Autoimmune polyarthritis in dogs

Által | 2022. szeptember 27., kedd

Navigáció

  • Publication types
  • You might also be interested in...
  • Clinical Presentation
  • Canine Immune-Mediated Polyarthritis: Meeting the Diagnostic and Therapeutic Challenges
  • Publication types

    Cases were analyzed as total IMPA cases and as subgroups [breed, systemic lupus erythematosus SLE , reactive, and idiopathic] and compared with the general canine hospital population. The hock joint appeared to be the most reliable for diagnosis of IMPA, and arthrocentesis of both hock joints may aid in case identification. Traduit par Docteur André Blouin Introduction Joint disease is common in all ages and breeds of dogs.

    Disorders affecting the joints can generally be classified as either inflammatory or noninflammatory. Noninflammatory joint disease that results from poor conformation, trauma, or developmental disorders is correctly termed degenerative joint disease. Immune-mediated noninfectious nonerosive polyarthritis IMPA is the most common polyarticular disease in dogs 1 , 2. This condition is believed to be a result of immune-complex deposition within the synovium, resulting in a sterile synovitis 1 , 3.

    It is diagnosed by excluding all possible causes. Idiopathic polyarthritis is more common in sporting and large breeds. The treatment of choice is based on prednisone. Some dogs might require lifelong medication. Some breeds are more prone to specific immune-mediated polyarthritis. In shar-peis, for instance, polyarthritis manifests through swelling of the carpal joints.

    This condition cannot be treated. Breed-specific polyarthritis has been also reported in Akita Inus, Bernese mountain dogs, beagles, boxers, German short-haired pointers and Weim­a­ran­ers. Some breeds respond well to immunosuppressive medication, while in others, the disease is more difficult to manage. Immune-mediated polyarthritis is a disorder of the immune system leading to inflammation in multiple joints.

    This condition in dogs is similar to the rheumatoid arthritis in humans. Immune-mediated polyarthritis is different to osteoarthritis which occurs much more commonly in dogs after injuries or due to old age. The immune system is usually responsible for fighting infections in the body. In polyarthritis, the immune system wrongly starts to attack the tissues of the joints. What are the Signs of Immune-mediated Polyarthritis? The signs of polyarthritis in dogs can be very variable as inflammation affects joints in more than one limb.

    Common signs include: Stiffness and reluctance to move Lameness in different limbs at different times Lethargy and a poor appetite. Dogs with polyarthritis are usually found to have stiff, painful and swollen joints in more than one limb.

    Autoimmune polyarthritis in dogs

    Polyarthritis following vaccination in four dogs. Breed-specific polyarthritis has been also reported in Akita Inus, Bernese mountain dogs, beagles, boxers, German short-haired pointers and Weim­a­ran­ers. In: Taylor SM, ed. Underlying Disease Control of the causative disease process is an important part of successfully treating many secondary IMPA cases. Idiopathic polyarthritis is more common in sporting and large breeds.

    You might also be interested in...

    Noninflammatory joint disease that results from poor conformation, trauma, or developmental disorders is correctly termed degenerative joint disease. Immune-mediated noninfectious nonerosive polyarthritis IMPA is the most common polyarticular disease in dogs 1 , 2. This condition is believed to be a result of immune-complex deposition within the synovium, resulting in a sterile synovitis 1 , 3.

    Reported clinical signs are variable and may include reluctance to walk, stiffness, lameness, and joint swelling. Systemic signs may be absent or include pyrexia, inappetence, and multisystemic disease [dermatitis, hemolytic anemia 3 — 7 ].

    Occasionally, only systemic signs are observed 8 , 9. One classification scheme for nonerosive polyarthropathies is the type I—IV system, as outlined in Table 1 and utilized in other studies 2 , How is Immune-mediated Polyarthritis Diagnosed? A diagnosis of polyarthritis is made by taking joint fluid samples from multiple joints and submitting them for laboratory examination. The next step in the investigation of polyarthritis is to look for any possible underlying trigger factors for this disorder.

    This step is likely to include blood and urine tests, X-rays, abdominal ultrasound scanning or CT scans. Fig 1: Dogs with polyarthritis tend to have swollen and painful joints How is Immune-mediated Polyarthritis Diagnosed? Fig 1: Dogs with polyarthritis tend to have swollen and painful joints What Treatments are Available for Immune-mediated Polyarthritis?

    Polyarthritis is usually treated with the use of medications to suppress the over-active immune system. This includes the use of steroids and other similar medications. Most dogs with immune-mediated polyarthritis are treated for several months with immune-suppressive medications, the doses of the drugs are gradually reduced over that time. It is also generally recommended to culture a sample from at least 1 joint. The best samples for culture are the most grossly abnormal, such as those that are discolored or have markedly reduced viscosity, or those with the most fluid obtained.

    Unfortunately, some potential infectious organisms are not identified by routine culture methods, and a high rate of false-negative culture results has been reported even for cases with septic arthritis. Baseline tests include a serum biochemistry panel, a complete blood cell count, and urinalysis, with plans to follow up on any identified abnormalities. Many patients with IMPA have results consistent with systemic inflammation on these tests, such as leukocytosis, mild nonregenerative anemia, and hypoalbuminemia.

    However, these medications may be contraindicated for several diseases that present with similar signs, such as septic arthritis, or be unnecessary for some causes of secondary IMPA, such as those related to vaccines or common vector-borne diseases.

    The authors generally wait 24 to 48 hours for preliminary joint fluid culture results before starting immunosuppressive therapy. Because vector-borne diseases are relatively uncommon in our area, we typically do not wait for results of external laboratory tests before starting immunosuppression if point-of-care testing is negative.

    Analgesia For patients that present with joint pain, analgesic medications are indicated while awaiting test results to confirm the diagnosis.

    Although nonsteroidal anti-inflammatory drugs NSAIDs are among the most effective medications for many disorders associated with joint pain, they should mostly be avoided in cases for which IMPA is considered a likely differential diagnosis. If NSAIDs are used, a washout period of at least 48 hours should be observed before the administration of steroid medications, which may end up delaying effective treatment.

    Nonetheless, NSAIDs may be appropriate in cases in which the use of steroids is not anticipated, or when definitive treatment is delayed while awaiting test results or completing a course of antibiotics for a non-joint infection. Other options for analgesia in outpatient cases might include opioids such as tramadol or fentanyl patches , gabapentin, or amantadine. Underlying Disease Control of the causative disease process is an important part of successfully treating many secondary IMPA cases.

    This may include discontinuing medications if a drug reaction is suspected, treating a non-joint infection with antibiotics, controlling concurrent gastrointestinal problems, or removing or treating neoplastic lesions. Some cases of secondary IMPA may resolve when the underlying immune trigger has resolved. Specifically, IMPA related to recent vaccination or sulfonamide administration has been reported to resolve in as little as 3 days without immunosuppressive therapy.

    Similarly, immunosuppression is warranted for cases of secondary IMPA when control of the underlying condition is not possible or clinical signs persist despite control of the underlying problem. Glucocorticoids are the most commonly used medications, and clinical improvement is typically rapid.

    However, this may represent a relative overdose for large dogs. These drugs may be used concurrently with glucocorticoids to speed up the tapering process or to improve disease control in refractory cases. Ideally, repeat joint taps are performed to confirm resolution of the inflammation, since clinical signs sometimes abate before joint inflammation, but this is not always feasible because of cost or client perception related to the invasiveness of the procedure.

    Some data suggest that C-reactive protein levels help in differentiating IMPA from osteoarthritis and monitoring response to therapy.

    Tapering medications too quickly has been proposed to increase the risk of relapse. The decision of which medication to taper first is generally based on the reason for using multiple medications, but most often it is the steroid. In particular, if the patient is having clinically significant side effects related to the steroid or has another condition that may be adversely affected by steroid administration, the steroid should be tapered first.

    In most cases, the authors wait at least 3 to 4 weeks after the steroid has been completely stopped before considering a decrease in the dose of another immunosuppressive medication. The authors typically do not try to wean patients completely off of immunosuppressive therapy for at least 4 to 6 months from the start of the treatment.

    If there is a relapse, the medication protocol should be changed back to the most recent effective dose or combination, although some patients require even higher doses to regain control of the disease.

    Some patients may require very long-term or lifelong immunosuppressive therapy; if this is the case, the goal is to find the lowest effective dose. Conclusion Clinical presentations of canine IMPA—and therefore diagnostic and therapeutic strategies—vary greatly. One important clinical tip is to consider IMPA as a diagnostic differential in cases without obviously swollen or painful joints.

    Even when IMPA is strongly suspected, deciding which tests are appropriate to evaluate for possible underlying disease and how to start immunosuppressive medications is often difficult. By thinking carefully about the differential diagnosis and the relative benefits and risks of the different diagnostic and treatment options, successful outcomes are possible for many dogs.

    References 1.

    Clinical Presentation

    Autoimmune polyarthritis in dogs

    Immune-mediated polyarthritis is a disorder of the immune system leading to inflammation in multiple joints. This condition in dogs is similar to the rheumatoid arthritis in humans. Immune-mediated polyarthritis is different to osteoarthritis which occurs much more commonly in dogs after injuries or due to old age. The immune system is usually responsible for fighting infections in the body. In polyarthritis, the immune system wrongly starts to attack the tissues of the joints. What are the Signs of Immune-mediated Polyarthritis?

    The signs of polyarthritis in dogs can be very variable as inflammation affects joints in more than one limb. Common signs include: Stiffness and reluctance to move Lameness in different limbs at different times Lethargy and a poor appetite. Dogs with polyarthritis are usually found to have stiff, painful and swollen joints in more than one limb. Many have a fever. How is Immune-mediated Polyarthritis Diagnosed? A diagnosis of polyarthritis is made by taking joint fluid samples from multiple joints and submitting them for laboratory examination.

    The next step in the investigation of polyarthritis is to look for any possible underlying trigger factors for this disorder. This step is likely to include blood and urine tests, X-rays, abdominal ultrasound scanning or CT scans. Generally, once the primary condition is treated, polyarthritis resolves as well. Immune-mediated polyarthritis—a very common form of polyarthritis.

    Antibodies can destroy or inhibit the normal function of joint cells, causing polyarthritis. Autoimmune diseases also attack the nerves and organs kidneys, skin, eyes, etc. The treatment consists of immunosuppressive medication. Rheumatoid arthritis—can affect multiple joints. This type is most common in middle-aged or senior toy dogs. Rheumatoid arthritis erodes the cartilage and the treatment is based on immunosuppressive medication. Treatment only controls the disease; it does not cure it.

    Septic polyarthritis—due to infectious organisms. This form of polyarthritis is not very common in dogs and can be managed through treatment if diagnosed in due time. Idiopathic polyarthritis—a form of polyarthritis with unidentified causes. It is diagnosed by excluding all possible causes. Idiopathic polyarthritis is more common in sporting and large breeds.

    Canine Immune-Mediated Polyarthritis: Meeting the Diagnostic and Therapeutic Challenges

    What are the Signs of Immune-mediated Polyarthritis? The signs of polyarthritis in dogs can be very variable as inflammation affects joints in more than one limb. Common signs include: Stiffness and reluctance to move Lameness in different limbs at different times Lethargy and a poor appetite.

    Dogs with polyarthritis are usually found to have stiff, painful and swollen joints in more than one limb. Many have a fever. How is Immune-mediated Polyarthritis Diagnosed? A diagnosis of polyarthritis is made by taking joint fluid samples from multiple joints and submitting them for laboratory examination. The next step in the investigation of polyarthritis is to look for any possible underlying trigger factors for this disorder.

    This step is likely to include blood and urine tests, X-rays, abdominal ultrasound scanning or CT scans. Immune-mediated noninfectious nonerosive polyarthritis IMPA is the most common polyarticular disease in dogs 1 , 2.

    This condition is believed to be a result of immune-complex deposition within the synovium, resulting in a sterile synovitis 1 , 3. Reported clinical signs are variable and may include reluctance to walk, stiffness, lameness, and joint swelling. Systemic signs may be absent or include pyrexia, inappetence, and multisystemic disease [dermatitis, hemolytic anemia 3 — 7 ].

    Occasionally, only systemic signs are observed 8 , 9. One classification scheme for nonerosive polyarthropathies is the type I—IV system, as outlined in Table 1 and utilized in other studies 2 , Immune-mediated nonerosive polyarthritis may also be classified as 1 a breed-associated syndrome, 2 associated with systemic lupus erythematosus SLE , 3 occurring secondary to a distant immunogenic stimulus reactive , or 4 idiopathic.

    Idiopathic polyarthritis—a form of polyarthritis with unidentified causes. It is diagnosed by excluding all possible causes. Idiopathic polyarthritis is more common in sporting and large breeds. The treatment of choice is based on prednisone. Some dogs might require lifelong medication. Some breeds are more prone to specific immune-mediated polyarthritis. In shar-peis, for instance, polyarthritis manifests through swelling of the carpal joints. This condition cannot be treated.

    Breed-specific polyarthritis has been also reported in Akita Inus, Bernese mountain dogs, beagles, boxers, German short-haired pointers and Weim­a­ran­ers.

    How is Immune-mediated Polyarthritis Diagnosed? A diagnosis of polyarthritis is made by taking joint fluid samples from multiple joints and submitting them for laboratory examination. The next step in the investigation of polyarthritis is to look for any possible underlying trigger factors for this disorder. This step is likely to include blood and urine tests, X-rays, abdominal ultrasound scanning or CT scans. Fig 1: Dogs with polyarthritis tend to have swollen and painful joints How is Immune-mediated Polyarthritis Diagnosed?

    Fig 1: Dogs with polyarthritis tend to have swollen and painful joints What Treatments are Available for Immune-mediated Polyarthritis? Polyarthritis is usually treated with the use of medications to suppress the over-active immune system. This includes the use of steroids and other similar medications. Most dogs with immune-mediated polyarthritis are treated for several months with immune-suppressive medications, the doses of the drugs are gradually reduced over that time.

    Regular check-ups and blood tests are required. Fig 2: A joint fluid sample being taken from a dog with polyarthritis What Treatments are Available for Immune-mediated Polyarthritis? Most dogs that are treated for polyarthritis respond to treatment and are usually much brighter and more comfortable on medication.

    Some dogs with polyarthritis experience a flare-up when the doses are reduced or the medications are stopped, and these dogs may need long term sometime lifelong treatment. Print This Page Orthopaedics — Find out more To assist owners in understanding more about Orthopaedics we have put together a range of information sheets to talk you through the some of the more common orthopaedic conditions seen and treated by our Specialists.

    This condition is believed to be a result of immune-complex deposition within the synovium, resulting in a sterile synovitis 1 , 3. Reported clinical signs are variable and may include reluctance to walk, stiffness, lameness, and joint swelling. Systemic signs may be absent or include pyrexia, inappetence, and multisystemic disease [dermatitis, hemolytic anemia 3 — 7 ].

    Occasionally, only systemic signs are observed 8 , 9. One classification scheme for nonerosive polyarthropathies is the type I—IV system, as outlined in Table 1 and utilized in other studies 2 , Immune-mediated nonerosive polyarthritis may also be classified as 1 a breed-associated syndrome, 2 associated with systemic lupus erythematosus SLE , 3 occurring secondary to a distant immunogenic stimulus reactive , or 4 idiopathic. Breed-associated polyarthritis syndromes, in which a genetic basis is postulated to cause the sterile synovitis due to immune complex deposition, have been identified in the Akita 11 , boxer, weimaraner, Bernese mountain dog 12 , German shorthaired pointer, spaniel, and beagle breeds 3 , 4.

    Some of these dogs may exhibit concurrent signs of meningeal inflammation 8. Systemic lupus erythematosus SLE is a multisystemic immune-mediated disease, reported infrequently in the dog, in which polyarthritis is the most commonly associated clinical abnormality.

    Diagnosis requires documentation of multisystemic involvement, elimination of underlying infectious disease, and positive serologic tests [antinuclear antibody or lupus erythematosus cell preparation Table 2 ; 13, 14 ].

    Antigenic stimuli implicated include the following: 1 infective or inflammatory processes remote from the joints, such as bacterial endocarditis, pyometra, pleuritis, diskospondylitis, chronic salmonellosis, heartworm disease, urinary tract infection, and severe periodontitis 7 , 15 , 16 ; 2 neoplasia remote from the joints 4 , 5 ; 3 hepatic or gastrointestinal disease, such as chronic bacterial diarrhea, ulcerative colitis, and inflammatory bowel disease 4 , 17 ; 4 drug—induced effects in association with recent administration of sulfadiazine-trimethoprim 18 , penicillins, erythromycin, lincomycin, cephalosporins, and phenobarbital 3 ; and 5 recent vaccination 5 , 6 ,

    Leave a Reply

    Your email address will not be published. Required fields are marked *