Joint Inflammation and Disease Flashcards
Normal gross appearance of synovial fluid
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
What does total leukocytes indicate about synovial fluid
will be increased in case of joint disease or inflammation-> synovitis, also high in sepsis
How is total protein of synovial fluid calculated
refractometer
Structures affected by inflammatory joint disease
Joints- synovitis
Tendon sheaths- tendosynovitis
Bursae- bursitis
Possible causes of inflammatory joint disease
Developmental
Degenerative
iatrogenic
Causes of acute joint inflammation
Fracture with intra-articular component
Joint injection
Arthroscopy/bursoscopy,…
Causes of chronic joint inflammation
Bone fatigue
Osteoarthritis
how can lameness be examined
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
What is scintigraphy
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.
treatments for joint disease in horses
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
treatments for joint disease in horses
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
3 types of joint sepsis
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
Systemic options for the treatment of osteoarthritis
NSAIDs (all species) (+paracetamol- works in a different way so useful in combination)
Bisphosphonates (equine)
Glycosaminoglycan derivatives- regenerative therapies
Intra-articular options for treating osteoarthritis
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
Systemic options for treating joint sepsis
Antibiotics
NSAIDs
Inta-articular options for treating joint sepsis
can get higher concentration of antibiotics in one area which improves their sensitivity
Antibiotics
(Opiods)
Regional (IVRP) options for joint sepsis
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
What is a bisphosphonate
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.
What is a bisphosphonate
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.
how do glucocorticoids work to treat joint disease
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).
