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CVSOH BVSc4 > Lame - equine joint disease > Flashcards

Lame - equine joint disease Flashcards

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1
Q

What is the presentation of asymptomatic synovitis?

A

Inflammation of the synovium
Effusion of the joint or sheath
No pain
No lameness
No radiological changes

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2
Q

What is the aetiology of asymptomatic synovitis?

A

Uncertain
May be conformation
May be minor trauma

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3
Q

Should you treat asymptomatic synovitis? How?

A

No - will resolve on its own

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4
Q

What is the name for joint flares?

A

Reactive synovitis

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5
Q

What is the presentation of reactive synovitis?

A

Acute onset joint flare 24 hrs after joint injection

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6
Q

How can you test to make sure it is a reactive synovitis and not a septic arthritis?

A

Synoviocentesis - should have a total nucleated cell count of <30x10^9 cells/litre

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7
Q

What are the clinical signs associated with a reactive synovitis?

A

Lameness variable
Effusion and heat
Resents palpation/flexion

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8
Q

When should a reactive synovitis resolve?

A

In 1-3 days

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9
Q

What is the aetiology of reactive synovitis?

A

Injection induces inflammation
Reaction to the chemicals in the injection - steroid induced arthropathy

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10
Q

Should you treat reactive synovitis? How?

A

Yes - oral NSAIDs

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11
Q

What is the usual presentation of a traumatic synovitis?

A

Can be any horse but usually a young horse in training

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12
Q

What are the clinical signs of traumatic synovitis?

A

Effusion
Pain on flexion
May be lame

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13
Q

What test should you do for a traumatic synovitis? What results will you get?

A

Synoviocentesis - total nucleated cell count normal (<10x10^9 cells/litre)

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14
Q

What is a haemarthrosis?

A

Blood in the synovial fluid
Whole fluid will be pink - if just a string of red then probably iatrogenic

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15
Q

What is the aetiology of traumatic synovitis?

A

Trauma - single or repeated
May be more trauma to the surrounding area too eg. cartilage damage, ligament injury

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16
Q

What are the consequences of traumatic synovitis?

A

May heal fine
Chronic thickening
May progress to osteoarthritis

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17
Q

What is the treatment for traumatic synovitis?

A

Box rest
NSAIDs
Rehab - exercise plan
Surgery?
Hyaluronic acid and glycosaminoglycans

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18
Q

What animals tend to get septic arthritis?

A

Foals with bacteraemia
Any horse with a penetrating injury - can be tiny

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19
Q

What are the clinical signs of septic arthritis?

A

Lameness - progressive to non weight bearing
Resent palpation/flexion
Effusion
Heat

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20
Q

How do you diagnose septic arthritis?

A

Synoviocentesis
Total nucleated cell count > 10x10^9 cells/litre (most are >30 neutrophils)
Gross appearance - dark yellow/brown/red fluid
Less viscous

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21
Q

How can you treat septic arthritis?

A

Arthroscopic lavage - best
Needle flush - good for acute case
Penicillin and gentamicin

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22
Q

What is the gold standard septic arthritis treatment?

A

Systemic antimicrobials - before and after surgery penicillin and gentamycin
Arthroscopic lavage with lots of hartmanns
Synovectomy
Analgesia - NSAIDs

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23
Q

What is the prognosis for septic arthritis?

A

If surgery <24hr - 90%
Delayed surgery - bad
If left a week - 0%
65% return to athletic function

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24
Q

When does osteochondrosis usually present in horses?

A

Young horse - 2 months to 2 years

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25
What are the clinical signs of osteochondrosis?
Lameness Effusion
26
How do you investigate cases of osteochondrosis?
Lameness exam Positive flexion Responds to joint block?
27
What is the treatment for osteochondrosis dissecans?
Surgical removal of fragments - arthroscopic guidance
28
What is the prognosis for osteochondrosis dissecans?
Depends on extent and joint Good for hocks Guarded for shoulder
29
What does osteochondrosis dissecans predispose to?
Osteoarthritis Quick removal of bone fragments reduces this though
30
Where are subchondral bone cysts most commonly seen in horses?
Medial condyle of the stifle - larger than lateral
31
What are the treatment options for subchondral bone cysts?
Surgical debridement Translesional screw - crosses the cyst and stimulates more normal bone growth Intralesional corticosteroids
32
What is the prognosis for subchondral bone cysts?
Very dependent on age Better prognosis for younger horses than older horses
33
What is osteoarthritis classified as?
A disease process involving a disturbed balance between synthesis and degredation in joint tissues Characterised by focal loss of cartilage, subchondral bone sclerosis and marginal osteophyte formation
34
What is stage 1 osteoarthritis?
Synovitis But no morphological changes to articular cartilage
35
What is stage 2 osteoarthritis?
Synovitis - less acute Mild articular cartilage damage
36
What is stage 3 osteoarthritis?
Chronic synovitis Cartilage damage severe
37
What is stage 4 osteoarthritis?
Chronic synovitis Full thickness loss of articular cartilage
38
What is a primary cause of osteoarthritis?
Chronic repetitive trauma
39
What are some secondary causes of osteoarthritis?
Traumatic arthritis Articular fracture Osteochondrosis Septic arthritis
40
What are the risk factors for osteoarthritis?
Inherent - breed, age, conformation External - use
41
What is the joint at the top of the hock that is high range of movement?
Tibiotarsal
42
What are the joints in the middle of the hock called?
Proximal and distal intertarsal
43
What is the joint at the bottom of the hock joint called?
Tarsometatarsal
44
What joints of the hock communicate in horses?
TIbiotarsal and proximal intertarsal - always Intertarsals - sometimes communicate with each other Tarsometatarsal and distal intertarsal - sometimes communicate
45
How do you investigate osteoarthritis?
Full lameness workup
46
What signs of osteoarthritis will you find on a lameness workup?
Reduced range of motion Thickened joint Crepitus Positive flexion test and positive response to intraarticular block
47
What can you see on radiography of osteoarthritis in horses?
Periarticular new bone Subchondral bone schlerosis Narrow joint space
48
What are the treatment options for osteoarthritis?
Treat/limit synovitis Cant reverse bone pathology Arthrodesis
49
What is arthrodesis?
Fixing/fusing the joints so they dont hurt anymore - for low motion joints
50
What is the prognosis for osteoarthritis? What does it depend on?
Management rather than solution Depends on: Location Severity Treatment Rehabilitation program
51
What management factors affect OA associated lameness?
Exercise routine Box rest Cold weather Body weight - obesity Farriery
52
What is the optimum exercise routine for horses with OA associated lameness?
Regular controlled exercise Warm up and cool down Water treadmills beneficial
53
What farriery can help horses with OA associated lameness?
Regular shoeing with optimal balance
54
What joint conditions is surgery beneficial for in horses? What conditions is it not beneficial for?
OCD - remove fragments Fracture cases - stabilise, restore congruity Not beneficial for most osteoarthritis cases - lavage better
55
What NSAIDs can you use to treat joint conditions in horses?
Phenylbutazone Flunixin Meloxicam
56
How do NSAIDs work?
COX inhibitors reduce prostaglandin production
57
When can you not use NSAIDs in horses?
Performance horses - are performance enhancing Phenylbutazone - not for use in animals for human consumption
58
What are the two intraarticular corticosteroids used in horses?
Adcortyl (triamcinolone acetonide) Depo-medrone (methyl predisolone acetate)
59
How do intraarticular corticosteroids work?
Phospholipase A2 inhibitors Reduce arachidonic acid production Reduce inflammation mediators for synovium
60
What is the cumulative max dose for triamcinolone acetonide?
Less than 18mg per horse
61
What is the cumulative max dose for Depo-medrone (methyl predisolone acetate) ?
Less than 200mg per horse
62
What is the safest corticosteroid to use intraarticularly? Why?
Triamcinolone - more chondroprotective so best in high motion joints
63
What are the complications of intraarticular corticosteroids?
Risk of joint sepsis/joint flare - sterile prep Risk of laminitis if horse has equine metabolic disease or cushings
64
What is intraarticular hyaluronate?
Glycosaminoglycan
65
What are the functions of intraarticular hyaluronate?
Lubricant Anti-inflammatory Some analgesia
66
What is intraarticular interleukin-1 receptor antagonist protein (IRAP)?
Blocks interleukin receptors so less immune response Taken from blood serum
67
What is the risks of intraarticular interleukin-1 receptor antagonist protein (IRAP)?
High risk of joint sepsis - blood serum is a good culture medium
68
What is pentosan also known as?
Cartrophen
69
What is pentosan used for?
Used prophylactically to support cartilage recovery and so improve joint function
70
How is pentosan administered?
4 weekly intramuscular injections
71
What is adequan?
Systemic polysulphated glycosaminoglycans treatment
72
What does adequan do to improve joint function?
Inhibits matrix metaloproteases - inhibits catabolic enzymes Reduces inflammation Lubricates Repairs cartilage
73
How is adequan administered?
Every 4 days for 7 treatments Given IM
74
What are the side effects of adequan?
Haemorrhage
75
What is the method of action of bisphosphonates?
Reduce osteoblast activity
76
What conditions are bisphosphonates used for?
Hock OA Navicular syndrome Diseases with excessive bone development
77
What are the side effects of bisphosphonates?
Binds to circulating calcium at injection so may cause GI dysfunction - colic
78
How are bisphosphonates administered in horses?
IV - through drip over 1 hour With concurrent NSAIDs
79
How does intraarticular polyacrylamide gel (arthramid) work?
Take up into synovial lining - local effect Non-absorbable - long duration
80
What improvements to synovial joints do intraarticular polyacrylamide gel have?
Shock absorption Increases elasticity of joint capsule Improves synovial fluid quality
81
What are the side effects of intraarticular polyacrylamide gel?
Minimal Soreness Oedema at 1-2 weeks post injection
82
What is intraarticular protein rich plasma?
Blood derived product containing growth factor cells and cytokines
83
When is protein rich plasma used in horses??
Mostly in tendon and ligament injuries Now administered into joints
84
What is the situation with mesenchymal stem cells?
Still in early research/early clinical phase But seems to be improving lameness, cartilage and synovial fluid in horses with surgically induced osteochondrosis fragments in trials
85
What are shock waves used on?
Most commonly used in soft tissue injuries Can be used on joints - usually lower motion ones
86
What are shock waves? What is the treatment plan?
1500-2000 pulses per joint Done once a week for 3 weeks
87
Why is there limited evidence for oral joint supplements?
If evidence then becomes a licensable product as so price increases reducing takeup - price themselves out of the market
88
How many horse owners feed joint supplements?
50%
89
What ingredients are in oral joint supplements?
Glucosamine Chondroitin Hyaluronic acid Omega 3 fatty acids Green lipped mussel extract Minerals Vitamins

CVSOH BVSc4 (86 decks)

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