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Locomotor > Degenerative Joint Disease > Flashcards

Degenerative Joint Disease Flashcards

0
Q

What is articular cartilage made up of?

A

Chondrocytes and cartilage matrix

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1
Q

What makes up the joint capsule and synovial membrane?

A

Type A and type B synoviocytes

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2
Q

What are type A synoviocytes?

A

Triangular and are like a modified macrophage

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3
Q

What is the function of type B synoviocytes?

A

Make fluid

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4
Q

What is the cartilage matrix made up of?

A

75% water, 15% type II collagen fibres, 8% proteoglycans, <1% elastic and reticular fibres, 2% chondrocytes

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5
Q

What are common causes of DJD?

A

Trauma - acute ligament tear or repetitive such as concussion
Infectious inflammation such as septic arthritis
Non-infectious inflammation
Developmental disease such as dysplasia, angular limb deformity, flexural limb deformity or osteochondrosis

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6
Q

What does a failure of cartilage homeostasis lead to?

A

Breakdown products, matrix metalloproteinases and catabolic cytokines

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7
Q

What does the synovial membrane release in DJD?

A

PGs, leukotrienes, neuropeptides and cytokines

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8
Q

What impact does subchondral bone have on DJD?

A

Alters load absorption leading to cartilage damage and release of inflammatory mediators such as IL-1 and TNF

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9
Q

Where does the pain response come from in DJD?

A

No pain receptors in cartilage so pain comes from synovitis or joint distension or exposure of subchondral bone

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10
Q

What history needs to be taken when investigating degenerative joint disease?

A

Duration, specific event started, single/bilateral/multiple limbs, previous treatments and response, behavioural change

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11
Q

What should be noted on a clinical exam with suspected DJD?

A

Weight, BCS, lameness exam, muscular atrophy

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12
Q

What can be some useful diagnostic tests?

A

Intra-articular analgesia response
Synovial fluid analysis
Radiography, ultrasound, MRI
Arthroscopy +/- synovial biopsy

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13
Q

What are the treatment goals for DJD?

A

Pain reduction, stop inflammatory processes and chondroprotection

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14
Q

What conservative treatment options need to be performed along with medical/surgical interventions?

A

Weight loss and control
Exercise modification
Physiotherapy

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15
Q

How do NSAIDs help with DJD? Side effects?

A

Most common treatment and inexpensive and efficient
Inhibit COX pathway preventing prostaglandin synthesis
GI ulceration, nephritis, PLE and have had some -ve influence on cartilage and bone metabolism in ex vivo studies

16
Q

Which species are intra-articular corticosteroids often used in? What is their mode of action? Side effects?

A

Horses
Most potent anti-inflammatory drugs, inhibit PG synthesis, synthesis of cartilage degrading cytokines and cartilage degrading enzymes
-ve effects on cartilage metabolism and healing, increased risk of iatrogenic joint infections and laminitis

17
Q

What are drug choice and dose dependent on?

A

Joint volume, severity of inflammation, number of joints to treat and personal preference

18
Q

What is polysulphated glycosaminoglycan (Adequan)?

A

Extract from bovine lung and trachea

MMP inhibition, stimulates HA production and matrix synthesis

19
Q

What is polysulphated glycosaminoglycan licensed for use in the UK? How else can it be used?

A

IM at 500mg every 4 days for 28 days
Intra-articular injection resulting in a higher concentration but increased chance of sepsis and non-septic inflammation flare

20
Q

What is pentosan polysulphate (Cartrophen)?

A

Extract from beechwood hemicellulose
Stimulates HA synthesis and cartilage matrix synthesis
Inhibits MMPs, inflammatory mediators, platelet aggregation
Mobilises lipids, cholesterol, thrombi, fibrin

21
Q

What is sodium hyaluronate? What is its mode of action? How can it be administered?

A

Major structural component synthesised by chondrocytes and type B synoviocytes
Has anti-inflammatory function of steric hindrance and chemotactic response
Can administer IA/IV/PO

22
Q

What supplements can be used to treat DJD?

A

Glucosamine, chondroitin sulphate, glucosamine/condroitin sulphate combinations, green-lipped muscle extract, methylsulphonylmethane (MSM), devil’s claw

23
Q

What is the effect of IL-1 receptor antagonist protein?

A

Directly blocks effects of IL-1 leading to decreased inflammation in experimental studies but no controlled large scale studies done in horses

24
Q

How is IL-1 receptor antagonist protein made?

A

Autologus conditioned serum made by culturing patient blood in a special syringe, up regulates IRAP and other anti-inflammatory mediators which can then be administered IA

25
Q

What is tiludronate? What is it licensed for?

A

Non-nitrogenous biphosphonate which inhibits bone resorption and has anti-inflammatory properties
Licensed for use in distal tarsal osteoarthritis and navicular disease

26
Q

What are some surgical options for treatment of DJD?

A

Excision arthroplasty
Arthrodesis
Total joint replacement

Locomotor (17 decks)

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