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Locomotor > Investigating Joint Disease (La Fuente) > Flashcards

Investigating Joint Disease (La Fuente) Flashcards

1
Q

What is joint fluid?

A

Dyalisate from plasma

  • 2 filters, vascular endothelium and synovial interstitum
  • contains proteins , electrolytes, enzymes, water and HA
  • cells- synovial lining cells
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2
Q

How does a healthy joint differ from an inflamed joint? LOOK AT SLIDE

A
  • excessive synovial fluid in joint cavity
  • surrounding soft tissue inflammation
  • WBCs and inflammatory mediators released into synovial fluid via inflamed synovial membrane
  • normal articular cartilage
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3
Q

Which inflammatory cell is more commonly seen in joint fluid?

A

Macrophages more than neutrophils

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4
Q

What aspects of the Hx are important for joint dz?

A
  • single v multiple limb
  • intermittent v before/after excercise
  • excercise tolerance
  • travel Hx
  • parasites
  • systemic disease (IMHA, ITP etc)
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5
Q

What clues may the signalment give for joint disease?

A 
>age 
- puppies: instability
- senior: OA 
> breed 
- GSD hip dysplaisa 
- Labrador elbow dysplasia 
- greyhounds erosive joint disease
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6
Q

What type of lameness does crucial element rupture give?

A

Weight bearing (unless traumatic)

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7
Q

How may poly arthritis cases sit?

A

Not flexing any joints - sit on lateral aspects of HLs

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8
Q

What clinical signs may be seen with joint dz?

A 
>Lamenss 
- one or multiple limbs 
- severity 
- specific posture 
>systemic signs (variable) 
- fever
- lethargy
- anorexia 
- collapse 
> PE 
- fever
- murmur
- masses 
> orthopeadic examination
- joint effusion/buttress/muscle atrophy 
- pain/heat/decreased ROM
- instability (CCLR, CHD) crepitus  
> neuro exam 
- normal v deficits
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9
Q

What is a buttress?

A

Swelling medial aspect of the stifle d/t cruciate rupture and joint capsule swelling

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10
Q

Dxx for joint dz

A 
>Radiographs
- joint capsule and space (look for cloudy joint effusion) 
- bony relationships 
- bone density 
- subchondral bone 
- calcification 
- osteophytes and enthesiophytes 
>arthrocentesis
- single affected joint 
- or suspected polyarthropathy (at least 3 joints) 
- sedation or GA
- sterile procedure 
- slides, EDTA, blood culture (may be false negatives for septic arthritis, blood culture medium ^ chances of success) 
> and analysis of joint fluid
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11
Q

What is the cut off point for WBC in joint fluid?

A

3000
Above this = immune mediated poly arthritis OR septic
- positive culture to prove septic (rarely see bacteria in joint tap) though culture also gives false negatives

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12
Q

What is analysed of the joint fluid?

A
  • cell count
  • cytology
  • chemical analysis (TP, glucose)
  • culture (R/o inflammatory septic v nnonseptic autoimmune)
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13
Q

What cells can be seen on cytology?

A 
> synoviocytes 
- normal 
> neutrophils
- inflammatory
- degenerate v non-degenerate
> macrophages 
- non-inflammatory (DJD)  
> bacterial/fungal hyphae 
> haemophagocytosis
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14
Q

What chemical analysis can be carried out on joint fluid?

A 
> glucose 
- fluid: blood = 0.8-1 normal 
- decreased in septic arthritis 
> TP
-
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15
Q

If septic OA is suspected but culture negative what can be done?

A

Synovial biopsy.

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16
Q

How can culture give false results? How can this be improved?

A
  • false negative as culture doesn’t grow bacteria present (number too low??)
  • false positive with contamination (check cell count)
    > improve by sample into special culture media
    > OR synovial membrane biopsy
17
Q

What is the most common type of infectious inflammatory OA? Aetiologies?

A

> bacteria

  • dogs with OA pdf spontaneous SEPTIC OA (non weight bearing)
  • direct penetration
  • spread from adjacent tissues
  • haematogenous
18
Q

What bacteria are most commonly involved in some tic arthritis?

A

Staph
Strep
Pasteurella
(Skin commensals)

19
Q

How long does OA take to develop radiographic signs?

20
Q

What is seen in septic arthritis on joint tap and radiography?

A 
> joint fluid 
- septic inflammation (though not always degenerate neutrophils) 
- rare bacteria 
- positive culture 
> rads 
- acute (effusion)
- chronic (degenerative changes)
21
Q

Tx septic arthritis

A

6 weeks Abx BS

22
Q

What forms of infectious immune-mediated arthritis are possible and how can you r/o?

A

> Serology and travel hx (esp Mediterranean) (NB these do not have to infect the joint, the immune complexes cause the damage)
- infectious arthritis when suspecting immune-mediated polyarthritis
Borrelia Burgdorfory (Lyme disease)
- borrelial arthritis
Ehrlichia canis (Ehrlichosis)
- rickettsial arthritis [tick not endemic UK]
Leishamania Infantum (Leishmaniasis)
- Protozoal arthritis [not endemic UK]

23
Q

What are the 2 forms of immune based arthritis ?

A

Erosive v non-erosive

24
Q

How does septic arthritis differ in presentation to immune mediated?

A
  • One joint affected septically usually

- if immune mediated = poly arthritis

25
Q

Is erosive poly arthritis common? Subtypes? Most common subtype?

A

Not common!

  • Rheumatoid most common within this subset
  • PA greyhounds
  • feline chronic progressive PA
26
Q

What is rheumatoid arthritis?

A

Auto Ab against IgG

  • causes erosive poly arthritis
  • radiographic changes must be present too
27
Q

What is SLE?

A

Systemic lupus erythematosis

- causes NONerosive polyarthritis

28
Q

What are the 4 MAIN types of immune mediated polyarthritis and how can these be r/o?

A 
type 1: Idiopathic immune mediated poly arthritis (most common, 50% cases)
- need to r/o other subtypes) 
 type 2: infection (25%)
- serology 
 type 3: GI dz
- 
 type 4: Neoplasia
- imaging body cavities 
- depending on sigs CSF/Muscle biopsy etc.
29
Q

What test can r/o SLE?

A

ANA ( antinuclear antibodies)

- high titres with SLE, though other infectious/inflame processes can -> low titres

30
Q

What 2 types of synoviocytes ?

A

Type a and b

31
Q

Criteria for diagnosing rheumatoid arthritis in dogs

A

> 7 out of 11 criteria

  • stiffness after rest
  • pain 1+ joint
  • stiffnes 1+ joint
  • swelling in 1 additional joint within 3 months
  • symmetric joint swelling
  • subcut nodules over bony prominences of extensor surfaces of only rticular regions
  • radiographic evidence of destructive lesions
  • positive RF serum (titre >1.8)
  • poor mucin content of synovial fluid
  • characteristic histopath changes in synovial membranes
  • characteristic histopath changes in subcut nodules
32
Q

What are the 5 main types of NON erosive immune mediated (non-infectious) inflame arthritis?

A
  • SLE
  • idiopathic PA
  • PA/PM syndrome
  • PA/meningitis syndrome
  • PA akitas
33
Q

Criteria for diagnosing SLE in dogs

A
  • definitive or probable depending on no. major/minor signs +- serology
    > major
  • skin lesions, glomerulonephritis, polyarthritis, haemolytic anaemia, polymyositis, leukopenia, thrombocytopenia
    > minor
  • PUO, CNS signs/seizures, oral ulceration, lymphadenopathy, pericarditis, pleuritis
    > serology
  • ANA
  • Lupus erythmatosus cell preparation

Locomotor (29 decks)

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