Multiple limb lameness - joints Flashcards
What are the 11 causes/types of multiple limb lamenesses?
- Generalised osteoarthritis - seen in the older dog. (secondary osteoarthritis, due to concurrent developmental diseases eg elbow dysplasia
- Panosteitis - inflammatory condition in multiple long bones. Most common in the young male (< 2 years) German shepherd dog
- Septic arthritis - in the younger animal this occurs in multiple joints. (In the older animal a single joint.) It may occur following surgery or via haematogenous spread
- Lyme disease (Borrelia burgdorferi)
- Endocarditis and associated polyarthritis
- Pulmonary osteopathy - a paraneoplastic syndrome with proliferative new bone on the limbs.
- Metaphyseal osteopathy - inflammatory condition seen in young dogs.
- Rickets- seen occasionally. Associated with poor diet as well as lack of sunlight
- Nutritional hyperparathyroidism - all meat diet in the young animal. Poorly mineralised bones with multiple folding fractures and collapse of vertebrae
- Osteogenesis imperfecta - rare inherited disease which results in multiple fractures
- Immune mediated arthritis -
What are the most common cause of multiple limb lameness?
Immune mediated arthritis and secondary generalised athritis
What multiple limb lamenesses are young dogs prone too?
What virus causes multiple limb lameness in the cat?
What drug can cause induced polyarthritis in the doberman?
- young dogs are more prone to vaccine associated polyarthritis, panosteitis
- calici virus infection in the cat
- potentiated sulphonamides can cause poly athritis in the doberman
How long can it take for lameness due to borrelia infection to become apparent?
2-5 months
What should you radiograph in a cat that has multiple limb lameness and why?
Radiograph other body systems such as lungs for pulmonary osteopathy and pulmonary adenocarcinoma in the cat
In what condition that causes multiple limb lameness might clinical signs and Xrays not coincide?
panosteitis
in arthrocentesis of a joint with a dog with multiple limb lameness, you obtain increased white cells, predominantly neutrophils, what could this sugesst?
Immune mediated disease, septic poly athritis or vector borne disease (eg lyme disease)
What testing will you request joint fluid?
cytology, protein, and culture (for bacterial culture, it is best to collect into blood fluid medium)
make smears of joint tap, dry with hairdryer and examine in house
in what cases of multiple limb lamenesses are joint taps obligatory even if the animals does not have clinicla signs of polyathritis
in the pyrexic animal
If there is evidence of polyathritis what will you be requesting your samples be tested for?
serology or PCR for infectious conditions e.g. Borrelia burgdorferi (Lyme disease), Brucella, Leishmania and Ehrlichia in the imported dog.
Serology for rheumatoid and anti-nuclear factor
(RF and ANF are neither specific nor sensitive tests for rheumatoid arthritis or systemic lupus erythematosus)
What are the 2 general form of polyathritis?
What are the conditions within these?
Erosive forms
* Rheumatoid arthritis
* Chronic feline erosive progressive polyarthritis
Non-erosive forms
* Immune-mediated polyarthritis (4 types)
* Systemic lupus erythematosus
* Feline non-erosive chronic progressive polyarthritis
* Breed associated e.g. Sharpei fever and Juvenile onset polyarthritis of Japanese akitas
* Drug and vaccine associated polyarthritis’ e.g. sulphonamide and post-vaccinal
* Polyarthritis/myositis and polyarthritis/meningitis syndromes
What are the general points around immune mediated polyathritis?
- Should be considered in all pyrexic cases when an obvious cause is not identified
- Any synovial joint can be affected including the axial skeleton
- They can be divided into erosive and non erosive
- Non erosive immune mediated forms are divided into four sub groups
- Non erosive are also classified into those with multisystem involvement and breed associated types
- Erosive forms include rheumatoid arthritis and are generally more severe
What are the 4 types of non-erosive immune mediated poly athritis?
What non-erossive condition can cats get?
- Type I - no underlying disease detected (idiopathic-the most common form)
- Type II - associated with infection elsewhere e.g. respiratory or urinary tract infection. May spontaneously resolve with treatment of the underlying condition or require immunosuppression
- Type III - associated with GI disease
- Type IV - associated with neoplasia e.g. myeloproliferative disease
- Non-erosive chronic progressive polyarthritis of cats- this may be the same condition as the erosive form just a different manifestation of the same disease process
What is Systemic lupus erythematosus ?
what is the prognosis?
multisystem involvement (where body’s imune cells attack own tissues) with anaemia, eucopenia, thrombocytopenia, myositis, meningitis, glomerulonephritis. ANF positive and if three organ systems involved then a positive diagnosis.
Prognosis for this condition is poor
What occurs with shar peir fever?
- Common (as many as one in four) and characteristic of the breed
- Juvenile onset
- Pyrexia
- Swollen hock joint although swelling is primarily periarticular
- Later development of renal amyloidosis and renal failure
What is the prognosis of juvenile onset polyathritis of japanese akitas?
Less than one year of age
Poor prognosis
What is rheumatoid arthritis?
How is it diagnosed?
What is the prognosis?
Erosive condition
* Severe and debilitating
* Destructive with radiographic lucencies
* Loss of articular surfaces and collapse of joint space and subluxation of the joints
* RF (rheumatoid factor) positive but this can occur with other diseases
* Synovial biopsies show typical changes
* Several diagnostic criteria need to be satisfied to make this diagnosis
* Prognosis is poor and euthanasia is often required but is better in the cat
what is chronic feline erosive progressive polyarthritis?
what animal is this more common in?
What is the prognosis, why?
- The erosive and non erosive forms may be the same condition
- A rare condition most common in the young male
- A destructive polyarthritis.
- In both forms there is a marked proliferative reaction around the joints
- Joint subluxations can accompany the disease
- An aggressive and debilitating condition
- Responds poorly to treatment
What are the clinical signs associated with polyarthrits due to endocarditis?
what condition can result secondary to the endocarditis (other than arthritis)?
How is it diagnosed?
How is it treated?
- Intermittent pyrexia, lethargy and weight loss associated with several bacterial isolates
- Rapidly developing cardiac murmur often diastolic with aortic and mitral valves most commonly affected with an anaemia and leucocytosis
- Associated thromboembolism (both infected material and thrombi) which can result in renal failure
Diagnosed by echocardiography and blood culture (at least three samples taken at periods of pyrexia)
Treatment-long courses of antibiotics (based on culture) and anti-thrombotics
Treatmnt of joint associated lameness
What is the general treatemtn protocols for the following conditions:
non-immune diediated lameness:
Immune mediated lameness, types II, III and IV:
Immune mediated lameness:
What are the side effects of treating immune mediated lameness?
Non immune mediated- if the underlying cause can be identified treat this e.g. antibiotics for septic arthritis and endocarditis
Immune mediated- treatment of the underlying cause in **Types II, III and IV ** may result in the resolution of the signs but often immunosuppression is required
Immune mediated - generally immunosuppression is required. Management requires frequent monitoring particularly of liver enzymes and white cell and platelet levels
Immune mediated- side effects of treatment are common including myelosuppression and hepatopathies
what immunosupressive drugs are used for immune mediated lameness?
Prednisolone- the mainstay of treatment. Side effects common including polydipsia, polyuria and hepatopathies. Start on 2-4mg/kg then reduce to minimum effective dose
Azathioprine- used when prednisolone is ineffective. Not to be used in cats
Chlorambucil-can cause bone marrow suppression
Methotrexate (used with leflunomide in the treatment of rheumatoid arthritis in cats)
Ciclosporin, cyclophosphamide, levamisole
What treatements other than steroids can be given for immune mediated lameness?
Analgesia-
* NSAI to be avoided if using corticosteroids,
* Paracetamol (in the dog) and opiates.
* monoclonal antibody to nerve growth factor. * Weight reduction and hydrotherapy to maintain joint health
- Salvage procedures
- If medical management were to fail then surgical techniques can be employed including, arthrodesis and joint replacements
- Arthrodesis and joint replacements have to be managed carefully as the underlying process will continue in other joints
- On occasions euthanasia will be the most appropriate option
