and thrombocytopenia
Dxx:
- 8yo black lab, ME 39kg
- intermitten FL lame over the years, NSAIDs successful, presented for 4/10 LF lame 2 weeks ago nonresponsive to NSAIDs
- restriction on fleion and extension both elbows, worse R
- no pain
- radiographs
How can inflammaotry and non-inflammaotry joitns be distinguished?
- Arthrocentesis
- haem: WBC >3000/ul = inflammatory
- cytology: mononuclear/PMNCs (degenerate or not), intracellular bacteria (rare), macrophages w/ DJD
- culture: blood culture medium, r/o immune mediated dz
- appearance: viscosity, colour, elasticity, clarity
Ddx:
- 8yo black lab, ME 39kg
- intermitten FL lame over the years, NSAIDs successful, presented for 4/10 LF lame 2 weeks ago nonresponsive to NSAIDs
- restriction on fleion and extension both elbows, worse R
- no pain
- Non-inflammaotry DJD
- Inflam immune-mediated non-erosive PA eg. SLE, idiopathic PA
What is seen on arthrocentesis with DJD?
Macrophages high but WBCs low
Tx DJD/ OA?
- ^ dose NSAIDs/switch to different
- Tramadol/ACP
- anti-inflammaotry corticosteroid doses
- GAGs, HA
- short regular excercise
- hydro/physio
Ddx:
3yo M green iguana
- abnormal HL gait esp RH, movement stifle limiteed
- hard swelling right stifle, animal resists manipulation of this joint +- left stifle swelling and pain
- balanced mixed diet, UV ok
> Gout
- 1: accumulatino of urate crystal in organs and joints d/t chronic hyperuricemia d/t excess protein in the diet
- 2: d/t chronic hyuperuricemia d/t renal insufficiency/dehydration
Pseudo-gout
- deposition of other crystals not uric acid
MBD
- 2* nutritional hyperparathyroidism (most common reptile, d/t poor diet Ca:P ratio or Vit D3 deficiency or poor husbandry UVB light or heat
- 2* renal hyperparathyroidism d/t renal dz
Immune mediated
inflam/infectious
- abscess
fx
How would gout appear on radiogrpahs?
- mineralisation of affected joints
- calcium deposits can be left along with uric acid crystal s
How would MBD appear on radiographs?
generlised demineralisation of the skeleton
Further investigation for
3yo M green iguana
- abnormal HL gait esp RH, movement stifle limiteed
- hard swelling right stifle, animal resists manipulation of this joint +- left stifle swelling and pain
- balanced mixed diet, UV ok
> radiographs
bloods
- hydration status
- 2* nurtiional HPT -> low plasma 25-dihydroxycholecalciferol +- hypophosphataemia, hypocalcaemia and signs of reduced renal function
biochem
- gout: ^ uric acid in blood
arthrocentesis
- septic v immune mediated (degenerate neutrophils)
urinalysis
- haematuria/WBCs/renal casts with renal dz
Is USG in reptiles useful for assessing renal function?
Noooo because filtrate is isostheneuric so changes in kidney function are not reflected in USG
Tx gout?
> pain releif - NSAIDs - monitor for GI side effects > diet - 1* gout reduce/eliminate highprotein foods in diet > rehudration - 2* gout - water baths, fluid therapy, moist food > allopurinol - reduces blood uric acid levels - LONGTERM not during acute outbreak - will relaspe if taken off > euthanasia if apetitie suppressed and painful
How can gout and pseudogout be differentiated?
> Gout
- hyperuricemia on biochem
- radiogrpahic changes eroisons and overhangs
- needle shaped crystals in synovial fluid
pseudogout
- radio-opaque mineral in/around joints
- hypercalcaemia on biochem
- rhomboid shaped crystals in synovial fluid
Whichi NSAIDs ccan be used in reptiles?
lack of evidence
- NSAIDS (ketoprofen)
- butorphanol
- morphine
Which pathogen is commonly present in pigs but is usually subclinical and not cnecessarily the cause of disease?
- Mycoplasma and Glassers
What is periosteal proliferative arthritis the equivalent dz in dogs?
Rheumatoid arthritis
