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Flashcards in Investigating Joint Disease (La Fuente) Deck (33):
1

What is joint fluid?

Dyalisate from plasma
- 2 filters, vascular endothelium and synovial interstitum
- contains proteins , electrolytes, enzymes, water and HA
- cells- synovial lining cells

2

How does a healthy joint differ from an inflamed joint? LOOK AT SLIDE

- excessive synovial fluid in joint cavity
- surrounding soft tissue inflammation
-WBCs and inflammatory mediators released into synovial fluid via inflamed synovial membrane
- normal articular cartilage

3

Which inflammatory cell is more commonly seen in joint fluid?

Macrophages more than neutrophils

4

What aspects of the Hx are important for joint dz?

- single v multiple limb
- intermittent v before/after excercise
- excercise tolerance
- travel Hx
- parasites
- systemic disease (IMHA, ITP etc)

5

What clues may the signalment give for joint disease?

>age
- puppies: instability
- senior: OA
> breed
- GSD hip dysplaisa
- Labrador elbow dysplasia
- greyhounds erosive joint disease

6

What type of lameness does crucial element rupture give?

Weight bearing (unless traumatic)

7

How may poly arthritis cases sit?

Not flexing any joints - sit on lateral aspects of HLs

8

What clinical signs may be seen with joint dz?

>Lamenss
- one or multiple limbs
- severity
- specific posture
>systemic signs (variable)
- fever
- lethargy
- anorexia
- collapse
> PE
- fever
- murmur
- masses
> orthopeadic examination
- joint effusion/buttress/muscle atrophy
- pain/heat/decreased ROM
- instability (CCLR, CHD) crepitus
> neuro exam
- normal v deficits

9

What is a buttress?

Swelling medial aspect of the stifle d/t cruciate rupture and joint capsule swelling

10

Dxx for joint dz

>Radiographs
- joint capsule and space (look for cloudy joint effusion)
- bony relationships
- bone density
- subchondral bone
- calcification
- osteophytes and enthesiophytes
>arthrocentesis
- single affected joint
- or suspected polyarthropathy (at least 3 joints)
- sedation or GA
- sterile procedure
- slides, EDTA, blood culture (may be false negatives for septic arthritis, blood culture medium ^ chances of success)
> and analysis of joint fluid

11

What is the cut off point for WBC in joint fluid?

3000
Above this = immune mediated poly arthritis OR septic
- positive culture to prove septic (rarely see bacteria in joint tap) though culture also gives false negatives

12

What is analysed of the joint fluid?

- cell count
- cytology
- chemical analysis (TP, glucose)
- culture (R/o inflammatory septic v nnonseptic autoimmune)

13

What cells can be seen on cytology?

> synoviocytes
- normal
> neutrophils
- inflammatory
- degenerate v non-degenerate
> macrophages
- non-inflammatory (DJD)
> bacterial/fungal hyphae
> haemophagocytosis

14

What chemical analysis can be carried out on joint fluid?

> glucose
- fluid: blood = 0.8-1 normal
- decreased in septic arthritis
> TP
-

15

If septic OA is suspected but culture negative what can be done?

Synovial biopsy.

16

How can culture give false results? How can this be improved?

- false negative as culture doesn't grow bacteria present (number too low??)
- false positive with contamination (check cell count)
> improve by sample into special culture media
> OR synovial membrane biopsy

17

What is the most common type of infectious inflammatory OA? Aetiologies?

>bacteria
- dogs with OA pdf spontaneous SEPTIC OA (non weight bearing)
- direct penetration
- spread from adjacent tissues
- haematogenous

18

What bacteria are most commonly involved in some tic arthritis?

Staph
Strep
Pasteurella
(Skin commensals)

19

How long does OA take to develop radiographic signs?

3-4weeks

20

What is seen in septic arthritis on joint tap and radiography?

> joint fluid
- septic inflammation (though not always degenerate neutrophils)
- rare bacteria
- positive culture
> rads
- acute (effusion)
- chronic (degenerative changes)

21

Tx septic arthritis

6 weeks Abx BS

22

What forms of infectious immune-mediated arthritis are possible and how can you r/o?

> Serology and travel hx (esp Mediterranean) (NB these do not have to infect the joint, the immune complexes cause the damage)
- infectious arthritis when suspecting immune-mediated polyarthritis
> Borrelia Burgdorfory (Lyme disease)
- borrelial arthritis
> Ehrlichia canis (Ehrlichosis)
- rickettsial arthritis [tick not endemic UK]
> Leishamania Infantum (Leishmaniasis)
- Protozoal arthritis [not endemic UK]

23

What are the 2 forms of immune based arthritis ?

Erosive v non-erosive

24

How does septic arthritis differ in presentation to immune mediated?

- One joint affected septically usually
- if immune mediated = poly arthritis

25

Is erosive poly arthritis common? Subtypes? Most common subtype?

Not common!
- Rheumatoid most common within this subset
- PA greyhounds
- feline chronic progressive PA

26

What is rheumatoid arthritis?

Auto Ab against IgG
- causes erosive poly arthritis
- radiographic changes must be present too

27

What is SLE?

Systemic lupus erythematosis
- causes NONerosive polyarthritis

28

What are the 4 MAIN types of immune mediated polyarthritis and how can these be r/o?

type 1: Idiopathic immune mediated poly arthritis (most common, 50% cases)
- need to r/o other subtypes)
type 2: infection (25%)
- serology
type 3: GI dz
-
type 4: Neoplasia
- imaging body cavities
- depending on sigs CSF/Muscle biopsy etc.

29

What test can r/o SLE?

ANA ( antinuclear antibodies)
- high titres with SLE, though other infectious/inflame processes can -> low titres

30

What 2 types of synoviocytes ?

Type a and b

31

Criteria for diagnosing rheumatoid arthritis in dogs

> 7 out of 11 criteria
- stiffness after rest
- pain 1+ joint
- stiffnes 1+ joint
- swelling in 1 additional joint within 3 months
- symmetric joint swelling
- subcut nodules over bony prominences of extensor surfaces of only rticular regions
- radiographic evidence of destructive lesions
- positive RF serum (titre >1.8)
- poor mucin content of synovial fluid
- characteristic histopath changes in synovial membranes
- characteristic histopath changes in subcut nodules

32

What are the 5 main types of NON erosive immune mediated (non-infectious) inflame arthritis?

- SLE
- idiopathic PA
- PA/PM syndrome
- PA/meningitis syndrome
- PA akitas

33

Criteria for diagnosing SLE in dogs

- definitive or probable depending on no. major/minor signs +- serology
> major
- skin lesions, glomerulonephritis, polyarthritis, haemolytic anaemia, polymyositis, leukopenia, thrombocytopenia
> minor
- PUO, CNS signs/seizures, oral ulceration, lymphadenopathy, pericarditis, pleuritis
> serology
- ANA
- Lupus erythmatosus cell preparation