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Locomotor > Investigating joint disease > Flashcards

Investigating joint disease Flashcards

1
Q

What are the 2 types of joint synoviocyte?

A
  • A (like macrophage)

- B (like epithelial cell)

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2
Q

What are the 2 filters for joint fluid?

A
  • vascular endothelium

- synovial interstitium

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3
Q

Joint fluid - contents

A
  • proteins
  • electrolytes
  • enzymes
  • water
  • HA
  • cells: synovial lining cells
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4
Q

What is the first main catergory of canine arthritis?

A
  • Non- inflammatory (3000 WBC, PMNs e.g. neutrophils)
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5
Q

Categories of non-inflammatory arthritis?

A
  • traumatic
  • DJD
  • hemarthrosis
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6
Q

Categories of inflammatory arthritis.

A
  • infectious

- non-infectious

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7
Q

What are the categories of inflammatory, non-infectious canine arthrtiis?

A
  • immune-based

- non-immune based (rare)

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8
Q

Name 2 types fo non-immune based arthritis

A
  • crystal
  • neoplastic
  • both rare
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9
Q

Name 2 categories of immune-based arthritis

A
  • erosive

- non-erosive

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10
Q

Examples - inflammatory, non-infectious, immune-based, erosive arthritis

A
  • rheumatoid arthritis (RA)
  • polyarthritis (PA) of greyhound
  • feline progressive PA
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11
Q

Examples - inflammatory, non-infectious, immune-based, NON-erosive arthritis

A
  • SLE
  • Idiopathic PA
  • PA/PM syndrome
  • PA meningitis syndrome
  • PA akitas
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12
Q

Age presentation of arthritis

A
  • puppies (unstable)

- senior (OA)

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13
Q

What breed predispositions are there?

  • GSD
  • lab
  • greyhound
A
  • GAS: hip dysplasia
  • Lab: elbow dysplasia (also cruciate dz)
  • Greyhounds: erosive
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14
Q

Aspects of hx to include in workup

A
  • # limbs affected
  • relation to exercise/ intermiited
  • exercise tolerance
  • travel hx
  • parasites
  • systemic dz (IMHA, ITP etc)
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15
Q

Define ITP

A

Idiopathic thrombocytopenic purpura

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16
Q

Aspects of lameness to consider

A
  • # limbs
  • severity
  • specific postures /mvts
17
Q

Systemic signs of arthritis

A
  • variable
  • fever
  • lethargy, aanorexia
  • collapse
18
Q

How can endocarditis lead to polyarthritis (PA)?

A

can lead to immune-mediated polyarthritis

19
Q

How can tumours cause arthritis?

A

can lead to immune-mediated polyarthritis

20
Q

What to look for on PE with suspect arthritis?

A
  • fever
  • heart murmur
  • masses
21
Q

Aspects of orthopaedic exam for suspect arthritis

A
  • joint effusion, buttress, mm atrophy
  • pain/ heat/ decreased ROM
  • Instability (CCLR, CHD = Canine Hip Dysplasia), crepitus
22
Q

What should you determine on neuro exam of suspect arthritis?

A

whether there are deficits or not

23
Q

What areas to look for on radiograph when looking for arthritis

A
  • joint capsule
  • joint space
  • bony relationships
  • bone density
  • subchondral bone
  • calcification
  • osteophytes and enthesiophytes
24
Q

Where to perform arthrocentesis

A
  • affected joint (single arthropathy)

- at least 3 joints (suspected polyarthropathy)

25
Q

Method - arthrocentesis

A
  • sedation/ GA
  • landmarks
  • sterile (gloves, clip and scrub)
  • small syringe and needle
  • slides, EDTA tube, blood culture media
26
Q

Most common joints to tap for arthrocentesis - 3

A
  • carpus
  • tarsus
  • stifle
  • (elbow and hips possible but more difficult)
27
Q

Aspects of joint fluid analysis

A
  • cell count
  • cytology
  • chemical analysis (TP, glu)
  • culture (if suspect septic)
28
Q

What does joint fluid analysis allow you to differentiate?

A

Non-inflammatory (DJD) vs. inflammatory (infectious vs/ non-infectious)

29
Q

What do different cells on cytology suggest?

A
  • synoviocytes - normal
  • neutrophils - inflammatory (degenerate vs. non-degenerate)
  • macrophages = non-inflammatory
  • bacteria/fungi = septic
30
Q

Chemical analysis - joint fluid

A
  • glucose (fluid: blood = 0.8-1 normal): decreased in septic arthritis
  • TP (
31
Q

Culture - joint fluid

A
  • about 23% negative in spite of infection
  • care with false positive d/t contamination so check cell count
  • TO IMPROVE: special culture media or synovial membrane biopsy
32
Q

What is the most common infectious inflammatory arthritis of canines?

A
  • BACTERIAL
  • d/t direct penetration, spread from adjacent tissues, haematogenous, OA (since poor synovial membrane integrity)
  • Skin bacteria: Staph, Strep and Pasteurella
33
Q

In a septic joint fluid analysis, are the neutrophils always degenerate?

A

No

34
Q

Radiograph - acute./ chronic signs of arthritis

A
  • acute: effusion

- chronic: degenerative changes (but you can’t r/o septic arthritis based on this)

35
Q

What are the 3 main agents that are tested for when suspecting infectious agents?

A

Serology for:

  • Borrelia burgdorfery (Lyme disease)
  • Ehrlichia canis (Ehrlichiosis = rickettsial arthritis, tick not endemic in the UK)
  • Protozoal arthritis = Leishmania infantum, not endemic in UK, other signs (skin, renal)
36
Q

How are the different types of immune-based arthritis differentiated (i.e. erosive and non-erosive)

A

by radiography

37
Q

What tests are done when suspecting erosive polyarthritis (i.e. Rheumatoid arthritis most commonly)?

A

RHEUMATOID FACTOR:

  • Abs against IgG
  • high titres in RA (up to 70%)
  • radiographic changes too
38
Q

What tests are done when suspecting non-erosive immune-mediated polyarthritis ?

A
  1. ) ANA titre = antinuclear Ab
    - high titres in SLE (90%)
    - other inflammatory or infectious processes can lead to low titres
  2. ) image body cavities
  3. ) other (depending on CS - CSF, mm biopsy etc)
39
Q

List the 4 subtypes of immune-mediated polyarthritis

A
  1. ) idiopathic (50%), diagnosis of exclusion
  2. ) infection (25%)
  3. ) GIT dz
  4. ) neoplasia

Locomotor (31 decks)

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