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Orthopaedics > Orthopaedics synovial joints > Flashcards

Orthopaedics synovial joints Flashcards

1
Q

What are three key components of the extracellular matrix in articular cartilage

A

Hyaluronan
Type II collagen
Fibronectin

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2
Q

What is synovial fluid made of

A

Plasma dialysate + supplementation of hyaluran from synovial fibroblasts + lubricin from chondrocytes

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3
Q

What inflammatory mediators are released from synovial macrophages/other inflammatory cells

A

IL-1beta
IL-6
TNF
PGE2

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4
Q

What are the 4 types of non-inflammatory joint disease

A

Degenerative joint disease
Neoplasia
Trauma
DOD (developmental orthopaedic disease)

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5
Q

How can we subclassify immunological joint diseases

A

Whether erosive or non-erosive

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6
Q

What are some immunological erosive joint disaeses

A

Rheumatoid arthritis
Periosteal proliferative polyarthritis
Mycoplasma
Feltys

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7
Q

What are some immunological non-erosive joint diseases

A

Idiopathic joint disease
Systemic lupus erythematosus

Polyarthritis-polymyositis

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8
Q

Is erosive or non-erosive immunological joint disease more common

A

Non-erosive
- Especially idiopathic

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9
Q

When is joint disease painful

A

When there is erosion of superficial cells down to subchondral bone which contains nociceptors

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10
Q

How can we classify joint defects by thickeness

A

Chondral/ partial thickness
= commonly get chondral injury secondary to ligament destruction

Osteochondral/full thickness
= commonly due to fracture

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11
Q

Why might we convert a partial thickness chondral defect to full thickness

A

To engage the bone marrow for fibrocartilagenous repair

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12
Q

Is primary or secondary degenerative joint disease more common in small animals

A

Secondary

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13
Q

Examples of secondary degenerative joint disease

A

Congenital e.g achondroplasia
Developmental e.g osteochondrosis, hip/elbow dyspasia
Acquired e.g traumatic, CCL rupture

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14
Q

What are some acquired causes of degenerative joint disease

A

Trauma
Cranial cruciate or other ligament rupture

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15
Q

Non-immunological causes of non-infectious inflammatory joint disease

A

Crystal induced
Haemarthrosis where blood enters joint and has negative effects on the cartilage

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16
Q

Where are we more likely to see haematogenous spread of bacteria to joints

A

Large breed dogs with established DJD
Or dogs with joint replacements

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17
Q

Septic joint presentation

A

Sudden onset severe lameness
Painful, hot, swollen joint
Generally just a single joint affected

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18
Q

Early and chronic radiographic changes with septic joint

A

Soft tissue swelling, joint effusion

–> Chronic changes = cartilage loss, periosteal bone formation, osteolysis that may cross joint

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19
Q

What does osteolysis that crosses the joint surface suggest about the cause

A

Much more likely to be an infection rather than tumour

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20
Q

What is the best way to do bacterial isolation from synovial fluid

A

Synovial fluid inoculated into blood culture is best

Then synovial membrane

Then worst is direct culture

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21
Q

Changes in synovial fluid with septic joint

A

Increased volume
Turbid fluid
Decreased viscosity
High cell count with ~80% neutrophils (degenerate)

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22
Q

Changes in synovial fluid with DJD

A

Normal looking fluid (clear/straw)
May be slightly increased in volume
Slightly raised cell counts; monocytes

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23
Q

Synovial fluid characteristics in idiopathic joint disease or SLE

A

Clear/straw
Increased volume
Decreased viscosity
Increased cell counts with high proportion neutrophils (degenerate)

24
Q

Synovial fluid characteristics with rheumatoid arthritis

A

Yellow/cloudy fluid
Increased volume
Decreased viscosity
Increased cell counts, 85% neutrophils

25
Q

Synovial fluid characteristics with trauma to the joint

A

Haemorrhagic or xanthochromic colour fluid
Increased volume
Normal or reduced viscotiy
Variable cell counts with high % red blood cells

26
Q

Normal synovial fluid volume in a joint + characteristics

A

0.1 - 0.5ml
Clear/straw colour
Normal viscosity
1-3 x10^9/L monocytes mostly

27
Q

How to treat a joint infection

A

Flush and give antibiotics
May need debridment and lavage, especially with post-surgical septic joints to remove implants

Can do local antibiotics with depot preparation

28
Q

What is the signalment for rheumatoid arthritis

A

Small and toy breed dogs
Typically affects lower joints i.e carpus, tarsus, digits

29
Q

Presentation of RA

A

Collapse or joint deformity
May have secondary CCL rupture
Can have systemic signs e.g fever

30
Q

Diagnostic criteria for rheumatoid arthritis

A

2 out of:
> Destructive lesions on radiograph
> Serological evidence of rheumatoid factor
> Characteristic synovial membrane histology
> Other radiography characteristics (subchondral erosions, soft tissue swelling, osteopaenia in chronic disuse, joint deformity or laxity)

31
Q

Rheumatoid factor serology characteristics

A

Not specific since there is cross reactivity with other chronic inflammatory disease

Strong positive titre of >1:40 is suggestive of RA but a negative titre doesn’t rule it out

32
Q

Treatment of rheumatoid arthritis

A

NSAIDs, steroids, immunosuppression

May not always need drugs since the disease waxes and wanes

+ may need surgical stabilisation if there is subluxation of cranial cruciate disease

33
Q

What is systemic lupud erythematosus and what is the signalment

A

Inflammatory immune-mediated non-erosive disease
Associated with multi-organ disease

More common in females
More common in GSDs, afghans, irish setter, old english sheepdog

34
Q

CLinical signs of SLE

A

Most cases have shifting arthritis so appear stiff
+ disease often phasic

Associated with multi-organ disease e.g skin, GI, UG, AIHA, ITP

35
Q

Diagnostic criteria for SLE

A

Must meet all:
- Strong titre >1:64 of serum anti-nuclear antigen
- Involvement of more than 1 organ system
- Demonstrable immunopathology e.g anti-platelet Ab or positive Coombs test

36
Q

What might we see on the bloods of a dog with SLE

A

Anaemia
Leukopenia
Thrombocytopaenia

37
Q

Treatment of SLE

A

Corticosteroids
+ can add in immunosuppressants e.g azathioprine, cyclophosphamide, cyclosporine

38
Q

What is the most common inflammatory joint disease

A

Immune-mediated polyarthritis

39
Q

What are the 4 types of immune-complex polyarthritis hypersensitivities

A

1 = uncomplicated
2 = associated with a remote infection e.g pyo
3 = associated with GI tract disease
4 = associated with neoplasia

40
Q

Signalment for immune mediated polyarthritis

A

Young adults especially spaniels and shelties

41
Q

History and clinical signs of immune mediated polyarthritis

A

Waxing and waning lameness, stiff animal

Distal small joints are swollen and painful

42
Q

Diagnostic tests for immune mediated polyarthritis

A

On X ray see effusion/soft tissue thickening but no joint degeneration

Image thorax and abdomen to rule out GI (type 3) and neoplasia (4)

On arthrocentesis see increased cellularity esp of neutrophils

43
Q

Treatment of immune mediated polyarthritis

A

Treat underlying cause if present
Immunosuppression; tapening prednisolone over 2-6 months; tapening azathioprine/cyclophosphamide

50% achieve remission

44
Q

What breeds can sulphonamides cause non-erosive arthritis

A

Dobermans
Weimeraners

45
Q

What vaccine can cause arthritis as a reaction

A

Feline calicivirus vaccine

46
Q

Which species have age-related wear and tear in DJD

A

Humans and cats

47
Q

How does rupture of CCL affect joint lubrication

A

Doubles the coefficient of friction so get increased heat and damage to cells causing further cartilage degeneration

48
Q

Radiographical features of degenerative joint disease

A

Joint space narrowing
Osteophyte formation
Enthesophyte formation
Subchondral sclerosis

49
Q

Summary of medical/conservative management of DJD

A
  1. Weight loss
  2. Rehab
  3. Neutraceuticals e.g omega-3 fatty acis, glucosamne, chondroitin, green-lipped mussel
  4. Chondroprotectants
  5. NSAIDs
  6. Anti-NGF
50
Q

What chondroprotectants might we use when managing DJD

A
  • Hyaluronic acid; for viscosupplementation in synovitis and early DJD

PSGAGs to reduce PG degradation and MMP synthesis

51
Q

What are the surgical mangement options for DJD

A

Consider for severe non-medically responsive disease

  • Osteotomy
  • Arthrodesis
  • Joint replacement
52
Q

What is platelet rich plasma and how is it useful in DJD

A

Autologous concentrated platelets

REleases reparative products e.g PDGF, VEGF, FGF-2, TGF-beta

53
Q

What are the risks with NSAID use

A

GI disease
REnal disease

54
Q

What are librela and solensia

A

Monoclonal antibodies to nerve growth factor

55
Q

WHat things can make a dog non weight bearing lame

A

Neoplasia
Infection
Fracture
Ligament rupture

56
Q
A

Orthopaedics (6 decks)

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