Small animal surgery I > Arthritis > Flashcards

Arthritis Flashcards

(49 cards)

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1
Q

What is arthropathy?

A

Any joint disease

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2
Q

What is arthrosis?

A

A joint; “wear and tear” (human term)

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3
Q

What is arthritis?

A

Inflammation within a joint

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4
Q

What is polyarthritis?

A

Inflammation within several joints simultaneously

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5
Q

What is an osteophyte?

A

Outgrowth of bone; forms at synovial or articular margins

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6
Q

Where do enthesiophytes form?

A

Tendon/ligament attachments

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7
Q

What is a joint mouse?

A

Mobile fragment within a joint

Loose osteophyte or fragment of cartilage

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8
Q

What is a joint capsule?

A

Sac that encloses a joint

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9
Q

What does the suffix “-rrhaphy” mean?

A

To suture in place; to close

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10
Q

What is ankylosis?

A

Spontaneous fusion of a joint

End stage of joint disease

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11
Q

What is arthrodesis?

A

Surgical fusion of a joint

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12
Q

Define “arthrotomy”

A

Incision into a joint

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13
Q

What are the 3 types of joints?

A
  • Synovial
    • Elbow, hip, stifle, SI, vertebral facets
  • Fibrous
    • Skull, tooth sockets
  • Cartilaginous
    • Symphyses, growth plates
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14
Q

What is osteoarthritis?

A
  • Aberrant repair of articular cartilage –> degradation of articular cartilage
  • Altered subchondral bone metabolism
  • Periarticular osteophytosis
  • Synovial inflammation (synovitis)
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15
Q

How can you differentiate between inflammatory and non-inflammatory arthritis?

A

Joint tap

Determine whether highly cellular or not

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16
Q

How is the treatment of inflammatory arthritis different from that of non-inflammatory arthritis?

A

Inflammatory = medical treatment

Non-inflammatory = surgical treatment

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17
Q

What is the sub-classification of inflammatory arthritis?

A
  • Infectious
    • Bacterial (aka, septic), fungal, mycoplasmal, etc.
  • Non-infectious (immune-mediated)
    • Erosive (e.g., rheumatoid), non-erosive
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18
Q

What causes primary arthritis? What species is it more common in?

A
  • Idiopathic
    • Don’t know what the underlying cause is
  • Highly unusual in dogs
  • Relatively more common in cats
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19
Q

How does secondary arthritis differ from primary arthritis?

A
  • (DJD)
  • Developmental (OCD, hip dysplasia)
  • Acquired (trauma, neoplasia)
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20
Q

What are the pros and cons to using radiographs as a diagnostic tool in arthritis?

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A
  • Pros
    • Readily available
    • Inexpensive
    • Good for confirmation (high specificity)
  • Cons
    • Bad for ruling out (low sensitivity)
    • Correlation with clinical severity is variable
21
Q

What are some radiographic signs of arthritis?

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A
  • Osteophytes
  • Effusion
  • Increased/decreased joint space
  • Soft tissue swelling
  • Subchondral sclerosis
22
Q

What are the arrows pointing to?

23
Q

What is the single most important element of medical treatment for osteoarthritis?

What are some other non-surgical treatment options?

Study These Flashcards
A

WEIGHT MANAGEMENT IS THE SINGLE MOST IMPORTANT ELEMENT OF MEDICAL TREATMENT

Other options:

  • Exercise moderation
  • Physical rehabilitation therapy
  • Symptom-modifying agents (analgesics)
  • Disease-modifying agents (reparative)
  • Nutraceuticals
24
Q

What are the specific weight management goals/techniques (puppies and adults)?

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A
  • Puppies–delay/prevent radiographic OA
    • 25% more food doubles wt. at 6mo
    • Calorie restriction decreases OA prevalence
    • Avoid free-feeding
  • Adults–established OA
    • Reduces need for medication/sx
    • Decreased BCS –> longer lifespan
  • Good to excellent EBM support
  • Pharmaceuticals (Slentrol)
25
T/F: When treating osteoarthritis, moderate regular exercise is indicated immediately following diagnosis
FALSE **Once inflammation is controlled,** moderate regular exercise is indicated
26
What are 6 types of physical rehabilitation therapies for the non-surgical treatment of OA?
* Cold/heat therapy * Passive ROM exercises (patient is not doing work, everything is done **without** weight-bearing) * Massage * Swimming * Treadmill * Acupuncture
27
What are some symptom-modifying agents used in the non-surgical treatment of OA?
* NSAIDs * Tramadol * Gabapentin * Amantadine * Corticosteroids (intra-articular injection)
28
What is the goal of disease-modifying agents in the treatment of OA? What is an example? What should you avoid?
* Promote substrate synthesis over breakdown * Adequan--IM injection * Chemically similar to heparin--**don't give if patient is also on heparin**
29
What is the mechanism of action for NSAIDs in the treatment of OA?
* Reduce pro-inflammatory mediators by inhibiting cyclooxygenase * COX-1: responsible for maintaining normal physiologic processes * COX-2: "inducible form", activated in inflammation * Cats--glucuronidation
30
What is the mechanism of action for disease modifying agents in the treatment of OA?
* Promote synthesis over breakdown of cartilage * Building blocks of articular cartilage or fluid
31
What are some examples of disease-modifying agents?
* Polysulfated glycosaminoglycans (PS-GAG) * Adequan label recommends IM injection * Pentosane polysulfate--interstitial cystitis * Hyaluronic acid--synovial fluid * Heparin analogues
32
What are the mechanisms of action of nutraceuticals?
* Food or part of a food that provides medical benefits * Cartilage building blocks * Anti-inflammatory effects
33
What are some examples of nutraceuticals?
* Glucosamine/chondroitin (Cosequin) * Omega-3 fatty acids * Avocado and soybean unsaponifiables
34
What are the specific benefits/MoA of glucosamine? Is there any evidence?
* Stimulate proteoglycan synthesis of hyaline cartilage matrix in vitro * Anti-inflammatory effects * Preparation variability * EBM: efficacy uncertain, but safe
35
What is the specific MoA for omega-3 fatty acids? Is there any evidence that they are beneficial?
* Produce less inflammatory mediators * Quality studies proving ^
36
What are the benefits of avocado and soybean unsaponifiables? Example? Evidence?
* Anti-inflammatory, anti-osteoarthritic * Gasequen (cosequin + unsaponifiables) * Not a whole lot of evidence but probably won't hurt anything
37
What is the process/theory of autologous platelet therapy? Is there any evidence proving it's beneficial?
* Platelets collected and injected into involved joint * Pain and wt. bearing improved at 12wks (study by company who makes it) * Uknown mechanism; debated
38
When is stem cell therapy appropriate? What is the EBM?
* *Might* be appropriate for: * Non-responsive immune-mediated disease * When salvage or replacement is not viable * EBM very iffy in dogs for clinical arthritis
39
T/F: Stem cell therapy is wholly benign
FALSE--requires anesthesia
40
What are the possible side effects of NSAIDs?
* **All have side effects** * COX-1 inhibition: GI, renal * COX-1 sparing or COX-2 selective drugs may also cause GI ulceration, renal or hepatic problems
41
What are the side effects of disease-modifying agents? EBM?
* Heparin analogues--**don't use in animals with coagulopathies** * Adequan--good * PPS--fair, good EBM support for PS-GAG
42
What is the EBM behind nutraceuticals?
* Glucosamine/chondroitin--efficacy uncertain, but safe * Omega-3 FAs--good mechanism-wise, but feeding studies have shown ineffectiveness * **Lots of variation**
43
What does the term "salvage procedure" mean?
* Goal is to preserve life or limb function * No attempt to cure or fix underlying cause of DJD (or other disease) * Delayed as long as possible
44
What are the indications for and implications of a salvage procedure in general terms?
* Indicated for severe DJD * Generally delayed as long as possible * Outcome keyed to procedure/technique rather than cause
45
What are the differences between joint replacement and partial excision arthroplasty?
* Joint replacement arthroplasty * Intent: restore/preserve normal joint function * **Gold standard** * Artificial implants * Requires lots of training/expertise/equipment * Hip, elbow, stifle, shoulder * Partial excision arthroplasty * Remodeling of joint **without replacement** * Less specialized * Less training
46
Compare and contrast ankylosis to arthrodesis
* Arthrodesis--artificial fusion of a joint * Preferred over ankylosis * More rapid fusion * More complete fusion (true ankylosis is rare) * Less discomfort over time * Ankylosis--abnormal adhesion of bones to a joint * End-stage joint--let it do its thing on its on
47
What are the 4 principles of arthrodesis?
* Complete removal of ALL articular cartilage * Cancellous bone graft * Rigid fixation (usually DCP) * Standing angle
48
What are the guidelines for post-op management of arthrodesis?
* Coaptation (splint or ESF)--6-8wks * Activity restriction until bony fusion * Prolonged healing common--3mo minimum
49
What are the expected effects of arthrodesis of a given joint (general terms)?
* High motion joint--"peg leg" * Low motion joint--minimal effect on gait * Distal joints in carpus/tarsus
Small animal surgery I
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