Term
| What is the other name for septic arthritis? |
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Definition
| -suppurative or infective arthritis |
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Term
| What is septic arthritis? |
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Definition
| -presence of an infection within a joint |
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Term
| What can cause septic arthritis? |
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Definition
-bacteria: most common
-fungus
-rickettsial
-protozoal
-viral
-mycoplasma |
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Term
| What are the routes of infection that lead to septic arthritis? |
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Definition
-hematogenous
-local spread
-direct: surgical procedures, arthrocentesis, penetrating trauma |
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Term
| What are the common bacterial etiologic agents that lead to septic arthritis in the dog? |
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Definition
-Staph sp
-Strep sp
-Coliforms
-Corynebacterium |
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Term
| What are the common bacterial etiologic agents that lead to septic arthritis in the cat? |
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Definition
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Term
| Describe hematogenous septic arthritis in puppies. |
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Definition
-multiple joints > single
-bony erosion occasionally |
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Term
| Describe hematogenous septic arthritis in adult dogs. |
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Definition
=single joint > multiple
-often pre-existing OA |
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Term
| Describe the pathogenesis of septic arthritis? |
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Definition
-bacteria elecits an inflamamtory response
-Type B synoviocytes inc fluid pdn
-Synovial perm inc
-monocyte and neutrophils phagocytize bacteria
-macrophages release cytokines
-GAG and collagen network degradation
-infeciton invades subchondral bone |
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Term
| Describe the role of Type B synoviocytes in septic arthirits. |
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Definition
-produce fluid and dec quality of synovial fluid
-leads to capsular distention, release of inflammatory mediators => pain |
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Term
| What What do Type A synoviocytes do in septic arthritis? |
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Definition
| -contribute to bacterial destruction, release enzymes that destroy cartilage matrix |
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Term
| What enzymes do type A synoviocytes release? |
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Definition
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Term
| What are the risk factors for surgical infection leading to septic arthritis? |
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Definition
-lack of aseptic technique
-procedure > 90 mins
-implants placed
-tissue drying
-vascular compromise/tissue damage
-immunosuppression |
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Term
| What are the clinical signs of septic arthritis? |
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Definition
-severe unilateral lameness
-pain with palpation/ROM of joint
-heat
-effusion
-loss of range of motion
-regional lymphadenopathy
-systemic signs if septic: multipe joint become affected
-crepitus with chronicity |
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Term
| What do we see on rads with early septic arthritis? |
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Definition
-effusion
-periartiuclar soft issue swelling |
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Term
| What do we see on rads iwth late septic arthritis? |
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Definition
-widened joit space
-bone lysis/lysis around implants |
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Term
| How does concurrent OA affect the course of septic arthritis? |
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Definition
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Term
| How will fluid from arthrocentesis of septic arthritis appear grosly? |
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Definition
-less viscous
-turbidity present
-purulent color
0inc volume |
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Term
| How do we treat septic arthritis? |
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Definition
-antibiotic therapy 4-6w
-joint lavage
-drainage
-surgical debridement
-implant removal |
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Term
| Why do we avoid fluoroquinolones in young dogs? |
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Definition
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Term
| Why do we lavage joints with septic arthritis? |
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Definition
-bacterial load
-bacterial enzymatic insult
-pain rom inflammatory mediators
-pain from capsular distention |
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Term
| What do we use to lavage joints with septic arthritis? |
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Definition
-isotonic fluid: plasmalyte, normosol
-NO CHLORHEX OR BETADINE |
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Term
| Why would we consider surgical debridement to treat septic arthritis? |
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Definition
| -if no response to antibiotics after 72 hours |
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Term
| What are our joint salvage procedures for septc arthritis? |
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Definition
-arthrodesis when infection is resolved
-amputation
-total joint repalcemetn |
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Term
| What is the basic pathogenesis of immune-mediated arthritis? |
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Definition
-abnormal B-cell and T-cell interaction that drives the inflammatory process
-immune complex deposition and phagocytosis is the stimulus for synovial inflammation |
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Term
| What are the types of erozice immune-mediated arthritis? |
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Definition
-RA
-feline chronic progressive polyarthritis
-polyarthritis in greyhounds |
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Term
| What are the types of non-erosive immune-mediated arthritis? |
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Definition
-idiopathic
-systemic lupus erythematosus
-drug reaction
-breed-associated |
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Term
| What are the types of idiopathic non-erosive immune-meidated arthritis? |
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Definition
-Type I: idiopathic
-Type II: distant nfection
-Type III: GI
-Type IV: neoplastic |
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Term
| What is the typical signalment of immune-mediated arthritis? |
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Definition
-middle-aged
-female > male
-shetland sheepdog, collie, German shepherd
-shifting leg lameness |
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Term
| What do we see on rads of non-erosive immune-mediated arthritis? |
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Definition
-effusion
-periarticular ST hypertrophy
-minimal articular/bone changes |
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Term
| What do we see on rads of erozive immune-medaited arthritis? |
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Definition
-effusion
-periarticular hypertrophy
-SEVER articular cartilage, ligamentous, bony changes
bone lysis with occasional proliferation |
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Term
| In addition to rads, how do we diagnose immune-mediated arthritis? |
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Definition
-bloodwork
-cardiac and abdominal U/S
-ANA
-RA factor |
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Term
| What do we see on arthrocentesis of immune-mediated arthritis? |
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Definition
-high cell count: non-degen neutrophils
-no organisms
-low viscosity |
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Term
| How can we differentiate septic and immune-mediated arthritis based on neutrophil characteristics? |
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Definition
-SEptic = degenerative
-Immune-mediated = non-degen |
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Term
| How do we differentiate septic and immune-mediated arthritis based on history and physical exams? |
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Definition
-septic = monoarthropathy
-immune-mediated = polyarthropathy |
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Term
| How do we treat immune-mediated arthritis? |
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Definition
| -glucocorticoids then replace with azathioprine/cyclosporine/luflunamide |
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Term
| What are our options for surgically treating immune-mediated arthritis? |
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Definition
-arthrodesis
-subtotal synovectomy |
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Term
| What is the prognosis for non-erosive immune-mediated arthritis? |
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Definition
-50% in dogs cured
-most cats relapse |
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Term
| What is the prognosis for RA? |
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Definition
| -guarded for dogs and poor for cats |
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