Joint Disease

Question 1

What are the main differences between Immune Mediated Polyarthritis and Septic Arthritis?

Answer 1

Immune mediated- multiple joints, with other signs of illness such as prostatitis, GI disease
Septic- One joint and a single swollen limb

Question 2

What method is used to diagnose Joint arthritis?

Answer 2

Arthrocentesis to collect Synovial Fluid- best to do small joints and 4-6 different ones
Can also do cytology, cell counts, total protein etc.

Question 3

IMPA (Immune Mediated Polyarthritis) is caused by loss of regulation of immune response- but what does this mean?

Answer 3

Body fails to recognise the body’s own tissue components OR
Reaction is over the top and prolonged- Type III hypersensitivity reaction

Question 4

What diseases can lead to IMPA?
Give one example.

Answer 4

Leishmania
Rocky Mountain Spotted Fever
Borrelia (Lyme disease)

Question 5

__________ and __________ vaccines can cause IMPA

Answer 5

Calicivirus & Distemper

Question 6

What are the four types of IMPA?

Answer 6

1- idiopathic
2- associated with remote infections
3- associated with GI disease/ hepatic
4- associated with remote neoplasia

Question 7

What would synovial fluid cytology show us in a patient with IMPA?

Answer 7

Will be Neutrophilic (lots of)
& Monocytic

Question 8

Give an example of an Immune Mediated Erosive Polyarthritis.

Answer 8

Rheumatoid Arthritis
Periosteal Proliferative Arthritis in Cats
Felty’s Syndrome in Greyhounds

Question 9

Briefly describe how Erosive Arthritis infects joints?

Answer 9

Chronic Synovitis (inflammation) leads to production of the proliferative granulation tissue > this tissue invades articular cartilage and erodes sub chondral bone > the granulation tissue and inflamed synovium produce proteases that further joint destruction

Question 10

What medications can we prescribe to ‘treat’ Idiopathic IMPA?

Answer 10

Prednisolone- immunosuppressive
or use in conjunction with another…
Azathioprine- disease modifying drug
Ciclosporin- disease modifying drug
Leflunomide- anti-inflammatory

Question 11

What is a good prognostic indicator that IMPA treatment is effective?

Answer 11

Decrease in leucocytes and neutrophils

Question 12

What can cause Septic Arthritis?

Answer 12

Trauma, Haematogenous spread, Local spread for adjacent tissues, Iatrogenic e.g. from surgery, due to underlying joint disease

Question 13

How can we diagnose Septic Arthritis?

Answer 13

Culture & sensitivity of joint fluid
Cytology/ blood tests
[common to receive false negatives from culturing it]

Question 14

Small Animals with Septic Arthritis- how are these treated?

Answer 14

Broad spectrum antibiotics whilst pending culture e.g. Amoxicillin
Then 6 week course of antibiotics based on the culture
If caused by surgical implant then consider implant removal

Question 15

How serious is Acute Septic Arthritis in Equines?

Answer 15

VERY- considered an emergency

Question 16

How is Septic Arthriris in horses treated?

Answer 16

Lavage and administer intra articular antibiotics such as Penicillin
Resample joint fluid every 48 hours and can also give oral antibiotics

Question 17

How can we prevent an implant causing Septic Arthritis?

Answer 17

• Local delivery of antibiotics via impregnated sponges, PMMA beads etc.
• Daily dressing changes
• Physio/ hydrotherapy to reduce adhesions and prevent periarticular fibrosis

Question 18

What is crystal induced arthritis?

Answer 18

Occurs in species that do not have the enzyme uricase- renal damage leads to decreased excretion of urate which leads to urate crystals being deposited in joints