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Sem 6: SAM 2 > Systemic Lupus & Immune Mediated Polyarthropathies > Flashcards

Systemic Lupus & Immune Mediated Polyarthropathies Flashcards

1
Q

What are the most commonly reported manifestations for SLE?

A
  • Polyarthropathy (pain in multiple joints)
  • Skin lesions (mucocutaneous jxn)
  • Renal GLN or PLN
  • Blood dyscrasia

(must have atleast 2 to say its SLE)

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1
Q

What dog breeds are slightly more overrepresented with SLE?

A
  • GSD
  • Sheltie
  • Collies
  • Poodles
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2
Q

How can SLE be definitely diagnosed?

A
  • Positive anti-nuclear antibody (ANA) test from serum with at least 2 body systems affected

(Renal GLN or PLN, IMPA, immune mediated skin disease, IMHA, etc)

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3
Q

What is the treatment protocol for SLE?

A
  • Prednisone
  • Azathioprine
  • Levamisole? (sheep dewormer)
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4
Q

What is the prognosis of SLE?

A
  • Guarded, relapses occur
  • Long term therapy with Pred +/- Azathioprine, months or longer is needed
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5
Q

What are non inflammatory causes of polyarthropathy?

A
  • Osteoarthritis / DJD
  • Traumatic injury

(would see mononuclear plasma cells and macs in synovial fluid)

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6
Q

What are inflammatory causes of polyarthropathy?

A
  • Infectious (septic joint)
  • Rheumatoid arthritis (erosive IMPA)
  • Non erosive IMPA
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7
Q

List non erosive causes of IMPA

A
  • Idiopathic (Primary IMPA) most common
  • Type II: secondary to infection elsewhere (UTI, endocarditis)
  • Type III: Hepatic / GI associated
  • Type IV: Distant neoplasia
  • Misc tick borne disease, vaccine induced, drug induced, SLE
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8
Q

What are the most suggestive exam findings for Idiopathic/Primary IMPA?

A
  • Lameness/gait abnormalities
  • Fever
  • Joint pain and swelling affecting multiple limbs
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9
Q

How would you work up a middle age dog presenting with multiple limb lameness and evidence of joint pain and swelling on PE?

A
  • CBC, Chem, UA
  • Rads
  • Arthrocentesis of multiple joints for direct smear, cell counts, and bacterial culture of synovial fluid
  • 4DX for tick borne dz
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10
Q

What is seen in synovial fluid with IMPA?

A
  • Non degenerate neutrophils
  • Increased NCC > 3000

(Good diagnostic for IMPA but doesn’t determine the underlying cause)

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11
Q

What is seen in synovial fluid with osteoarthritis / DJD?

A
  • Mononuclear plasma cells and macs (Reactive joint)

(No neuts!!! Use arthrocentesis of synovial fluid to differentiate IMPA vs Rheumatoid Arthritis vs Reactive joint disease)

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12
Q

What is the treatment protocol for a patient diagnosed with Primary IMPA

A
  • Prednisone at immunosuppressive dose of 2mg/kg/day
  • Repeat arthrocentesis q 2-3 weeks
  • +/- Azathioprine, cyclosporine, etc
  • Some cases meds can be tapered off
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13
Q

What is the treatment protocol for a patient diagnosed with Secondary IMPA?

A
  • Short term NSAIDs and Doxy for Tick borne disease
  • Short term NSAIDs for drug/vaccine induced which resolves quickly
  • Treat neoplasia if IMPA secondary to LSA, OSA, HSA
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14
Q

What neoplasia can cause secondary IMPA?

A
  • LSA
  • OSA
  • HSA
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15
Q

What is the preferred treatment protocol for a patient with secondary IMPA due to Lyme disease?

A
  • Short term NSAIDs and Doxycycline

(no Pred for secondary IMPA!)

16
Q

What are common causes of non erosive secondary IMPA?

A
  • Chronic infection (UTI, endocarditis)
  • Drug induced (TMS, Carprofen)
  • Vaccine induced (Calicivirus in cats)
  • GI disease
  • Hepatic disease
  • Neoplastic disease (LSA, OSA, HSA)
  • SLE
17
Q

What is the prognosis for primary IMPA?

A
  • Responds well to Prednisone and relapse is uncommon
  • Possibility of life long meds
18
Q

What is the prognosis for secondary IMPA?

A

Depends on underlying cause!

(Tick borne vs neoplasia vs drug induced)

19
Q

What drugs are at risk of causing secondary IMPA?

A

TMS, Carprofen

20
Q

Which immune mediated polyarthropathy has the worst prognosis?

A

Rheumatoid arthritis - erosive bony lesions, aggressive with no definitive tx

21
Q

What is seen in synovial fluid with Rheumatoid arthritis?

A

High NCC > 3000 with Non degenerate neutrophils

22
Q

What is seen in synovial fluid with septic joint polyarthropathy?

A

Bacteria / septic joint with degenerative neutrophils

23
Q

What is rheumatoid arthritis?

A
  • Chronic, progressive inflammatory joint disease characterized by erosive and destructive changes within multiple joints
24
Q

What signalment in dogs is most commonly seen with rheumatoid arthritis?

A
  • Small to medium breeds
  • Greyhounds
  • Shetland sheepdogs
  • Middle aged
25
Q

How does rheumatoid arthritis typically present?

A
  • Initial CS are parallel to IMPA (joint pain, swelling, fever)
  • Recurrent episodes with increasing frequency
26
Q

How can rheumatoid arthritis be diagnosed?

A
  • Non Degenerate neuts in synovial fluid from arthrocentesis
  • Rads to ID erosive bony changes within joint
  • Positive agglutination test for serum RF
  • Negative for bacterial culture
27
Q

How is rheumatoid arthritis treated and what is the prognosis?

A
  • No specific tx
  • Prednisone, but usually becomes refractory
  • Very POOR prognosis
28
Q

What can cause IMPA in young kittens?

A
  • Calicivirus
  • Feline leukemia virus

Sem 6: SAM 2 (34 decks)

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