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Arthritis
- general term, no specific organism
- inflammation of the joint
- many causes:
- - old age/wear
- -- #1
- -- cells slow down, wear
- -- osteoarthritis
- - immune mediated - attacking self
- -- rheumatiod
- - septic
- -- trauma - penetrating wound into joint can cause sepsis
- - infectious
- -- Lymes
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Osteoarthritis
- most common form of arthritis in animals
- affects dogs and cats
- - more common in dogs than cats as we have different expectations
- old age
- injury resulting in joint instability
- congenital instability of joints
- - dysplasia
- - luxating patellas
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Osteoarthritis clinical signs
- decreased activity
- - lay in one position too long and get stiff
- restlessness
- pain on motion
- - resistance = pain
- crepitus
- muscle atrophy
- - measure circumference of thigh in animal
- obesity - secondary to reluctance to move (less activity)
- changes in normal behavior - as pain increases
- - reluctance to jump #1 sign in cats
- stiffness in cold
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Osteoarthritis diagnosis
- age (breed)
- clinical signs - subtle changes
- imaging
- - radiographs REQUIRED for definitive diagnosis
- -- narrow joint space
- -- osteophytes (bone spurs)
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Osteoarthritis treatment
- joint support
- - some animals respond, some don't
- - adequan injections
- -- helps synovial fluid
- -- weekly for 4 weeks then monthly
- -- stimulates hyaluronic acid
- - glucosamine chondroitin
- -- some people start this early
- - herbal
- NSAIDs
- - rimadyl
- - metacam (blindness in cats)
- - zubrin
- - deramaxx
- narcotic pain relief can be prescribed
- - issues of abuse of the drug by humans
- - may give them 6-8 months
- - eg Tramadol
- we don't have the capability to make whole again
- - manage pain
- - arrest disease
- diet
- - joint support diets - eg Hills J/D
- - weight reduction - slentrol - pill - fen fen for dogs
- exercise
- - moderate, regular exercise is good for the joints
- - swimming - aquatherapy
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Osteoarthritis prognosis
- this is a chronic, progressive disease
- arthritis is not fatal
- problems associated with decreased mobility may lead to euthanasia
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Spondylosis
- degenerative arthritis of the spine
- symptoms may resemble disc disease, Wobblers, myelopathy
- spurs that form a bony bridge
- - won't bend very well
- - microfractures in bony bridge
- occurs in dogs and cats
- hypersensitivity in back, especially cats
- diagnosed with imaging
- - bridging of the vertebral bodies
- - treated as other arthritic conditions
- not a synovial joint, so manage pain
- - no frisbee
- - modify your behavior
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Anterior Cruciate Rupture
- ACL or cranial cruciate ligament rupture
- most common ligamentous injury in dogs
- rotational injury - rotate so far that other (external) ligaments can't support joint
- luxating patellas predispose them to this
- 10 years ago rare - middle-aged/older female obese dogs - was known as quarterback injury
- now common - all weights, ages, genders
- signalment - that part of the veterinary medical history dealing with the animal's age, sex and breed
- ACUTE INJURY?
- - presents that way from owner's perspective
- - likely degenerative changes lead to rupture
- sudden onset of significant lameness - 3 legged lame
- little or no pain on palpation
- - there is swelling, reluctance to move
- toe touching behavior - rest leg on toe
- partial or total rupture may occur
- - partial tear will improve in 7-10 days
- - will not be 100%
- - can feel crepitus
- - leg will be thinner as it is less used
- buttressing
- - collateral ligament will thicken to stabilize joint
- - bone also gets thicker
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Anterior Cruciate Rupture clinical signs
- toe touching lameness
- - won't toe touch with broken leg
- no improvement with rest
- little pain on palpation
- - more pain can mean damage to meniscus or wimpy dog
- buttressing if chronic
- femur slips forward on tibia sometimes
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Anterior Cruciate Rupture diagnosis
- history
- physical exam
- - larger dog may need to sedate as muscles are stronger and will tense
- - drawer sign
- -- femur sliding over tibia
- -- subtle movement where there shouldn't be any
- imaging
- - rules out other causes - osteosarcoma
- - may also have damage to meniscus - no space on x-ray means meniscus is gone
- - orthopedic dept will do MRI
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Anterior Cruciate Rupture treatment options
- rest and PT - can get 80% of use back
- imbrication
- - The operative overlapping of layers of tissue in the closure of wounds or the repair of defects
- - take all of connective tissue and make it tight
- - good for sm & not too active dogs
- - kind of like ace bandage on the outside
- figure 8 wire
- tightrope
- TPLO - Tibial Plateau Leveling Osteotomy
- - patented like PENN hip
- - pay to learn & pay every time you do this surgery
- - surgery of choice for large active dogs
- - cut bone to move tibial plateau down, leaving a lip of bone in front to stop femur sliding off
- post-surgery study
- - 1 year - TPLO most stable
- - 5 year - amount of arthritis the same regardless of which surgery was done
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Anterior Cruciate Rupture post-operative care
- regardless of which surgery it was
- exercise restriction for 3-6 weeks - need to be crated
- gradual increase in activity 4-8 weeks post-op
- - good time for PT - eg underwater treadmill or swimming
- full return to use 12 weeks post-op
- - will have residual lameness
- weight management is important if patient obese
- - most surgeons will not operate until lose weight
- most of the time these go really well
- - TPLO - regain 90% of use
- - do nothing - regain 70% of use
- when they go bad, they go really bad
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Anterior Cruciate Rupture prognosis
- arthritis of knee within 3-5 years regardless of repair method
- common for other knee to be affected within one year in dogs (as they are now using it more)
- post-op PT is highly beneficial
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Intervertebral Disc Disease (IVD)
- did this with nervous system, so brief overview
- cervical or lumbar
- thoracic uncommon (ribs stabilize them)
- may be acute or chronic
- long backed dogs susceptible
- - lhasas
- - bassett hounds
- - dachshunds
- - poodles
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Intervertebral Disc Disease clinical signs
- depends on:
- - location of disc
- -- cervical
- -- lumbar
- - rate of progression
- -- acute
- -- chronic
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Intervertebral Disc Disease clinical signs - cervical
- neck pain
- reluctance to eat
- weakness in hind end
- if sudden, whole body paralysis
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Intervertebral Disc Disease diagnosis - cervical
- breed
- clinical signs
- imaging
- - x-ray
- - myelogram - x-ray of the spinal cord after injection of air or a radiopaque substance into the subarachnoid space
- - MRI
- - CT
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Intervertebral Disc Disease clinical signs - thoraco-lumbar
- reluctance to climb stairs
- reluctance to jump
- back pain
- decreased CP (concious proprioception - placing reflex)
- sudden hind limb paralysis
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Intervertebral Disc Disease diagnosis - thoraco-lumbar
- breed
- clinical signs
- imaging
- - x-ray
- - MRI
- - CT
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Intervertebral Disc Disease treatment
- medical
- - strict confinement
- - corticosteroids
- - intensive nursing
- -- bladder
- surgical
- - fenestration
- -- cervical
- -- go in ventral, slide everything out of way, make window, pull out part of vertebrae
- - hemilaminectomy
- -- lumbar
- -- remove half of lamina, hole in bone to get to herniated disc
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Intervertebral Disc Disease prognosis
- guarded
- - frequently multiple discs are involved
- - surgical intervention can further destabilize spine
- - pain management
- - carts
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Myopathies
- figure out if bone, ligament, or muscle
- diseases of muscles - on the rise
- inflammatory
- - rare
- - bacterial - protozoal - toxoplasmosis in cats
- immune-mediated
- - most frequently seen
- - body not recognizing self
- - polymyositis
- -- dogs and cats
- -- fairly common
- acquired
- - feline polymyopathy
- -- associated with hypokalemia
- --- not enough potassium in diet
- --- see most often in renal failure
- --- usually give Tumil K - potassium gluconate is most bioavailable
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Atrophic Myositis
- less common in cats
- must check potassium levels
- eosinophilic myositis - eosinophils attack muscles
- muscles of mastication in dogs
- - can appear in other muscles, but not usually
- reluctance to open mouth
- - even under sedation, can't open it
- swelling & pain
- atrophy & fibrosis
- - if not treated aggressively
- - after fibrosis, there's no more function & never will be
- CPK (creatinine phosphokinase) - check levels; elevated when muscle dying
- eosinophil count also elevated
- muscle biopsy for definitive dx - often don't do this
- glucocorticosteroids
- - immune suppressor
- - very aggressive early on
- - high doses (1 mg/lb) prednisone in office
- - usually respond well, can sometimes gradually wean off
- can look like retrobulbar abcess
- primarily seen in goldens
- rapid onset
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