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Small animal surgery I > Arthritis > Flashcards

Flashcards in Arthritis Deck (49)
1

What is arthropathy?

Any joint disease

2

What is arthrosis?

A joint; "wear and tear" (human term)

3

What is arthritis?

Inflammation within a joint

4

What is polyarthritis?

Inflammation within several joints simultaneously

5

What is an osteophyte?

Outgrowth of bone; forms at synovial or articular margins

6

Where do enthesiophytes form?

Tendon/ligament attachments

7

What is a joint mouse?

Mobile fragment within a joint

Loose osteophyte or fragment of cartilage

8

What is a joint capsule?

Sac that encloses a joint

9

What does the suffix "-rrhaphy" mean?

To suture in place; to close

10

What is ankylosis?

Spontaneous fusion of a joint

End stage of joint disease

11

What is arthrodesis?

Surgical fusion of a joint

12

Define "arthrotomy"

Incision into a joint

13

What are the 3 types of joints?

  • Synovial
    • Elbow, hip, stifle, SI, vertebral facets
  • Fibrous
    • Skull, tooth sockets
  • Cartilaginous 
    • Symphyses, growth plates

14

What is osteoarthritis?

  • Aberrant repair of articular cartilage --> degradation of articular cartilage
  • Altered subchondral bone metabolism
  • Periarticular osteophytosis
  • Synovial inflammation (synovitis)

15

How can you differentiate between inflammatory and non-inflammatory arthritis?

Joint tap

Determine whether highly cellular or not

16

How is the treatment of inflammatory arthritis different from that of non-inflammatory arthritis?

Inflammatory = medical treatment

Non-inflammatory = surgical treatment

17

What is the sub-classification of inflammatory arthritis?

  • Infectious
    • Bacterial (aka, septic), fungal, mycoplasmal, etc.
  • Non-infectious (immune-mediated)
    • Erosive (e.g., rheumatoid), non-erosive

18

What causes primary arthritis? What species is it more common in?

  • Idiopathic
    • Don't know what the underlying cause is
  • Highly unusual in dogs
  • Relatively more common in cats

19

How does secondary arthritis differ from primary arthritis?

  • (DJD)
  • Developmental (OCD, hip dysplasia)
  • Acquired (trauma, neoplasia)

20

What are the pros and cons to using radiographs as a diagnostic tool in arthritis?

  • Pros
    • Readily available
    • Inexpensive
    • Good for confirmation (high specificity) 
  • Cons
    • Bad for ruling out (low sensitivity) 
    • Correlation with clinical severity is variable

21

What are some radiographic signs of arthritis?

  • Osteophytes
  • Effusion
  • Increased/decreased joint space
  • Soft tissue swelling
  • Subchondral sclerosis

22

What are the arrows pointing to?

Osteophytes

23

What is the single most important element of medical treatment for osteoarthritis?

What are some other non-surgical treatment options?

WEIGHT MANAGEMENT IS THE SINGLE MOST IMPORTANT ELEMENT OF MEDICAL TREATMENT

Other options:

  • Exercise moderation
  • Physical rehabilitation therapy
  • Symptom-modifying agents (analgesics)
  • Disease-modifying agents (reparative)
  • Nutraceuticals 

24

What are the specific weight management goals/techniques (puppies and adults)?

  • Puppies--delay/prevent radiographic OA
    • 25% more food doubles wt. at 6mo
    • Calorie restriction decreases OA prevalence
    • Avoid free-feeding
  • Adults--established OA
    • Reduces need for medication/sx
    • Decreased BCS --> longer lifespan
  • Good to excellent EBM support
  • Pharmaceuticals (Slentrol)

25

T/F: When treating osteoarthritis, moderate regular exercise is indicated immediately following diagnosis

FALSE

Once inflammation is controlled, moderate regular exercise is indicated

26

What are 6 types of physical rehabilitation therapies for the non-surgical treatment of OA?

  • Cold/heat therapy
  • Passive ROM exercises (patient is not doing work, everything is done without weight-bearing)
  • Massage
  • Swimming
  • Treadmill
  • Acupuncture 

27

What are some symptom-modifying agents used in the non-surgical treatment of OA?

  • NSAIDs
    • Tramadol
    • Gabapentin
    • Amantadine
    • Corticosteroids (intra-articular injection)

28

What is the goal of disease-modifying agents in the treatment of OA?

What is an example?

What should you avoid?

  • Promote substrate synthesis over breakdown
  • Adequan--IM injection
  • Chemically similar to heparin--don't give if patient is also on heparin

29

What is the mechanism of action for NSAIDs in the treatment of OA?

  • Reduce pro-inflammatory mediators by inhibiting cyclooxygenase
  • COX-1: responsible for maintaining normal physiologic processes
  • COX-2: "inducible form", activated in inflammation
  • Cats--glucuronidation

30

What is the mechanism of action for disease modifying agents in the treatment of OA?

  • Promote synthesis over breakdown of cartilage
  • Building blocks of articular cartilage or fluid

31

What are some examples of disease-modifying agents?

  • Polysulfated glycosaminoglycans (PS-GAG)
    • Adequan label recommends IM injection
  • Pentosane polysulfate--interstitial cystitis
  • Hyaluronic acid--synovial fluid
  • Heparin analogues

32

What are the mechanisms of action of nutraceuticals?

  • Food or part of a food that provides medical benefits
    • Cartilage building blocks
    • Anti-inflammatory effects

33

What are some examples of nutraceuticals?

  • Glucosamine/chondroitin (Cosequin)
  • Omega-3 fatty acids
  • Avocado and soybean unsaponifiables

34

What are the specific benefits/MoA of glucosamine? Is there any evidence?

  • Stimulate proteoglycan synthesis of hyaline cartilage matrix in vitro
  • Anti-inflammatory effects
  • Preparation variability
  • EBM: efficacy uncertain, but safe

35

What is the specific MoA for omega-3 fatty acids? Is there any evidence that they are beneficial?

  • Produce less inflammatory mediators
  • Quality studies proving ^

36

What are the benefits of avocado and soybean unsaponifiables?

Example?

Evidence?

  • Anti-inflammatory, anti-osteoarthritic
  • Gasequen (cosequin + unsaponifiables)
  • Not a whole lot of evidence but probably won't hurt anything

37

What is the process/theory of autologous platelet therapy? Is there any evidence proving it's beneficial?

  • Platelets collected and injected into involved joint
  • Pain and wt. bearing improved at 12wks (study by company who makes it)
  • Uknown mechanism; debated

38

When is stem cell therapy appropriate? What is the EBM?

  • Might be appropriate for:
    • Non-responsive immune-mediated disease
    • When salvage or replacement is not viable
  • EBM very iffy in dogs for clinical arthritis

39

T/F: Stem cell therapy is wholly benign

FALSE--requires anesthesia

40

What are the possible side effects of NSAIDs?

  • All have side effects
  • COX-1 inhibition: GI, renal
  • COX-1 sparing or COX-2 selective drugs may also cause GI ulceration, renal or hepatic problems

41

What are the side effects of disease-modifying agents? EBM?

  • Heparin analogues--don't use in animals with coagulopathies
  • Adequan--good
  • PPS--fair, good EBM support for PS-GAG

42

What is the EBM behind nutraceuticals?

  • Glucosamine/chondroitin--efficacy uncertain, but safe
  • Omega-3 FAs--good mechanism-wise, but feeding studies have shown ineffectiveness
  • Lots of variation

43

What does the term "salvage procedure" mean?

  • Goal is to preserve life or limb function
  • No attempt to cure or fix underlying cause of DJD (or other disease)
  • Delayed as long as possible

44

What are the indications for and implications of a salvage procedure in general terms?

  • Indicated for severe DJD
  • Generally delayed as long as possible
  • Outcome keyed to procedure/technique rather than cause

45

What are the differences between joint replacement and partial excision arthroplasty?

  • Joint replacement arthroplasty
    • Intent: restore/preserve normal joint function
    • Gold standard
    • Artificial implants
    • Requires lots of training/expertise/equipment
    • Hip, elbow, stifle, shoulder
  • Partial excision arthroplasty
    • Remodeling of joint without replacement
    • Less specialized
    • Less training 

46

Compare and contrast ankylosis to arthrodesis

  • Arthrodesis--artificial fusion of a joint
    • Preferred over ankylosis
      • More rapid fusion
      • More complete fusion (true ankylosis is rare)
      • Less discomfort over time
  • Ankylosis--abnormal adhesion of bones to a joint
    • End-stage joint--let it do its thing on its on

47

What are the 4 principles of arthrodesis?

  • Complete removal of ALL articular cartilage
  • Cancellous bone graft
  • Rigid fixation (usually DCP)
  • Standing angle

48

What are the guidelines for post-op management of arthrodesis?

  • Coaptation (splint or ESF)--6-8wks
  • Activity restriction until bony fusion
  • Prolonged healing common--3mo minimum

49

What are the expected effects of arthrodesis of a given joint (general terms)?

  • High motion joint--"peg leg"
  • Low motion joint--minimal effect on gait
    • Distal joints in carpus/tarsus