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Equine Medicine and Surgery > Lecture 12: Equine Osteoarthritis > Flashcards

Lecture 12: Equine Osteoarthritis Flashcards

1
Q

Where are the nerve endings in a joint capsule

A

Fibrous joint capsule

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2
Q

What does a flexion test do

A

Puts stress on fibrous joint capsule, aggregates nerves and can make lame limb more obvious

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3
Q

What is synovial fluid

A

Ultrafiltrate of plasma and secretions

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4
Q

What is the intima of synovial fluid

A

Made of synovial cells that act as a filter of what is going in and out of joint capsule

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5
Q

What does the subintima contain

A

Ground substance/ glycoaminoglycosides (GAG)

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6
Q

How does synovial effusion occur when joint swells

A

Intima space gets bigger and fluid leaks in faster than it can get removed

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7
Q

What is the appearance of normal synovial fluid

A

Vicious

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8
Q

What is the cell count of normal synovial fluid

A

<500/ul

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9
Q

What % do lymphocytes, monocytes and synovial lining cells make up for normal synovial fluid

A

90%

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10
Q

Neutrophils make up __% of normal synovial fluid

A

10%

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11
Q

Is there endogenous hyaluronic acid

A

Yes, 0.5mg/ml

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12
Q

T or F: synovial fluid clots

A

False, no clot no fibrin, unless swollen then fibrin will leak in

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13
Q

What layer maintains the tensile strength in the articular hyaline cartilage

A

Tangential layer

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14
Q

What layer of the articular hyaline cartilage maintains the cyclic deformation/squish

A

Radial layer

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15
Q

Healing of the joint/articular hyaline cartilage requires removal of what layer

A

Calcified cartilage

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16
Q

What makes up the ground substance

A

Glycoaminoglycans (GAGs) and proteoglycans

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17
Q

What type of strength do the more superficial layers of articular cartilage provide

A

Tensile strength

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18
Q

What type of strength do the deeper layers of articular cartilage provide

A

Compressive, stiffness (squish)

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19
Q

Describe the joint lubrication for low loads

A

Boundary lubrication from hyaluranon and lubricin- decreases friction

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20
Q

What structures provide joint lubrication for low loads

A

Synovial membrane, synovium-cartilage, cartilage-cartilage

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21
Q

Describe the joint lubrication at high loads

A

Hydrostatic (squeeze film) lubrication of cartilage-cartilage interface

Fluid will extrude from cartilage surface to go between cartilage surfaces and then fluid goes back in (why we need squish)

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22
Q

What provides structural support and is the primary shock absorber- protects articular cartilage

A

Subchondral bone

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23
Q

___takes away cushion and cartilage in damaged in subchodnral bone

A

Sclerosis

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24
Q

What are some inciting causes of DJD

A
  1. Direct injury
  2. Biochemical- inflammation, sepsis, iatrogenic (steroids)
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25
What happens to cartilage in DJD
Loss of proteoglycans, becomes weaker, fibrillates and cracks, ground substance disappears
26
What is the end result of DJD
Osteoarthritis
27
How does OA appear on radiographs
1. Narrowing of joint space 2. Subchondral bone and periarticular changes- sclerosis, lysis/cystic lesions, periarticular osteophyte formation
28
Identify which is normal and which has DJD
Left: DJD, narrowing Right: normal
29
Identify the general problem and then issues indicated by 1-3
OA- ringbone (high at pastern joint) 1. Joint narrowing 2. Subchondral sclerosis 3. Lysis
30
Identify the problem and where is it
Distal Tarsal OA (Bone spavin) Loss of joint space, Subchondral bone sclerosis/lysis
31
What are some factors in DJD for abnormal stresses on normal cartilage
1. Chondral/ osteochodnral injury 2. Joint instability (collateral ligament tears) 3. Steroid (MPA) injections
32
What are some factors in DJD that are normal stresses on abnormal cartilage
1. Synovitis 2. Capsulitis 3. Osteochondrosis
33
what is wrong
P1 fracture
34
What is wrong and how can this contribute to OA
Collateral ligament tear- causing joint instability
35
What is wrong and how can this contribute to OA
Space where arrow is pointing is too big between carpal and intermediate carpal bones Leads to joint instability
36
What is wrong here and what can it lead to that will contribute to OA
Distal tibial OCD- leading to synovitis
37
OCD is a very common cause of ___
Synovitis
38
What is wrong here and what can it lead to that contributes to OA
Chip fracture at P1- bone fragment will wiggle and create inflammation—> synovitis
39
What are the main players in synovial inflammation
1. Synovial cell 2. Chondrocytes 3. PMN (especially with sepsis)
40
Which is normal vs abnormal, what is wrong. And use of what could have caused this?
Left: normal Right: GAG loss due to steroids (Mehthylprednisolone acetate/ MPA
41
What is wrong here
cartilage fibrillation
42
What is wrong here
erosion of shoulder joint
43
T or F: limited capacity to repair articular cartilage in adults
True
44
T or F: hyaline cartilage can be replaced
False
45
What is hyaline cartilage replaced with
Cartilage defect granulation/ fibrous tissue fibrocartilage Type 1 collagen (not as good as type 2)
46
What does this show
Fibrocartilage, due to repair from injury of articular cartilage
47
Fibrocartilage is important in repair of damage to joint/ articular cartilage because it…..
Seals the defect and stops the inflammation
48
Image on left had defect cartilage removed to expose ___ indicated by yellow arrow
Subchondral bone
49
How do you manage joint inflammation
1. Prevention- conformation, foot care 2. Exercise management 3. Weight loss
50
What are the systemic medical management options for osteoarthritis
1. NSAIDs- phenylbutazone, banamine 2. Glucosamine 3. DSMO IV 4. Hyaluronic acid IV 5. Polysulfated glycosamingolycans (adequan)
51
How do NSAIDS decrease inflammation
Inhibit arachidonic acid pathway by inhibiting COX
52
Corticosteroids can be used intra-articularly but cause ___depletion over time
GAG
53
What is the drug of choice for intra-articular steroids
Triamcinolone acetonide
54
How does triamcinolone acetonide work
Inhibit PLA2 in arachodonic acid pathway and suppresses inflammation
55
What is the maximum dose for traimcinolone per horse
18mg/horse
56
Steroid induce __can be observed with exceeding maximum
Laminitis
57
What steroid has significant GAG depletion
Methylprednisolone acetate (MPA)
58
MPA should not be used in what joints
High motion joints
59
___acid does not mitigate negative effects of MPA
Hyaluronic acid
60
Hyaluronic acid with ___or ___ does have chondroprotective effect
Triamcinolone and betamethasone
61
___with MPA is very harmful to cartilage
Lidocaine
62
What does hyaluronic acid do in joint
Anti-inflammatory Steric hinderance of particles through synovium/ mesh filter/ intima
63
T or F: hyaluronic acid has negative effects on cartilage
False
64
What do polysulfated glycoaminoglycans (adequan) do in tx of joints
1. Stimulate endogenous hyaluronic acid 2. Increase proteoglycans and collagen synthesis by chondrocytes 3. Inhibit metalloproteases
65
Intra-articular use of adequan must be given with ___because it potentiates joint infections
Amikacin
66
What is the mechanism of action of IRAP
Blocks IL-1
67
IRAP is made from
Horses own blood
68
T or F: IRAP has negative effects
False
69
PRP has ___proteins
Potent anti-inflammatory proteins
70
PRP is used more for __injuries
Ligament
71
PRP can cause post injection ___
Flare
72
What is post injection flare
Acute swelling/effusion and lameness immediate post injection to 24-48hrs Chemical reaction to whatever you injected
73
What do you do for post injection flare
If continues to worsen 24-48hrs after injection lavage joint, put on hyaluronic acid and no steroids

Equine Medicine and Surgery (27 decks)

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