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Preeti: SA Surgery > Arthritis and OCD Objectives > Flashcards

Arthritis and OCD Objectives Flashcards

1
Q

Any joint disease is known as an

A

arthropathy

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2
Q

Broad term for degenerative and other diseases of the joint

A

Arthrosis

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3
Q

Inflammation within a joint

A

Arthritis

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4
Q

Inflammation in several joints simultaneously

A

Polyarthritis

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5
Q

Term for surgical closure of the joint capsule

A

Capsulorrhapy

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6
Q

Surgical tightening of fascia, joint capsule, tendon

or

surgical pleating and folding of tissue to realign organs and provide

extra support,e.g. chronically stretched joint capsule.

A

Imbrication

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7
Q

Surgical repair or shaping of a joint

A

Arthroplasty

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8
Q

a bony outgrowth associated with the degeneration of cartilage at joints

A

Osteophyte

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9
Q

abnormal bony projections at the attachment of a tendon or ligament

A

Enthesophytes

(They are not to be confused with osteophytes, which are abnormal bony projections in joint spaces)

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10
Q

a loose fragment (as of cartilage) within a synovial space

A

Joint mouse

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11
Q

abnormal stiffening and immobility of a joint due to fusion of the bones

or

spontaneous fusion of a joint (when osteophytes come together)

as an end result of chronic joint disease

A

Ankylosis

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12
Q

Surgical fusion of a joint

A

Arthrodesis

(better than ankylosis which occurs on its own)

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13
Q

Incision into a joint

A

arthrotomy

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14
Q

What are the 3 categories of joints?

A

Synovial

Cartilagenous

Fibrous

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15
Q

What category of joints are being referred to when talking

about arthritis?

A

Synovial joints

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16
Q

What is the difference between inflammatory and non-inflammatory

arthritis?

A

Inflammatory means that the primary cause of the arthritis is inflammation

Non-inflammatory means that inflammation is a secondary effect of the primary cause of the arthritis

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17
Q

What are the primary sub‐classifications of inflammatory arthritis?

A
  1. Infectious
    1. bacterial (septic)
    2. fungal
    3. mycoplasmal
  2. Non-Infectious (Immune-mediated)
    1. Erosive (rheumatoid)
    2. Non-erosive
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18
Q

What are the primary sub‐classifications of NON - inflammatory arthritis?

A
  1. Primary (Idiopathic) Osteoarthritis
  2. Secondary Osteoarthritis (DJD)
    1. Developmental (OCD, Hip Dysplasia)
    2. Acquired (trauma, neoplasia)
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19
Q

Which is more common (primary vs. secondary arthritis)

in dogs? In cats?

A

Primary is more common in CATS

Secondary is more common in DOGS

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20
Q

How do you differentiate between inflammatory and non-inflammatory

arthritis?

A

JOINT TAP!

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21
Q

What are the radiographic findings associated with arthritis?

A

Osteophytes

Soft tissue swelling

Joint inflammation or effusion

Subchondral sclerosis

Increased or decreased joint space

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22
Q

What are the limitations of radiographs for diagnosis of arthritis?

A

Rads are highly specific, but minimally sensitive for diagnosis of arthritis

If you don’t see it, you CANNOT say for sure it is not there,

especially in the elbow

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23
Q

What are the 6 categories of nonsurgical treatment for osteoarthritis?

A

Weight management

Exercise moderation

Physical rehabilitation

Symptom-modifying agents (analgesics)

Disease-modifying agents (reparatives)

Neutraceuticals (food or food products that provide medical benefits)

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24
Q

What is the most effective nonsurgical treatment for osteoarthritis?

A

WEIGHT MANAGEMENT

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25
What is the MOA of NSAIDs?
Reduce pro-inflammatory mediators by inhibiting **cyclooxygenase** (COX-1 Inhibition)
26
Why should you never give cats NSAIDs and what do you prescribe for analgesia instead?
Cats are poor at glucoronidation (in the liver) which is how NSAIDs are broken down. Give **Onsior (Robenacoxib)** instead - metabolized by the kidney
27
What is absolutely **contraindicated** if treating an animals with NSAIDs?
STEROIDS!
28
What is the general mechanism of action for reparatives?
To promote synthesis over breakdown or by providing articular cartilage or fluid building blocks
29
What is the MOA for the following neutraceutical? **Glucosamine/Chondroitin** (Cosequin)
Stimulate proteoglycan synthesis of hyaline cartilage matrix in vitro
30
What is the MOA for the following neutraceutical? **Omega 3 Fatty Acids** (EPA, DHA)
**Compete with arachidonic acid as a substrate for COX** Results in production of less proinflammatory mediators (decreased need for NSAIDs) *Basically, Omega-3 sorostitutes are whores because they love to compete for some COX*
31
What is the MOA for the following neutraceutical? **Avocado and Soybean Unsaponifiables (ASU)** (Dasuquin)
Decrease inflammatory mediators and increase cartilage matrix synthesis
32
What are the common side effects of NSAIDs?
For COX-1 inhibitors: **GI** and **Kidney** side effects For COX-2 selective drugs: **GI, Kidney,** and **Liver** side effects
33
What is a side effect to be cautious of when using Avocado and Soybean Unsaponifiables (ASU)?
Has *induced* arthritis in some animals!
34
What is the level of EBM support for reparatives like **PS-GAG** and **PPS**?
**GOOD** EBM support EBM for PS-GAG is best
35
What is the level of EBM support for Glucosamine/Chondroitin?
EBM states efficacy is uncertain, but it is safe
36
What is the level of EBM support for Omega-3 Fatty Acids?
**GOOD** EBM for Omega-3's | (and rarely cause GI probs)
37
What is the level of EBM support for weight management?
**Good to EXCELLENT** EBM support
38
What is a salvage procedure?
A procedure in which the goal is to **preserve** life/limb function, but there is NO ATTEMPT to cure or fix the problem (in this case, the cause of DJD)
39
What are the differences between joint replacement and partial excision arthroplasty in general terms?
_A Joint Replacement Arthroplasty_ is a surgical procedure in which parts of an arthritic or damaged joint are removed and replaced with a prosthesis _A Partial Excision Arthroplasty_ is where the joint is **remodeled** but nothing is removed
40
What is the difference between ankylosis and arthrodesis?
_Ankylosis_ is the body's attempt to stabilize/fix a joint by growing bony osteophytes which eventually fuse together. _Arthrodesis_ the surgical method of doing the same thing, usually done to ameliorate the pain caused by the arthritic joint.
41
What are the the principles of arthrodesis?
Complete removal of ALL articular cartilage Cancellous bone graft Rigid fixation at standing angle (usually DCP)
42
What are the guidelines for postoperative management of arthrodesis?
Coaptation for 6 - 8 weeks Activity restriction until bony fusion Prolonged healing for 3 months minimum
43
What is the expected effect of arthrodesis of a given joint in general terms?
For **high motion** joints: "Peg Leg" gait For **low motion** joints: Minimal effect on gait
44
Define osteochondrosis
DEFECT IN ENDOCHONDRAL OSSIFICATION (self-limiting developmental derangement of normal bone growth, primarily involving the centers of ossification in the epiphysis. [1, 2] It usually begins in childhood as a degenerative or necrotic condition. Bydefinition, osteochondrosis is an aseptic ischemic necrosis.)
45
Describe the basic pattern of long bone growth
Starts from epiphyseael center of ossification→ Travels outward in an "ossification wave"→ Anastomoses form: perichondral plexus and epiphyseal bone supply
46
\_\_\_\_\_% of long bone growth occurs at the physis
80%
47
Endochondral ossification occurs at the \_\_\_\_\_\_
epiphysis
48
Endochondral ossification is usually complete by \_\_\_\_\_ months of age
6 months
49
The **epiphysis** contributes \_\_\_\_\_% of bone growth
20%
50
An error or interruption in the anastomoses process leads to \_\_\_\_\_ epiphyseal cartilage due to cartilage ______ downstream
_thicker_ _necrosis_
51
Describe the pathophysiology of osteochondrosis
Disruptions in anastomoses→ cartilage necrosis downstream→ cartilage cannot ossify→ thickened cartilage→ acts as a "stress riser" (rising from inside the bone to the surface)→ necrotic cleft between cartilage and bone→ focused stress over cleft→ fracture of cartilage and defect in joint surface
52
How does a fissure between the thickened cartilage and subchondral bone trigger degenerative joint disease?
Fissure/fractured cartilage causes a *defect in the joint surface* which accelerates DJD
53
What does the term “multifactorial” mean when applied to the etiology of OCD?
Need both genetic and non-genetic factors for OCD to present: 1. Genetics: 1. Dogs, male, large/giant breeds 2. Non-Genetic Factors: 1. High Ca/Vit D (promote errors in endochondral ossification) 2. Energy 3. Trauma
54
What is the gender and breed disposition of OCD?
Males, large/giant breed dogs, Great Danes
55
What is the significance of heritability in OCD?
Heritability is 10 - 45%, so should NOT BREED these animals
56
What is the relationship between dietary calcium and vitamin D levels and OCD?
**HIGH** Ca/Vit D promotes errors in endochondral ossification
57
How does dietary energy relate to the development of OCD?
Dietary energy: Promotes development of bone and muscle Increases stress on developing cartilage with RAPID growth
58
What is the difference between microtrauma and macrotrauma as related to OCD?
**Micro**trauma= normal weightbearing stress But in OCD, abnormal weakened cartilage is more prone to injury, and lesions occur even with normal stresses **Macro**trauma= athletic, high impact stress In OCD, may cause subclinical to become clinical
59
What does the phrase “developmental orthopedic disease” signify?
It means that the disease is **heritable**!
60
What is a “biphasic age distribution” (referring to age at presentation) and why it is present with OCD?
Means that two age groups can typically present with the disease. In OCD, can present in young animals due to *inflammatory arthritis* or in older animals due to *secondary DJD*
61
Describe a typical patient with OCD (this applies to OCD manifesting in all joints)
Male, large or giant breed dog Either 4 - 8 months or middle-aged to old Limb lameness, pain on joint manipulation, bilateral issues
62
What are the locations where OCD is commonly found in dogs?
Shoulder- humeral head (caudolateral) Elbow- humeral condyle (medial) Hock (Ankle)- talar ridge (medial or lateral) Stifle- femoral condyle (medial or lateral)
63
Describe the radiographic findings compatible with OCD
For the shoulder- *flattened caudal humeral head* =OCD May see joint mouse (loose cartilage flap)
64
What are the potential preventive measures recommended with OCD?
Energy, calcium, and vitamin D restriction Exercise restriction
65
Describe a patient for which conservative treatment of OCD might be acceptable
Small lesion Young patient (\<6m) Clinically silent, or only mild lameness Poor surgical outcome
66
List the components of conservative management for OCD
Energy, calcium, and vitamin D restriction Exercise restriction Weight control NSAIDs
67
Describe the most common surgical treatment for OCD and the difference in the type of cartilage that forms as the defect heals
Sx = Fragment removal and subchondral bone debridement Articular cartilage is replaced by **fibrocartilage**

Preeti: SA Surgery (10 decks)

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