SA Joint Dx and OA Flashcards
What is the difference between primary and secondary arthritis?
Primary arthritis has no underlying aetiology - it is more rare
Secondary arthritis is much more common and occurs usually due to some form of damage to the joint
Is primary or secondary arthritis more common?
Secondary more common
What are you likely to see in the animals history when they ahve arthritis?
Stiffness particularly on rising - watch the dog as they come into the consult room
Worse after exercise
Waxes and wanes
Shifting lameness? Could suggest autoimmune dx
Worse in colder weather?
Exposure to ticks - lyme dx can potentially cause lameness
Bleeding tendency? Blood in the joint is very painful
What are you likely to see on a physical exam in an animal with arthritis?
- Lame
- Pain on manipulation
- Swelling to joints
- Associate muscle atrophy
- Neurological deficits?
- Systemic signs?
- Always compre with opposite limb
How can you make a provisional diagnosis for arthritis?
- If lameness mild - not unreasonable to trial therapy e.g. rest and analgesia
- If failts to respond after 1 - 2 weeks, a definitive dagnosis should be sought after
- Always try to get the owner to come back/make contact with the owner to find out if its worked or not
How can you confirm the diagnosis of arthritis?
Confirming the diagnosis
- further manipulation of joints ± sedation or GA: standard and joint specific (e.g. cranial draw, Ortolani)
- diagnostic imaging: radiography ( ± contrast), ultrasound, EMG, CT, MRI, scintigraphy
- arthrocentesis
- intra-articular or regional blocks (rarely performed in small animals)
- arthroscopy
- exploratory arthrotomy
What is ortolani a sign of?
Hip dysplasia
How should you perform radiography when trying to diagnose arthritis?
- Good quality: positioning, exposure and development
- Standard orthogonal views +/- stress views
- Radiograph opposite side for comparison if unsure
- Read filsm methodically
WHat is one of the first things you will see with an unhappy joint?
Joint effusion
Comment on these 2 radiographs
Left - normal
Arthritis joint on the right - can see new bone on distal end of patellar and some sclerosis
Area of whiteness within joint on right - joint effusions
What is demonstrated in these radiographs? What is it used for?
Which joint is it often used in?
Contrast arthrogram - a series of images of a joint after injection of a contrast medium
The canine shoulder is the only joint routinely assessed with positive contrast arthrography
What is ultrasound useful for with regards to arthritis?
Good for peri-articular soft tissue structures e.g. bicipital tendon
Can be used for detection of meniscal tears but requires a very skilled operator
What is arthrocentesis?
Arthrocentesis is a diagnostic test that is performed to determine the cause of joint swelling or arthritis, including septic bursitis, gout, or rheumatoid arthritis. Also known as joint aspiration, the procedure uses a sterile needle and syringe to drain fluid from a joint for further examination.
With arthrocentesis, when are you likely to just look at a single joint and when are you most likely to look at multiple joints?
Single joint likely to be septic or traumatic
Multiple joints (at least 3) for detection of polyarthritis
Where do you collect the artocentesis sample into?
Done by aseptic technique
Collection into plain, EDTA and blood culture medium if likely to be infected
Smears for cytology as well as count from EDTA sample
When doing a synovial fluid analysis, what should you look for?
Gross appearance
Viscosity (string test)
Protein content and mucin test
Cytology
What is normal synovial fluid like?
Honey coloured
Like syrup
Relatively clear
Good viscosity
With synovial fluid cytology, what is likely with small numbers of foamy macrophages?
Suggestive of degeneratiev disease
With synovial fluid cytology, what is likely with large numbers of neutrophils?
Large numbers of neutrophils in both sepsis and polyarthritis
Have a look at this table about synovial fluid analysis with regards to normal joint, degenerative joint disease, immune mediated arthritis and bacterial infective arthritis
What is a fragmented coronoid process most common in?
Most common in elbow dysplasia
What is arthroscopy?
What are some pros and cons?
Diadvantages:
- Difficult to do
Advantages:
- Joint morbidity reduced
- Magnification
- Therapeutic as well as diagnosti
What is this arthroscopy of?
Fragmented coronoid process - damaged articular cartilage
How can arthrotomy be useful for diagnostic?
Visualisation of pathology
Synovial biopsy
