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Locomotor > Inflammatory Arthritis > Flashcards

Inflammatory Arthritis Flashcards

1
Q

What are the clinical signs of inflammatory arthritis?

A 
General stiffness
Lameness
Pyrexia, lethargy, inappetence
Multiple painful swollen joints
Stilted posture
Arthralgia
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2
Q

What diagnostic tests should be done if arthralgia is found on clinical exam?

A

Cytology of joint fluid

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3
Q

What does a positive culture of joint fluid cytology indicate?

A

Septic arthritis

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4
Q

What further tests should be done if cytology of joint fluid is sterile?

A

CBC biochem
US
Thoracic radiographs
Echocardiography

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5
Q

How is septic and immune-mediated arthrocentesis differentiated?

A

Septic - degenerative neutrophils

IM - non-degenerative neutrophils

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6
Q

What diagnostic test and result in arthralgia indicated chronicity?

A

Radiographs
Normal –> Acute
Erosion of cartilage and subchondral bone –> Chronic

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7
Q

How is inflammatory arthritis categorised?

A

First broken down into infective and non-infective.

Non-infective is further broken down into erosive and non-erosive

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8
Q

Describe normal joint fluid

A

Clear, pale yellow
Transparent
V viscous
Low WBCs

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9
Q

Describe DJD synovial fluid

A 
Yellow
Transparent
Viscous
May clot spontaneously 
Low WBCs
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10
Q

Describe immune mediated arthritis synovial fluid…

A 
Yellow, may be blood tinged
Transparent or opaque
Watery
Spontaneously clots
High protein
High WBCs
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11
Q

Describe bacterial infective arthritis synovial fluid…

A 
Yellow, may be blood tinged
Opaque
Watery
Clots spontaneously
V high protein
High WBCs
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12
Q

What can cause septic arthritis?

A

Haematogenous e.g. foals umbilicus
Trauma
Iatrogenic e.g. IA injections

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13
Q

How is septic arthritis treated in small animals?

A

Amoxiclav

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14
Q

How is septic arthritis treated in horses?

A

Penicillin, gentamicin IA/IM
Thorough lavage, arthroscopy
Sample joint fluid q48hrs
Oral ABs

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15
Q

Outline the pathogenesis of immune-mediated polyarthritis…

A

Ag/ab complexes deposited on synvoium > synoviocytes activated > release chrondrodestructive collagenases > osteoclasts cause bone resorption and subchondral cysts > Pannus formation

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16
Q

How does the immune system fail during immune-mediated polyarthritis?

A

Fails to recognise self > autoaggressive cells proliferate

17
Q

What risk factors are there for developing autoimmune disease?

A 
Inherited
Certain infections
Bacterial endocarditis
Discospondylitis
Immune mediated bowel disease
Neoplasia
Chronic hepatitis
18
Q

Out the Igs involved in types 1-4 hypersensitivity reactions

A
  1. IgE - Mast cells basophils
  2. IgG or IgM
  3. IgG or IgM
  4. Intracellular
19
Q

Which type of hypersensitivity is immune mediated arthritis?

A

Type III

20
Q

Define monoarticular, pauciarticular and polyarticular

A

Monoarticular - affecting 1 joint

Pauciarticular - affecting 2-5 joints

Polyarticular - affecting 6+ joints

21
Q

What should be included in a PE in an arthritic patient?

A

Observe walking
Full clinical exam
Palpation and manipulation
ROM, pain, heat, swelling and crepitus

22
Q

What diagnostic tests are used in a patient with polyarthropathy?

A

Arthrocentesis
Joint radiography
Synovial biopsy

23
Q

What can cause non-erosive polyarthritis?

A 
Systemic lupus erthematosus
Lyme disease
Iatrogenic
Calicivirus 
Steroid-responsive meningitis-arteritis
IBD
Vaccine induced
24
Q

Outline the pathogenesis of erosive polyarthritis

A

Chronic synovitis > profilerative granulation tissue (pannus) > invades articular cartilage and subchondral bone > protreases and collagenases produced > further joint destruction

25
Q

What other disease procress does erosive arthritis cause changes similar too?

A

Septic arthritis

26
Q

Give 3 examples of erosive joint disease

A

Rheumatoid arthritis
Periosteal proliferative polyarthritis in cats
Polyarthritis of greyhounds (Felty’s syndrome)

27
Q

What are the clinical signs of Felty’s syndrome?

A

Rheumatoid arthritis
Splenomegaly
Neutropenia

28
Q

What radiographic changes occur in erosive arthritis?

A

Subchondral bone erosion
Destructive symmetrical multijoint arthropathy
Collapse of joint spaces
Joint deformity of subluxation
Periarticular new bone formation
Calcification of periarticular soft tissues

29
Q

How can rhumatoid arthritis and SLE be differentiated in diagnosis/

A

Serology
RA +ve for rheumatoid factor
SLE - anti-nuclear antibody test

30
Q

What are the general principles of therapy to treat inflammatory arthritis?

A

Removal inciting factor
Suppress immune respoinse
Analgesia
Reduce joint stress

31
Q

What drugs can be used to treat inflammatory arthritis?

A

Pred
Cyclophosphamide
Anti TNFa, IL-1 blockers
Leflunomide (antirheumatic drugs)

32
Q

When might surgery be indicated in inflammatory arthritis?

A

Persistent inflammation can cause subluxation

33
Q

Outline the pathogenesis of gout in reptiles

A

Renal damage –> decreased excretion of urate –> urate crystal deposition –> inflam reaction

34
Q

How is gout treated in reptiles?

A

Fluid therapy

Locomotor (16 decks)

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