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CVSOH BVSc4 > Lame - equine joint disease > Flashcards

Lame - equine joint disease Flashcards

1
Q

What is the presentation of asymptomatic synovitis?

A

Inflammation of the synovium
Effusion of the joint or sheath
No pain
No lameness
No radiological changes

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2
Q

What is the aetiology of asymptomatic synovitis?

A

Uncertain
May be conformation
May be minor trauma

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3
Q

Should you treat asymptomatic synovitis? How?

A

No - will resolve on its own

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4
Q

What is the name for joint flares?

A

Reactive synovitis

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5
Q

What is the presentation of reactive synovitis?

A

Acute onset joint flare 24 hrs after joint injection

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6
Q

How can you test to make sure it is a reactive synovitis and not a septic arthritis?

A

Synoviocentesis - should have a total nucleated cell count of <30x10^9 cells/litre

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7
Q

What are the clinical signs associated with a reactive synovitis?

A

Lameness variable
Effusion and heat
Resents palpation/flexion

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8
Q

When should a reactive synovitis resolve?

A

In 1-3 days

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9
Q

What is the aetiology of reactive synovitis?

A

Injection induces inflammation
Reaction to the chemicals in the injection - steroid induced arthropathy

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10
Q

Should you treat reactive synovitis? How?

A

Yes - oral NSAIDs

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11
Q

What is the usual presentation of a traumatic synovitis?

A

Can be any horse but usually a young horse in training

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12
Q

What are the clinical signs of traumatic synovitis?

A

Effusion
Pain on flexion
May be lame

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13
Q

What test should you do for a traumatic synovitis? What results will you get?

A

Synoviocentesis - total nucleated cell count normal (<10x10^9 cells/litre)

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14
Q

What is a haemarthrosis?

A

Blood in the synovial fluid
Whole fluid will be pink - if just a string of red then probably iatrogenic

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15
Q

What is the aetiology of traumatic synovitis?

A

Trauma - single or repeated
May be more trauma to the surrounding area too eg. cartilage damage, ligament injury

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16
Q

What are the consequences of traumatic synovitis?

A

May heal fine
Chronic thickening
May progress to osteoarthritis

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17
Q

What is the treatment for traumatic synovitis?

A

Box rest
NSAIDs
Rehab - exercise plan
Surgery?
Hyaluronic acid and glycosaminoglycans

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18
Q

What animals tend to get septic arthritis?

A

Foals with bacteraemia
Any horse with a penetrating injury - can be tiny

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19
Q

What are the clinical signs of septic arthritis?

A

Lameness - progressive to non weight bearing
Resent palpation/flexion
Effusion
Heat

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20
Q

How do you diagnose septic arthritis?

A

Synoviocentesis
Total nucleated cell count > 10x10^9 cells/litre (most are >30 neutrophils)
Gross appearance - dark yellow/brown/red fluid
Less viscous

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21
Q

How can you treat septic arthritis?

A

Arthroscopic lavage - best
Needle flush - good for acute case
Penicillin and gentamicin

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22
Q

What is the gold standard septic arthritis treatment?

A

Systemic antimicrobials - before and after surgery penicillin and gentamycin
Arthroscopic lavage with lots of hartmanns
Synovectomy
Analgesia - NSAIDs

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23
Q

What is the prognosis for septic arthritis?

A

If surgery <24hr - 90%
Delayed surgery - bad
If left a week - 0%
65% return to athletic function

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24
Q

When does osteochondrosis usually present in horses?

A

Young horse - 2 months to 2 years

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25
Q

What are the clinical signs of osteochondrosis?

A

Lameness
Effusion

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26
Q

How do you investigate cases of osteochondrosis?

A

Lameness exam
Positive flexion
Responds to joint block?

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27
Q

What is the treatment for osteochondrosis dissecans?

A

Surgical removal of fragments - arthroscopic guidance

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28
Q

What is the prognosis for osteochondrosis dissecans?

A

Depends on extent and joint
Good for hocks
Guarded for shoulder

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29
Q

What does osteochondrosis dissecans predispose to?

A

Osteoarthritis
Quick removal of bone fragments reduces this though

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30
Q

Where are subchondral bone cysts most commonly seen in horses?

A

Medial condyle of the stifle - larger than lateral

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31
Q

What are the treatment options for subchondral bone cysts?

A

Surgical debridement
Translesional screw - crosses the cyst and stimulates more normal bone growth
Intralesional corticosteroids

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32
Q

What is the prognosis for subchondral bone cysts?

A

Very dependent on age
Better prognosis for younger horses than older horses

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33
Q

What is osteoarthritis classified as?

A

A disease process involving a disturbed balance between synthesis and degredation in joint tissues
Characterised by focal loss of cartilage, subchondral bone sclerosis and marginal osteophyte formation

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34
Q

What is stage 1 osteoarthritis?

A

Synovitis
But no morphological changes to articular cartilage

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35
Q

What is stage 2 osteoarthritis?

A

Synovitis - less acute
Mild articular cartilage damage

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36
Q

What is stage 3 osteoarthritis?

A

Chronic synovitis
Cartilage damage severe

37
Q

What is stage 4 osteoarthritis?

A

Chronic synovitis
Full thickness loss of articular cartilage

38
Q

What is a primary cause of osteoarthritis?

A

Chronic repetitive trauma

39
Q

What are some secondary causes of osteoarthritis?

A

Traumatic arthritis
Articular fracture
Osteochondrosis
Septic arthritis

40
Q

What are the risk factors for osteoarthritis?

A

Inherent - breed, age, conformation
External - use

41
Q

What is the joint at the top of the hock that is high range of movement?

A

Tibiotarsal

42
Q

What are the joints in the middle of the hock called?

A

Proximal and distal intertarsal

43
Q

What is the joint at the bottom of the hock joint called?

A

Tarsometatarsal

44
Q

What joints of the hock communicate in horses?

A

TIbiotarsal and proximal intertarsal - always
Intertarsals - sometimes communicate with each other
Tarsometatarsal and distal intertarsal - sometimes communicate

45
Q

How do you investigate osteoarthritis?

A

Full lameness workup

46
Q

What signs of osteoarthritis will you find on a lameness workup?

A

Reduced range of motion
Thickened joint
Crepitus
Positive flexion test and positive response to intraarticular block

47
Q

What can you see on radiography of osteoarthritis in horses?

A

Periarticular new bone
Subchondral bone schlerosis
Narrow joint space

48
Q

What are the treatment options for osteoarthritis?

A

Treat/limit synovitis
Cant reverse bone pathology
Arthrodesis

49
Q

What is arthrodesis?

A

Fixing/fusing the joints so they dont hurt anymore - for low motion joints

50
Q

What is the prognosis for osteoarthritis? What does it depend on?

A

Management rather than solution
Depends on:
Location
Severity
Treatment
Rehabilitation program

51
Q

What management factors affect OA associated lameness?

A

Exercise routine
Box rest
Cold weather
Body weight - obesity
Farriery

52
Q

What is the optimum exercise routine for horses with OA associated lameness?

A

Regular controlled exercise
Warm up and cool down
Water treadmills beneficial

53
Q

What farriery can help horses with OA associated lameness?

A

Regular shoeing with optimal balance

54
Q

What joint conditions is surgery beneficial for in horses? What conditions is it not beneficial for?

A

OCD - remove fragments
Fracture cases - stabilise, restore congruity

Not beneficial for most osteoarthritis cases - lavage better

55
Q

What NSAIDs can you use to treat joint conditions in horses?

A

Phenylbutazone
Flunixin
Meloxicam

56
Q

How do NSAIDs work?

A

COX inhibitors reduce prostaglandin production

57
Q

When can you not use NSAIDs in horses?

A

Performance horses - are performance enhancing
Phenylbutazone - not for use in animals for human consumption

58
Q

What are the two intraarticular corticosteroids used in horses?

A

Adcortyl (triamcinolone acetonide)
Depo-medrone (methyl predisolone acetate)

59
Q

How do intraarticular corticosteroids work?

A

Phospholipase A2 inhibitors
Reduce arachidonic acid production
Reduce inflammation mediators for synovium

60
Q

What is the cumulative max dose for triamcinolone acetonide?

A

Less than 18mg per horse

61
Q

What is the cumulative max dose for Depo-medrone (methyl predisolone acetate) ?

A

Less than 200mg per horse

62
Q

What is the safest corticosteroid to use intraarticularly? Why?

A

Triamcinolone - more chondroprotective so best in high motion joints

63
Q

What are the complications of intraarticular corticosteroids?

A

Risk of joint sepsis/joint flare - sterile prep
Risk of laminitis if horse has equine metabolic disease or cushings

64
Q

What is intraarticular hyaluronate?

A

Glycosaminoglycan

65
Q

What are the functions of intraarticular hyaluronate?

A

Lubricant
Anti-inflammatory
Some analgesia

66
Q

What is intraarticular interleukin-1 receptor antagonist protein (IRAP)?

A

Blocks interleukin receptors so less immune response
Taken from blood serum

67
Q

What is the risks of intraarticular interleukin-1 receptor antagonist protein (IRAP)?

A

High risk of joint sepsis - blood serum is a good culture medium

68
Q

What is pentosan also known as?

A

Cartrophen

69
Q

What is pentosan used for?

A

Used prophylactically to support cartilage recovery and so improve joint function

70
Q

How is pentosan administered?

A

4 weekly intramuscular injections

71
Q

What is adequan?

A

Systemic polysulphated glycosaminoglycans treatment

72
Q

What does adequan do to improve joint function?

A

Inhibits matrix metaloproteases - inhibits catabolic enzymes
Reduces inflammation
Lubricates
Repairs cartilage

73
Q

How is adequan administered?

A

Every 4 days for 7 treatments
Given IM

74
Q

What are the side effects of adequan?

A

Haemorrhage

75
Q

What is the method of action of bisphosphonates?

A

Reduce osteoblast activity

76
Q

What conditions are bisphosphonates used for?

A

Hock OA
Navicular syndrome
Diseases with excessive bone development

77
Q

What are the side effects of bisphosphonates?

A

Binds to circulating calcium at injection so may cause GI dysfunction - colic

78
Q

How are bisphosphonates administered in horses?

A

IV - through drip over 1 hour
With concurrent NSAIDs

79
Q

How does intraarticular polyacrylamide gel (arthramid) work?

A

Take up into synovial lining - local effect
Non-absorbable - long duration

80
Q

What improvements to synovial joints do intraarticular polyacrylamide gel have?

A

Shock absorption
Increases elasticity of joint capsule
Improves synovial fluid quality

81
Q

What are the side effects of intraarticular polyacrylamide gel?

A

Minimal
Soreness
Oedema at 1-2 weeks post injection

82
Q

What is intraarticular protein rich plasma?

A

Blood derived product containing growth factor cells and cytokines

83
Q

When is protein rich plasma used in horses??

A

Mostly in tendon and ligament injuries
Now administered into joints

84
Q

What is the situation with mesenchymal stem cells?

A

Still in early research/early clinical phase
But seems to be improving lameness, cartilage and synovial fluid in horses with surgically induced osteochondrosis fragments in trials

85
Q

What are shock waves used on?

A

Most commonly used in soft tissue injuries
Can be used on joints - usually lower motion ones

86
Q

What are shock waves? What is the treatment plan?

A

1500-2000 pulses per joint
Done once a week for 3 weeks

87
Q

Why is there limited evidence for oral joint supplements?

A

If evidence then becomes a licensable product as so price increases reducing takeup - price themselves out of the market

88
Q

How many horse owners feed joint supplements?

A

50%

89
Q

What ingredients are in oral joint supplements?

A

Glucosamine
Chondroitin
Hyaluronic acid
Omega 3 fatty acids
Green lipped mussel extract
Minerals
Vitamins

CVSOH BVSc4 (86 decks)

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