Joint Additives Flashcards
modes of administration for polyglycan
- IA
- IV (do NOT use- speeds up progression of OA)
Polyacrylamide hydrogels (PAAG)
synthetic hydrogel that remains in synovial structure for extended periods of time
4% Noltrex Vet
2.5% arthramid Vet
Adequan
a Polysulfated glycosaminoglucans (PSGAGs) that upregulates glycosaminoglycans and collagen synthesis and decreases inflammatory mediators
BUT can be immunosuppressive IA; therefore give with amikacin
this steroid has chondroprotective effects
triamcinolone acetonide
what is HA often combined with?
triamcinolone (steroid)
HA is a chondroprotectant and provides analgesia
TA is a chondroprotectant and provides anti-inflammatory effects
aggrecan
a type of proteoglycan that forms aggregates with HA -> protects collagens from damage
layers in synovial membrane (2)
- subintimal: blood supply + innervation
- intimal: synovocytes (macrophage type A and fibroblast type B)
Polysulfated glycosaminoglucans (PSGAGs): functions (3)
chondroprotectant that
- inhibits degradation enzymes
- counteracts IL-1
- reduces synovial effusion
where does the HA come from? what is it and what does it do?
Type B synoviocytes (fibroblasts)
it’s a chondroprotectant
it’s a long unbranched non-sulfated GAG that provides viscoelasticity, lubrication, scavenges free radicals, increases endogenous production of HA, and decreases degradation of aggrecan
***ALSO provides analgesia IA
examples of biologics (5)
- platelet rich plasma
- IRAP (interluekin-1 receptor antagonism protein)
- pro-stride
- stem cells
- pulpcyte (mix of allogenic stem cells and cartilaginous matrix components)
articular cartilage is comprised of…(4)
- 80% water
- Proteoglycans
- HA
- collagens
PSGAGs should never be used with what?
steroids!! because it has its own immunosuppressive effect
effects of triamcinolone
steroid that is a chondroprotectant and provides anti-inflammatory effects
true or false: OA can be present without rad signs
true
one of the first visible signs of joint degeneration
cartilage fibrillation
hyaluronic acid
backbone of the catilaginous matrix;
proteoglycans (like aggrecan) bind HA filaments via protein links to create a polarized charge, which provides a sponge like shock absorbing effect
function of articular cartilage?
- creates joint surface
- special extracellular matrix that distributes compressive loads
often used post surgical to replace synovial fluid
polyglycan
HA + chondroitin sulfate + N-acetyle-D-glucosamine
***do NOT give IV (increases progression of OA)
polyglycan: what is it? what is it used for?
HA + chondroitin sulfate + N-acetyle-D-glucosamine
often used post surgical to replace synovial fluid
***do NOT give IV (increases progression of OA)
recommended protocol for IA injections of HA?
20 mg once weekly for 3 weeks
enthesiophyte formation occurs where?
soft tissue attachments
types of synovocytes? what layer of the synovial membrane are they in?
both are in the intimal layer
- Type A: macrophages
- Type B: fibroblasts (produce HA, aggrecan, collagen, cytokins, eicosanoids, proteases)
administration of Polysulfated glycosaminoglucans (PSGAGs)
- IA
- IM
BUT studies suggest decreases PGE-2 better when given IA
what’s used to define the health of a joint?
articular cartilage
options to manage OA (5)
- chondroprotectants: HA, PSGAGs,PGs, Pentosan Gold plus Halo, triamcinolone steroid
- NSAIDs
- steroids
- blood based products
- cell based treatments
OA signs
- effusion
- decreased viscosity of synovial fluid
- increased TP of fluid
- cartilage appears more yellow
- cartilage fibrillation one of first signs
which steroid should NOT be used in joints?
methylprednisolone acetate: bade for cartilage
(some clinicians still use in low motion joints)
betamethasone is not as good as triamcinolone acetonide but probably not as bad as methylprednisolone acetate
backbone of the catilaginous matrix
hyaluronic acid
true or false: the molecular weight of HA that should be used is controversial
true
proteoglycans are comprised of (3)….
- protein
- glycosaminoglycan (GAG)
steroids should NOT be used with _____ in joints
PSGAGs
true or false: once destroyed cartilage never heals
true
what’s the joint’s shock absorber?
subchondral bone because it’s more deformable than cortical bone
goals of joint treatment (4)
- reduce inflammation
- slow degeneration
- reduce pain
- restore synovial fluid to normal
not a strong link between IA steroids and laminitis; what is a good precaution anyway?
decrease dose in horses with metabolic disease
this proteoglycan forms aggregates with HA; it’s able to bind 5x its weight in water and thus acts as a sponge with each step; it therefore allows the cartilage to function as a shock absorber
aggrecan
HA vs PSGAGs
HA: greater effect on cartilage fibrillation; less effective for severe/chronic OA
PSGAGs: greater effect on synovial membrane
modes of administration of HA? which is more efficacious?
- IV (may be more efficacious)
- IA
true or false: trauma -> decreased quality of proteoglycans + decreased synthesis of PGs
true
chondroprotectants
- HA
- PSGAGs (polysulfated glycosaminoglycans)
- PG (polyglycan)
- pnetosan gold plus halo (studies suggest no benefit)
- steroid: triamcinolone
osteophyte formation occurs where…
bone covered in hyaline/fibrocartilage
