grand rounds presentation
TRANSCRIPT
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An approach to Feline Polyarthritis - A case of periosteal proliferative
polyarthritisGlynn Woods
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8Yo M(n) DMSH Fully vaccinated
3m shifting lameness No trauma Weight loss Lethargy
Started of RIGHT hindlimb – metacam.
Bout of ILLNESS – blood panel. Steroids tapering
PELVIC pain – RADS and Virus panel – Steroids
Month later – LEFT forelimb lameness - coinciding with a reduction of his steroid dose
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Deteriorated significantly, in comparison to referring vet letter
37.3 degrees, 186bpm and 36rpm
Dull, lethargic and unwilling to move
Painful in several limbs perceivable more so in his L fore
When he did stand his hind leg gait was very stiff
Joint effusion
Popliteal lymph nodes were palpable
No other significant findings on clinical exam
Clinical exam
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Haematology - Neutrophilia and Monocytosis Biochemistry - Mild hyperglobulinaemia
Cytology –Lymphoid hyperplasia
IV line was placed for provision of hartmanns and methodone.
Initial investigations
.
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Viral Testing - negative
Joint Culture Cytology
Radiographs ***
Ultrasound Abdomen
Further investigation
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RADIOGRAPHS HERE
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Periosteal Proliferative Polyarthritis
Immune mediated HS3
Linked to viruses
Males
Carpi and Hocks
1 – 5y
Fever, lethargy, stiff gait, joint pain and swelling
Lymph node hyperplasia
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ClassificationJoint Disorders
Non inflammatory
Inflammatory
Developmental
Degenerative
Neoplastic
Traumatic Infectious
Immune mediated
Erosive Non - Erosive
Idiopathic IMPA
Reactive PA
Systemic Lupus
Feline PPP
Feline RA
Bacterial
Mycoplasm
Calici virus
Corona virus
Rickettsial
Lyme
Fungal
Based on Clinical / RAD
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Clinical Exam - Non specific pain- Lameness- Stiff gait- Reluctance to walk- Owner percieved pain – “Just nae right!”
Radiographs
Arthrocentesis
Synovial analysis- Colour, viscosity and turbidity- Estimated cell count and differential leukocytes- More inflammation there is the greater the # of Leukocytes and greater proportion of neutrophils.- Affirmed diagnosis. - Submit for anaerobic and aerobic culture as well as mycoplasma.
Diagnostic approach
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FIV and FeLV
Antibody titres
Must rule out a REACTIVE POLYARTHROPATHY
Haematology Biochemistry Urine analysis Thoracis and abdomenal RADs Abdominal ultrasound Urine/blood culture Lymphnode aspirates Inflammatory proteins - ______________________________________
Additional investigations
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SEPTIC
Mycoplasma
Borrilia
Feline calici virus.
Corona virus
Infectious inflammatory joint disease
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Highly prevalent in dogs. But considered RARE in cats
Non erosive IMPA is caused by deposition of immune complexes in the synovial membrane and the ensuing inflammatory response. Can occur primary (idiopathic), secondary to stimulation (reactive) or as a feature of SLE.
Reactive accounts for 25% pyenephritis, pneumonia, toxiplasmosisa dn enteritis, felv, fip, and CBA.
Rule out! Is so important.
Not responding to doxy – then glucocorticoid warranted.
Can use prednisone prednisolone, ciclosporin, leflunimide, chlorambucil, methotrexate...
Immune mediated inflammatory JD.
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Uncommon immune mediated disorders can result in erosive damage .Periosteal proliferative PA marked periarticular . Second is a deforming arthritis resembling rhuematoid arthritis in humans.
Both deemed Chronic Progressive PA. Postulations that it was caused by Feline syncitum virus in genetically predisposed cats. But because that
virus is so far and wide spread its hard to associate in papers.
FPPPA. Male cats(intact or not), any age, fever lethargy, a stuff gait, joint pain, carpus and hock. Edema of skin and soft tissues. LN hyperplasia. RAD changes not noticable for first 10-12 weeks. Over time it worsens the periosteal changes. Synovial biopsy initally reeals a neutrophillic synoviitis and tendonitis but with time and chronicity plasma cells and lymphocytes increase.
Feline rheumatoid arthritis insidious, over weeks and months. Middle aged cats and siamese over represetned. RARE. Fever and systemic disease do not occur so these cats are rarely investgate before severe disease pathway. RADs – subchondral central and marginal erosiions and periarticular sof ttissue swelling.
Erosive immune mediated polyarthritis
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Pred 2mg.kg q 12h PO 3-4 days
Same for 4 weeks
Assess clinical response and perform fluid cytology
Have they resolved?
Tapering dose, evaluating clinical response and performing synovial cytology before each reduction
Idiopathic immune mediated PA treatment strategy.
NAW
AYE
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Treatment:- Doxycyline Synulox Prednisolone Famotidine
Check-up appointment- Doing great!- Blood glucose
Back tae Koshka
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OA which is common in cats
Infectious > immune mediated in cats.
Suspect Calici virus
Don’t forget mycoplasma
Rule out reactive or infectious causes.
Don’t be scared of these cases!
The “Winning” points
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