Joint Inflammation and Disease

Question 1

Normal gross appearance of synovial fluid

Answer 1

Colour- Yellow/straw colour
Transparency- should be clear, if turbid or opaque it implies there are too many cells in it
Viscosity- Should be viscous, put drop on fingers, indicates protein content

Question 2

What does total leukocytes indicate about synovial fluid

Answer 2

will be increased in case of joint disease or inflammation-> synovitis, also high in sepsis

Question 3

How is total protein of synovial fluid calculated

Answer 3

refractometer

Question 4

Structures affected by inflammatory joint disease

Answer 4

Joints- synovitis
Tendon sheaths- tendosynovitis
Bursae- bursitis

Question 5

Possible causes of inflammatory joint disease

Answer 5

Developmental
Degenerative
iatrogenic

Question 6

Causes of acute joint inflammation

Answer 6

Fracture with intra-articular component

Joint injection
Arthroscopy/bursoscopy,…

Question 7

Causes of chronic joint inflammation

Answer 7

Bone fatigue
Osteoarthritis

Question 8

how can lameness be examined

Answer 8

Palpation
Observation
Perineural anaesthesia- to confirm or identify the site (or sites) of pain that is (are) causing lameness. It also localizes the lameness of the forelimb or hindlimb that was not specifically identified on baseline observation of the horse.
Intrasynovial anesthesia- often done in coffin joint

Question 9

What is scintigraphy

Answer 9

uses radioactive tracers that allow the identification of changes in bone metabolism before they become visible on radiographs – for example, for identifying hairline fractures. It can identify problems in any part of the skeleton, but is especially useful in areas where clinical examination including diagnostic analgesia is often difficult, such as the pelvis and back.
The horse receives an intravenous injection of the radioactive substance Technetium, which acts as a ‘bone tracing’ agent. The bone scan camera is positioned next to the horse and is able to detect areas of increased bone turnover known as ‘hot spots’. It is the most sensitive method for the detection of fractures, inflammation, and infection and it shows pathology earlier than any other method.

Question 10

treatments for joint disease in horses

Answer 10

Anti-inflammatories
Corticosteroid injection- triamcinolone acetonide is most commonly used

Biological therapies
Hyaluronic acid helps increase the viscosity of joint

Can be treated systemically with NSAIDS but need to be careful if they are competition horse

Surgical- arthroscopy, endoscopy, bursoscopy

Joint lavage

Question 11

treatments for joint disease in horses

Answer 11

Anti-inflammatories
Corticosteroid injection- triamcinolone acetonide is most commonly used

Biological therapies
Hyaluronic acid helps increase the viscosity of joint

Can be treated systemically with NSAIDS but need to be careful if they are competition horse

Surgical- arthroscopy, tenoscopy, bursoscopy

Joint lavage

Question 12

3 types of joint sepsis

Answer 12

Traumatic
Wound creates a way for bacteria to get into synovial structures

Iatrogenic
Infection following medication or injection into the joint

Haematogenous
Most common in foals
Bacteria travel through blood into the joint
Should palpate joints of new born foals daily

Question 13

Systemic options for the treatment of osteoarthritis

Answer 13

NSAIDs (all species) (+paracetamol- works in a different way so useful in combination)​
Bisphosphonates (equine)​
Glycosaminoglycan derivatives​- regenerative therapies

Question 14

Intra-articular options for treating osteoarthritis

Answer 14

Corticosteroids​!- none licensed in small animals, could use horse ones as part of the cascade, all are chrondrotoxic

Glycosaminoglycan derivatives (hyaluronic acid)​

Synthetic hydrogels​

Biological products (stem cells (allogenic or autogenic), IRAP, PRP)​
IRAP- Interleukin-1 reactive protein, harvested and incubated from patients’ own blood- has immunomodulatory effects
PRP- similar effects to IRAP

Question 15

Systemic options for treating joint sepsis

Answer 15

Antibiotics
NSAIDs

Question 16

Inta-articular options for treating joint sepsis

Answer 16

can get higher concentration of antibiotics in one area which improves their sensitivity
Antibiotics​
(Opiods)​

Question 17

Regional (IVRP) options for joint sepsis

Answer 17

Intra-regional lymph effusion- apply tourniquet to the region above the point that you want to perfuse, catheterize distended vein and leave tourniquet on for 30-45 mins to expose region to drug
Antibiotics

Question 18

What is a bisphosphonate

Answer 18

A bisphosphonate is a class of medications commonly used to treat bone disorders, such as osteoporosis, Paget’s disease, and bone metastases. Bisphosphonates work by inhibiting the activity of osteoclasts, cells that break down bone tissue, thus reducing bone loss and increasing bone density.

Question 19

What is a bisphosphonate

Answer 19

A bisphosphonate is a class of medications commonly used to treat bone disorders, such as osteoporosis, Paget’s disease, and bone metastases. Bisphosphonates work by inhibiting the activity of osteoclasts, cells that break down bone tissue, thus reducing bone loss and increasing bone density.
Bisphosphonates are typically administered orally or by injection, and are available in various forms, including alendronate, risedronate, ibandronate, zoledronic acid, and others. The specific medication and dosage used will depend on the patient’s condition and individual needs.

Bisphosphonates are generally well-tolerated, but may have potential side effects, such as gastrointestinal upset, musculoskeletal pain, and rare cases of osteonecrosis of the jaw. Patients taking bisphosphonates may also require regular monitoring, such as bone density scans and blood tests.

Question 20

how do glucocorticoids work to treat joint disease

Answer 20

Glucocorticoids are steroid hormones with potent anti-inflammatory effects.
They bind to glucocorticoid receptors in cells, including those in joints.
This decreases production of pro-inflammatory cytokines and chemokines, leading to less inflammation, swelling, pain, and stiffness in the joints.
Glucocorticoids can be administered locally (intra-articular injections) or systemically (oral tablets or intravenous injections).
Local administration is more potent but has risks (e.g. joint infection, cartilage damage, lameness).
Systemic administration is reserved for severe cases and must be carefully dosed and monitored to avoid side effects (e.g. gastrointestinal ulceration, immune suppression, metabolic disorders).