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LAS > Joint Additives > Flashcards

Joint Additives Flashcards

1
Q

modes of administration for polyglycan

A
  • IA

- IV (do NOT use- speeds up progression of OA)

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2
Q

Polyacrylamide hydrogels (PAAG)

A

synthetic hydrogel that remains in synovial structure for extended periods of time

4% Noltrex Vet
2.5% arthramid Vet

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3
Q

Adequan

A

a Polysulfated glycosaminoglucans (PSGAGs) that upregulates glycosaminoglycans and collagen synthesis and decreases inflammatory mediators

BUT can be immunosuppressive IA; therefore give with amikacin

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4
Q

this steroid has chondroprotective effects

A

triamcinolone acetonide

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5
Q

what is HA often combined with?

A

triamcinolone (steroid)

HA is a chondroprotectant and provides analgesia
TA is a chondroprotectant and provides anti-inflammatory effects

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6
Q

aggrecan

A

a type of proteoglycan that forms aggregates with HA -> protects collagens from damage

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7
Q

layers in synovial membrane (2)

A
  • subintimal: blood supply + innervation

- intimal: synovocytes (macrophage type A and fibroblast type B)

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8
Q

Polysulfated glycosaminoglucans (PSGAGs): functions (3)

A

chondroprotectant that

  • inhibits degradation enzymes
  • counteracts IL-1
  • reduces synovial effusion
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9
Q

where does the HA come from? what is it and what does it do?

A

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

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10
Q

examples of biologics (5)

A
  • platelet rich plasma
  • IRAP (interluekin-1 receptor antagonism protein)
  • pro-stride
  • stem cells
  • pulpcyte (mix of allogenic stem cells and cartilaginous matrix components)
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11
Q

articular cartilage is comprised of…(4)

A
  • 80% water
  • Proteoglycans
  • HA
  • collagens
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12
Q

PSGAGs should never be used with what?

A

steroids!! because it has its own immunosuppressive effect

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13
Q

effects of triamcinolone

A

steroid that is a chondroprotectant and provides anti-inflammatory effects

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14
Q

true or false: OA can be present without rad signs

A

true

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15
Q

one of the first visible signs of joint degeneration

A

cartilage fibrillation

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16
Q

hyaluronic acid

A

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

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17
Q

function of articular cartilage?

A
  • creates joint surface

- special extracellular matrix that distributes compressive loads

18
Q

often used post surgical to replace synovial fluid

A

polyglycan

HA + chondroitin sulfate + N-acetyle-D-glucosamine

***do NOT give IV (increases progression of OA)

19
Q

polyglycan: what is it? what is it used for?

A

HA + chondroitin sulfate + N-acetyle-D-glucosamine

often used post surgical to replace synovial fluid

***do NOT give IV (increases progression of OA)

20
Q

recommended protocol for IA injections of HA?

A

20 mg once weekly for 3 weeks

21
Q

enthesiophyte formation occurs where?

A

soft tissue attachments

22
Q

types of synovocytes? what layer of the synovial membrane are they in?

A

both are in the intimal layer

  • Type A: macrophages
  • Type B: fibroblasts (produce HA, aggrecan, collagen, cytokins, eicosanoids, proteases)
23
Q

administration of Polysulfated glycosaminoglucans (PSGAGs)

A
  • IA
  • IM

BUT studies suggest decreases PGE-2 better when given IA

24
Q

what’s used to define the health of a joint?

A

articular cartilage

25
Q

options to manage OA (5)

A
  • chondroprotectants: HA, PSGAGs,PGs, Pentosan Gold plus Halo, triamcinolone steroid
  • NSAIDs
  • steroids
  • blood based products
  • cell based treatments
26
Q

OA signs

A
  • effusion
  • decreased viscosity of synovial fluid
  • increased TP of fluid
  • cartilage appears more yellow
  • cartilage fibrillation one of first signs
27
Q

which steroid should NOT be used in joints?

A

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

28
Q

backbone of the catilaginous matrix

A

hyaluronic acid

29
Q

true or false: the molecular weight of HA that should be used is controversial

A

true

30
Q

proteoglycans are comprised of (3)….

A
  • protein

- glycosaminoglycan (GAG)

31
Q

steroids should NOT be used with _____ in joints

A

PSGAGs

32
Q

true or false: once destroyed cartilage never heals

A

true

33
Q

what’s the joint’s shock absorber?

A

subchondral bone because it’s more deformable than cortical bone

34
Q

goals of joint treatment (4)

A
  • reduce inflammation
  • slow degeneration
  • reduce pain
  • restore synovial fluid to normal
35
Q

not a strong link between IA steroids and laminitis; what is a good precaution anyway?

A

decrease dose in horses with metabolic disease

36
Q

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

A

aggrecan

37
Q

HA vs PSGAGs

A

HA: greater effect on cartilage fibrillation; less effective for severe/chronic OA

PSGAGs: greater effect on synovial membrane

38
Q

modes of administration of HA? which is more efficacious?

A
  • IV (may be more efficacious)

- IA

39
Q

true or false: trauma -> decreased quality of proteoglycans + decreased synthesis of PGs

A

true

40
Q

chondroprotectants

A
  • HA
  • PSGAGs (polysulfated glycosaminoglycans)
  • PG (polyglycan)
  • pnetosan gold plus halo (studies suggest no benefit)
  • steroid: triamcinolone
41
Q

osteophyte formation occurs where…

A

bone covered in hyaline/fibrocartilage

LAS (51 decks)

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