Lame - SA joint problems

Question 1

What is degenerative joint disease also known as?

Answer 1

Osteoarthritis

Question 2

What are the different classifications of joint disease?

Answer 2

Osteoarthritis
Septic arthritis
Immune mediated arthritis

Osteochondrosis
Neoplastic
Trauma

Question 3

What is articular cartilage also known as?

Answer 3

Hyaline cartilage

Question 4

What is osteoarthritis?

Answer 4

Degenerative disease of synovial joints

Question 5

What is a simplified explanation of what happens in osteoarthritis?

Answer 5

Deterioration of articular cartilage and the formation of new bone at joint margins (osteophytes)

Question 6

What are some secondary causes of osteoarthritis?

Answer 6

Congenital eg. achondroplasia (dwarfism)
Developmental eg. hip dysplasia
Acquired eg. after fractures

Question 7

What is the pathogenesis of osteoarthritis?

Answer 7

Loss of cartilage matrix constituents and chondrocytes
Flaking and fibrillation - less smooth
Osteophytes
Synovial membrane thickening and fibrosis

Question 8

What makes up the cartilage matrix?

Answer 8

Collagen
Glycosaminoglycans
Chondrocytes

Question 9

What is the onset of osteoarthritis?

Answer 9

Insidious, chronic, slowly progressive
Can be acute lameness if done lots of exercise

Question 10

How do you confirm the diagnosis of osteoarthritis on radiograph?

Answer 10

Osteophyte formation
Soft tissue swelling
Joint effusion
Subchondral sclerosis
Synoviocentesis

Question 11

What changes occur to the synovial fluid in osteoarthritis?

Answer 11

Increase in volume, decrease in viscosity

Question 12

How do you treat/manage osteoarthritis?

Answer 12

Exercise modulation
Weight loss
Physical therapy/hydrotherapy
Drugs - end stage OA
Surgical options
Environmental modification

Question 13

What exercise should animals with osteoarthritis do? Why?

Answer 13

Little and often, not vigorous
Avoid inactivity - strengthen ligaments, prevent fibrosis, maintain muscle tone

Question 14

Why is massage good for osteoarthritis?

Answer 14

Stimulates circulation

Question 15

How does hydrotherapy improve osteoarthritis?

Answer 15

Improves range of motion
Muscle strength improves
Fitness
No high impact

Question 16

What drugs can you give for end stage osteoarthritis, or if management isnt working?

Answer 16

NSAIDs
Corticosteroids - last resort

Question 17

How do NSAIDs help osteoarthritis?

Answer 17

Analgesic
Catabolic - increases proteoglycan synthesis
Has GI side effects though

Question 18

What are some nutraceutical drugs/chondroprotectives?

Answer 18

Pentosan polysulphate
Glycosaminoglycans

Question 19

What benefits do nutraceutical drugs/chondroprotectives have?

Answer 19

Claim to stop or moderate the degenerative processes in the cartilage
Improve joint fluid
Improve healing

Question 20

What are some surgical options for osteoarthritis?

Answer 20

Correct inciting cause to delay progression of osteoarthritis
eg. TPLO for cranial cruciate ligament rupture
Hip dysplasia - TPO (triple pelvic osteotomy)
Patella luxation

Salvage procedures

Question 20

What are some salvage procedures done for osteoarthritis?

Answer 20

Joint replacement
Joint fusion eg. carpus
Joint removal eg. remove femoral head

Question 21

How can you modify the environment for osteoarthritis?

Answer 21

Soft beds
Ramps or steps
Low litter tray
Feed on the floor for cats

Question 22

What is the pathogenesis of septic joint disease?

Answer 22

Bacteria rapidly proliferate in the joint
Acute inflammatory response
Cytokine release
Cartilage loss
Erosions

Question 23

What is the signalment for septic/infectious joint disease?

Answer 23

Cats - bites
Dogs - young large breed males but can affect all

Question 24

What are the clinical signs of septic joint disease?

Answer 24

Acute or chronic Painful Effusion/swollen Severe lameness Single joint

Question 25

How can you diagnose septic joint disease?

Answer 25

Radiography Arthrocentesis

Question 26

How does synovial fluid present in septic joint disease?

Answer 26

Less viscous Increased volume Darker in colour High numbers of cells - neutrophils

Question 27

How do you treat septic joint disease?

Answer 27

Remove infected fluid Lavage Antibiotics - culture Surgical debridement

Question 28

What is the prognosis of septic joint disease?

Answer 28

Good in acute cases with appropriate therapy Poor in chronic cases with cartilage loss

Question 29

What are the two different categories of immune mediated inflammatory joint disease?

Answer 29

Erosive and non erosive

Question 30

What is the most common immune mediated inflammatory joint disease?

Answer 30

Idiopathic immune mediated polyarthritis

Question 31

What does it mean to be an erosive immune mediated inflammatory joint disease?

Answer 31

Can see bone erosion on imaging

Question 32

What is the main erosive immune mediated inflammatory joint disease?

Answer 32

Rheumatoid arthritis

Question 33

What are some non erosive immune mediated inflammatory joint diseases?

Answer 33

Idiopathic immune mediated polyarthritis Polyarthritis/polymyositis Polyarthritis/meningitis Vaccine/drug reactions

Question 34

What is rheumatoid arthritis usually seen in? Is it common?

Answer 34

Small breed dogs - rare

Question 35

What occurs in rheumatoid arthritis?

Answer 35

Erosive joint disease Joint collapse Crepitus and instability Pain variable

Question 36

What is idiopathic immune mediated polyarthritis?

Answer 36

Type III hypersensitivity reaction - immune complex deposition that affects multiple small distal limb joints Causes stiffness and lameness in young dogs

Question 37

What are the different types of idiopathic immune mediated polyarthritis?

Answer 37

Type I - uncomplicated Type II - associated with remote infection eg. pyometra Type III - Associated with GI tract disease Type IV - associated with neoplasia

Question 38

What are the clinical signs of idiopathic immune mediated polyarthritis?

Answer 38

Lameness of distal small joints Pyrexia Can migrate from joint to joint

Question 39

What does idiopathic immune mediated polyarthritis look like on radiograph?

Answer 39

Soft tissue swelling

Question 40

How do you diagnose idiopathic immune mediated polyarthritis?

Answer 40

Arthrocentesis of 6 joints Increase in volume, change in colour Lots of neutrophils - not as active as in septic arthritis though No bacteria

Question 41

How do you treat idiopathic immune mediated polyarthritis?

Answer 41

Treat any underlying cause Immunosuppressive drugs - prednisolone Azathioprine, cyclophosphamide if these dont work Then taper down

Question 42

What is the prognosis for idiopathic immune mediated polyarthritis?

Answer 42

Type I - cure in 50% of cases Other half need continued medication or euthanasia

Question 43

What are some examples of tumours than invade the joints?

Answer 43

Synovial sarcoma Fibrosarcoma Haemangiosarcoma

Question 44

How can you tell if a tumour in the joint is an osteosarcoma or not?

Answer 44

Osteosarcomas dont tend to cross joints - not in multiple bones

Question 45

What is the treatment for joint neoplasia?

Answer 45

Amputation

Question 46

What predisposes dogs to osteochondrosis?

Answer 46

Hereditary disease - dont breed affected dogs Multifactorial - high calorie diet Exercise

Question 47

What is the pathogenesis of osteochondrosis?

Answer 47

Failure of endochondral ossification resulting in a thickened area of cartilage (cartilage doesnt turn to bone)

Question 48

What is osteochondritis dissecans?

Answer 48

When the flap of cartilage separates from the bone into the joint

Question 49

What is the signalment of osteochondrosis?

Answer 49

Age - 4-8 months Large/giant breeds Cats - very rare More in males

Question 50

What are the clinical signs of osteochondrosis?

Answer 50

Insidious onset lameness Chronic Deteriorates after rest or excessive exercise Bilateral Reduced range of motion in the joint Pain on manipulation Effusions/swelling of the joint

Question 51

How do you diagnose osteochondrosis?

Answer 51

Radiography/CT Saucer shaped defect in the bone Joint mice - balls of cartilage next to joint Osteophytes Mineralised flaps

Question 52

What conservative treatment can you use to treat osteochondrosis?

Answer 52

Rest, NSAIDs, diet

Question 53

What surgical treatment can you use to treat osteochondrosis?

Answer 53

Surgery - arthrotomy, arthroscopy for cartilage flap removal Chondrectomy - remove cartilage

Question 54

What are the complications of osteochondrosis surgery?

Answer 54

Seroma formation Failure to remove all cartilage flap causing chronic lameness

Question 55

What is the prognosis for osteochondrosis?

Answer 55

Better for stifle and shoulder (loose joints) Better for smaller lesions Worse for tighter joints eg. hock and elbow Worse for large lesions or chronic problem

Question 56

What will all dogs develop with osteochondrosis?

Answer 56

Osteoarthritis

Question 57

Where does osteochondrosis occur in the shoulder?

Answer 57

Caudomedial humeral head (OCD)

Question 58

Where does osteochondrosis occur in the elbow?

Answer 58

Medial humeral condyle (OCD) Anconeal and coronoid process on ulna

Question 59

Where does osteochondrosis occur in the carpus?

Answer 59

Retained cartilaginous cores on the ulna

Question 60

Where does osteochondrosis occur in the stifle?

Answer 60

Lateral condyle of the femur

Question 61

Where does osteochondrosis occur in the hock?

Answer 61

Medial talar ridge on the talus

Question 62

What is the most common to least common joints to get osteochondrosis in in the dog?

Answer 62

Elbow - most common Shoulder Hock Stifle - least common