Inflammatory Arthritis

Question 1

What are the clinical signs of inflammatory arthritis?

Answer 1

General stiffness
Lameness
Pyrexia, lethargy, inappetence
Multiple painful swollen joints
Stilted posture
Arthralgia

Question 2

What diagnostic tests should be done if arthralgia is found on clinical exam?

Answer 2

Cytology of joint fluid

Question 3

What does a positive culture of joint fluid cytology indicate?

Answer 3

Septic arthritis

Question 4

What further tests should be done if cytology of joint fluid is sterile?

Answer 4

CBC biochem
US
Thoracic radiographs
Echocardiography

Question 5

How is septic and immune-mediated arthrocentesis differentiated?

Answer 5

Septic - degenerative neutrophils

IM - non-degenerative neutrophils

Question 6

What diagnostic test and result in arthralgia indicated chronicity?

Answer 6

Radiographs
Normal –> Acute
Erosion of cartilage and subchondral bone –> Chronic

Question 7

How is inflammatory arthritis categorised?

Answer 7

First broken down into infective and non-infective.

Non-infective is further broken down into erosive and non-erosive

Question 8

Describe normal joint fluid

Answer 8

Clear, pale yellow
Transparent
V viscous
Low WBCs

Question 9

Describe DJD synovial fluid

Answer 9

Yellow
Transparent
Viscous
May clot spontaneously 
Low WBCs

Question 10

Describe immune mediated arthritis synovial fluid…

Answer 10

Yellow, may be blood tinged
Transparent or opaque
Watery
Spontaneously clots
High protein
High WBCs

Question 11

Describe bacterial infective arthritis synovial fluid…

Answer 11

Yellow, may be blood tinged
Opaque
Watery
Clots spontaneously
V high protein
High WBCs

Question 12

What can cause septic arthritis?

Answer 12

Haematogenous e.g. foals umbilicus
Trauma
Iatrogenic e.g. IA injections

Question 13

How is septic arthritis treated in small animals?

Answer 13

Amoxiclav

Question 14

How is septic arthritis treated in horses?

Answer 14

Penicillin, gentamicin IA/IM
Thorough lavage, arthroscopy
Sample joint fluid q48hrs
Oral ABs

Question 15

Outline the pathogenesis of immune-mediated polyarthritis…

Answer 15

Ag/ab complexes deposited on synvoium > synoviocytes activated > release chrondrodestructive collagenases > osteoclasts cause bone resorption and subchondral cysts > Pannus formation

Question 16

How does the immune system fail during immune-mediated polyarthritis?

Answer 16

Fails to recognise self > autoaggressive cells proliferate

Question 17

What risk factors are there for developing autoimmune disease?

Answer 17

Inherited
Certain infections
Bacterial endocarditis
Discospondylitis
Immune mediated bowel disease
Neoplasia
Chronic hepatitis

Question 18

Out the Igs involved in types 1-4 hypersensitivity reactions

Answer 18

1. IgE - Mast cells basophils
2. IgG or IgM
3. IgG or IgM
4. Intracellular

Question 19

Which type of hypersensitivity is immune mediated arthritis?

Answer 19

Type III

Question 20

Define monoarticular, pauciarticular and polyarticular

Answer 20

Monoarticular - affecting 1 joint

Pauciarticular - affecting 2-5 joints

Polyarticular - affecting 6+ joints

Question 21

What should be included in a PE in an arthritic patient?

Answer 21

Observe walking
Full clinical exam
Palpation and manipulation
ROM, pain, heat, swelling and crepitus

Question 22

What diagnostic tests are used in a patient with polyarthropathy?

Answer 22

Arthrocentesis
Joint radiography
Synovial biopsy

Question 23

What can cause non-erosive polyarthritis?

Answer 23

Systemic lupus erthematosus
Lyme disease
Iatrogenic
Calicivirus 
Steroid-responsive meningitis-arteritis
IBD
Vaccine induced

Question 24

Outline the pathogenesis of erosive polyarthritis

Answer 24

Chronic synovitis > profilerative granulation tissue (pannus) > invades articular cartilage and subchondral bone > protreases and collagenases produced > further joint destruction

Question 25

What other disease procress does erosive arthritis cause changes similar too?

Answer 25

Septic arthritis

Question 26

Give 3 examples of erosive joint disease

Answer 26

Rheumatoid arthritis Periosteal proliferative polyarthritis in cats Polyarthritis of greyhounds (Felty's syndrome)

Question 27

What are the clinical signs of Felty's syndrome?

Answer 27

Rheumatoid arthritis Splenomegaly Neutropenia

Question 28

What radiographic changes occur in erosive arthritis?

Answer 28

Subchondral bone erosion Destructive symmetrical multijoint arthropathy Collapse of joint spaces Joint deformity of subluxation Periarticular new bone formation Calcification of periarticular soft tissues

Question 29

How can rhumatoid arthritis and SLE be differentiated in diagnosis/

Answer 29

Serology RA +ve for rheumatoid factor SLE - anti-nuclear antibody test

Question 30

What are the general principles of therapy to treat inflammatory arthritis?

Answer 30

Removal inciting factor Suppress immune respoinse Analgesia Reduce joint stress

Question 31

What drugs can be used to treat inflammatory arthritis?

Answer 31

Pred Cyclophosphamide Anti TNFa, IL-1 blockers Leflunomide (antirheumatic drugs)

Question 32

When might surgery be indicated in inflammatory arthritis?

Answer 32

Persistent inflammation can cause subluxation

Question 33

Outline the pathogenesis of gout in reptiles

Answer 33

Renal damage --> decreased excretion of urate --> urate crystal deposition --> inflam reaction

Question 34

How is gout treated in reptiles?

Answer 34

Fluid therapy