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49 Cards in this Set
- Front
- Back
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Arthrosis |
A joint
Sometimes refers to osteoarthritis |
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Polyarthritis |
Inflammation that simultneously affects several joints |
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Osteoarthritis/Ostearthrosis |
A primarily noninflammatory degenerative joint disease characterised by articular cartilage degeneration, osteophytosis and synovial membrane changes |
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Osteophytosis |
Marginal bone hypertrophy, that normally occurs with DJD |
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Ankylosis |
The result of DJD or inflammatory diseases, in which the joint is fused after new bone production |
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Synovial Joints |
Joints lined with synovial membrane that allow for relatively free movement.
Ex. Shoulder, hip, elbow, stifle |
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Fibrous joints |
Joints connected with fibrous tissue, that allow for no movement
Ex. Skull and teeth |
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Cartilaginous joints |
Connected with cartilage, allowing for little movement
Ex. Mandibular symphysis and growth plates |
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Arthroscopy |
The use of an endoscope to examine and treat joints |
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Arthrodesis |
Surgical treatment leading to joint fusion |
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Dysplasia |
The abnormal development of tissues, organs, or cells and is frequently diagnosed in dogs as hip or elbow dysplasia |
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What is a joint composed of? |
- Cartilage - Subchondral bone - Joint fluid - Synovium - Ligaments |
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How are arthropathies categorized? |
1. Inflammatory
2. Noninflammatory |
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How are inflammatory arthropathies categorized? |
1. Infectious
2. Noninfectious |
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How are noninfectious arthropathies categorized? |
1. Erosive
2. Nonerosive |
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What are the common noninflammatory arthropathies? |
- DJD (usually secondary)
- Those resulting from trauma or neoplasia |
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What are some nonerosive, noninfectious arthropathies? |
- Idiopathic IM noneorsive polyarthritis
- Chronic inflammatory-induced polyarthritis
- Plasmacytic-lymphocytic synovitis
- Arthritis associated with systemic disease (SLE) |
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What are some erosive/deforming arthropathies? |
- Rheumatoid arthritis
- Feline chronic progressive polyarthritis
- Erosive polyarthritis of Greyhounds
- Periosteal proliferative arthropathy |
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Physical exam findings of a dog with joint disease |
- Varying degrees of lameness - Muscular asymmetry btwn limbs - Joint enlargement - Abnormalities in ROM - Instability, pain and crepitation during joint manipulations |
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What could cause joint enlargement? |
- Increased joint effusion
- Periarticular fibrosis
- Osteophytosis |
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What are some general radiographic findings in diseased joints? |
- Proliferative or erosive bone lesions - Increased joint fluid - Adjacent soft tissue changes (muscle atrophy) |
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What possible radiographic findings could be present with inflammatory, infectious joint disease? |
- Subchondral bone sclerosis or lysis - Periarticular bone formation - Joint space narrowing - Joint capsule distention and adjacent soft tissue swelling |
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What possible radiographic findings could be present with inflammatory, noninfectious, nonerosive joint disease? |
- Soft tissue swelling and joint capsule distension without bony changes
- Multiple joints affected |
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What possible radiographic findings could be present with inflammatory, noninfectious, erosive joint disease? |
- Joint space collapse
- Subchondral bone destruction
- Periosteal new bone formation along with soft tissue swelling
- Multiple joints affected |
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What possible radiographic findings could be present with noninflammatory DJD? |
- Soft tissue swelling and intracapsular distension
- Diminished joint space
- Periarticular osteophytosis
- Subchondral bone plate usually intact but may be sclerotic |
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What possible radiographic findings could be present with noninflammatory trauma to joints? |
- Depends on the trauma (fracture, luxation)
- Ultimately may lead to DJD |
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What possible radiographic findings could be present with noninflammatory neoplasia in joints? |
- Soft tissue swelling and intracapsular distension
- Destruction of the subchondral bone plate (often on both sides of the joint) with aggressive bone proliferation |
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Why is CT helpful for assessing joint disease? |
- No superimposition of overlying structures
- Useful for evaluating bony changes
- Iding joint incongruites and fragmentation in osteoarthritic joints |
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Why is MRI useful for assessing joint disease? |
- Evaluation of menisci or soft tissue structures surrounding diseased joints
- Looking at ligament injuries |
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Why is US useful for assessing joint disease? |
- Evaluating intra-articular and extra-articular soft tissue structures
Ex. Shoulder, menisci |
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What do phagocytic mononuclear cells suggest in synovial fluid? |
DJD |
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What do nondegenerative neutrophils suggest in synovial fluid? |
- SLE - Feline chronic progressive arthopathy - Plasmacytic-lymphocytic synovitis - Idiopathic I-M nonerosive polyarthritis - Chronic inflammatory-induced polyarthritis - Rheumatoid arthritis - infectious arthritis |
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What do degenerate neutrophils in synovial fluid suggest? |
- Bacterial arthritis
- Rickettsial or spirochetal polyarthritis |
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What should be looked at in synovial fluid analysis? |
- Volume - Viscosity (normally quite viscous) - Turbidity - Cellularity and cell type - Cytology (RBCs?) - Bacterial culture results |
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What are the 5 basic principals of medical management for joints? |
1. Weight management 2. Nutritional supplementation 3. Exercise moderation 4. Physical therapy 5. Anti-inflammatory medication |
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Nutritional supplementation with Omega-3 fatty acids |
- Anti-inflammatory by replacing arachidonic acid in cell walls with eicosapentaenoic acid
- Eases pain of OA and decreases need for NSAIDs |
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Chondroprotective agents |
- Slow cartilage degradation
- Promote cartilage matrix synthesis
- Precursors for hyaline cartilage matrix (glucoseamine and chondrotian sulfate)
- Not really sure if they actually work |
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What are the main targets of physical rehab? |
1. Strengthening
2. Endurance
3. Range of motion |
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NSAIDs |
- Reduce pro-inflammatory mediators (thromboxanes, PGs, and oxygen radicals) by inhibiting COX - Coxibs are preferable (COX-2) - Lessen clinical signs of OA |
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Side-effects of NSAIDs |
- GI ulcers
- Liver or kidney failure
- Altered platelet function (increased clotting times)
- Keratoconjunctivits sicca |
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Some examples of NSAIDs used with joint disease |
- Carprofen
- Meloxicam
- Firocoxib |
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Polysulfated glycosaminoglycans and Hyaluronic acid |
- Enhance macromolecular synthesis by chondrocytes and hyaluron synthesis by synoviocytes - Inhibit degradative enzymes (MMPs) or inflammatory mediators - Remove or prevent the formation of fibrin, thrombi, or plaques in synovia or subchondral blood vessels |
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Pentosan polysulfate |
- Provides protection against cartilage damage
- Preserves proteoglycan content and stimulates hyaluronic acid synthesis |
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Hyaluronan |
- A large glycosaminoglycan foud in joint fluid and cartilage - In joint fluid it contributes to viscoelasticity - In cartilage it forms the backbone for proteoglycan - Can be given intra-articularly to help restore viscosity to joint fluid - Anti-inflammatory |
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What are some principals of articular surgery? |
- Surgical approach should minimise damage to the supportive structures of the joint - Avoid damaging the articular cartilage - Complete closure of the joint capsule is not necessary as a synovial layer will rapidly reform - Use absorbable sutures to close joint capsule, as nonabsorbale ones cause irritation and OA - Debridment of osteophytes has little value |
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Arthrotomy |
An open surgical approach to a joint, using traditional surgical instruments |
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When is closed reduction of traumatic joint luxations preferred? Why? |
- Traumatic luxations of otherwise normal joints (whenever possible)
- Minimises contamination, anaesthetic time, and iatrogenic ST damage and promotes rapid healing.
- Not if there's fractures or extensive ST damage |
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What occurs with joint immobilisation? |
- Progressive proteoglycan loss and depression of proteoglycan synthesis, which leads to softening of the cartilage with prolonged immobilisation - Helps restore cartilage after injury - However, forced activity after injury may further damage softened cartilage - The more rigid, the more cartilage degeneration |
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