OA And OCD

Question 1

What makes up hyaline/articular cartilage?

Answer 1

Chondrocytes dispersed within an extracellular matrix

Relatively avascular — nutrition from synovial fluid

Proteoglycans (repel each other)— shock absorber

Question 2

What is osteoarthritis?

Answer 2

Non-inflammatory degenerative joint disease (DJD)

— articular cartilage degeneration
—marginal bone hypertrophy AKA osteophytosis
—synovial membrane changes

Question 3

Inflammatory arthropathy, infectous causes?

Answer 3

Bacterial 
Viral 
Rickettsial 
Fungal 
Mycoplasma 
Protozoal 
Spirochete

Question 4

Inflammatory arthropathy, non-infectious, erosive

What diseases fall under this ?

Answer 4

Rheumatoid arthritis

Feline chronic progressive polyarthritis

Question 5

Inflammatory arthropathy, non-infectous and non-erosive.

What diseases fall under this?

Answer 5

Immune-mediated polyarthritis

Chronic inflammatory- induced polyarthritis

Systemic lupus erythematosis

Question 6

What are the non-inflammatory arthropathy EVS?

Answer 6

Dysplasia
DJD
Trauma
Neoplasia

Question 7

What are risk factors for osteoarthritis?

Answer 7

Size and growth rate
Breed and genetics

OBESITY

Advanced age

Repeated trauma and mechanical stress

Question 8

What radiographic changes do you see in infectious inflammatory arthropathy?

Answer 8

Subchondral bone may be sclerotic or lytic

+/-periarticular bone formation
+/-joint space narrowing
+/- joint capsule distention and soft tissue swelling

Question 9

What radiographic changes do you see in an non-infectious, nonerosive arthropathy?

Answer 9

Soft tissue swelling and joint capsule without bony changes

Multiple joints affected

Question 10

What radiographic changes do you see in a non-infectious, erosive arthropathy?

Answer 10

Joint space collapse
Subchondral bone proliferation
Periosteal bone production
Soft tissue swelling

Multiple joints affected

Question 11

What additional diagnostics to radiographs can be done in joint disease?

Answer 11

CT — bony changes
MRI — soft tissue (tendon and ligament)
Ultrasound
Bone Scintigraphy — localized, not diagnostic

Arthrocentesis

Question 12

Arthrocentesis comes back with phagocytic monocular cells.

Dx?

Answer 12

Non-inflammatory joint disease

Eg Degenerative joint disease

Question 13

Arthrocentesis comes back with non-degenerative neutrophils?

Answer 13

Non-infectious inflammatory diseases

Eg SLE, rheumatoid arthritis, infectious arthritis, immune mediated polyarthritis

Question 14

Arthrocentesis comes back with degenerative neutrophils

Dx?

Answer 14

Infectious inflammatory arthropathy

Question 15

How do you medically manage joint diseases?

Answer 15

Weight management***
Nutritional supplements
-omega 3 fatty acids (anti-inflammatory)
-chondroprotectants; glucosamine/chrondroitin and ASU
Exercise moderation
Physical therapy

Anti-inflammatories and other pain management

Question 16

What pain management options can you use in OA?

Answer 16

NSAIDS

• COX1 or 2 inhibitors
• EP4 receptor blocker — galiprant

NOT- corticosteroids (depress chondrocyte functin)

Polysulfated gycosaminioglycans (PSGAGs)

Acupuncture?

Question 17

What is osteochrondrosis?

Answer 17

Disturbance of endochondrial ossification that leads to cartilage retention/thickening

Increased thickens —> malnourished and necrotic chondrocytes causing clefts of calcified and non calcified tissue

Fissures and cartilage flaps (OCD)

Question 18

What is the etiology of osteochrondrosis ?

Answer 18

Genetic and nutritional factors

Question 19

Signalment associated with osteochrondrosis?

Answer 19

Large/giant breeds

Male>females

Clinical signs present at 4-8moths but can be later

Bilateral disease but present with unilateral lameness

Question 20

How can you diagnose osteochondrosis?

Answer 20

PE
Radiographs
CT/MRI
Arthroscopy

Question 21

PE findings in a dog with shoulder joint OCD?

Answer 21

Pain on hyperextension and flexion of shoulder

Question 22

Radiographic findings of a shoulder with OCD?

Answer 22

Flattening of the subchondral bone of caudal humeral head

Saucer shaped radiolucent area

Question 23

How do you conservatively treat shoulder OCD? When is this treatment method indicated

Answer 23

Rest
Diet: control energy, Ca, and Vit D intake
NSAIDS

Small defects
Minimal to no lameness
Very young dog (<6months)

Question 24

What is the surgical treatment for OCD?

Answer 24

Flap removal and joint lavage

Debridement of bone with curette or shaver (promote bleeding and some healing)

Defects heals with fibrocartilage

Arthroscopy&raquo_space; arthrotomy

Question 25

What is the prognosis for a shoulder with OCD that has been surgically treated? What would you expect without surgery?

Answer 25

Near normal function
Pet dog— good to excellent
Working dog— fair to good

DJD is expected without surgery

Question 26

In the elbow joint, where does OCD develop?

Answer 26

Distal humerus on the medial humeral condyle

Question 27

What do you see on PE of a dog with OCD of the elbow joint?

Answer 27

Pain on elbow extension and lateral rotation of the forearm

Question 28

What is the prognosis for elbow OCD?

Answer 28

Early intervention gives best change but does not prevent DJD

Arthroscopy&raquo_space; arthrotomy

Medical management long term

Question 29

Where does OCD develop in the stifle joint?

Answer 29

Lateral femoral condyle (most commonly)

Medial can also be affected

Question 30

Where does OCD develop in the tarsal joint?

Answer 30

Medial&raquo_space; lateral trachear ridge of talus

Question 31

What is the prognosis for OCD of tarsus?

Answer 31

Guarded to poor

Surgical intervention

Arthroscopy is ideal
Arthrotomy may not be any better than medical managment

Doesn’t prevent OA

Question 32

How are end stage OCD cases managed?

Answer 32

Medically or total joint replacement

Prognosis is dependent on level of DJD present

Shoulder>stifle>elbow>tarsus