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Exam 4
Septic and Immune-mediated Arthritis
39
Veterinary Medicine
Professional
11/21/2016

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Cards

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