Arthritis: osteoarthritis

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Sections available in full article Introduction, Presenting signs, Acute presentation, Age predisposition, Breed predisposition, Pathogenesis, Etiology, Predisposing factors, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Histopathology findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Prevention, Prophylaxis, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr John Innes BVSc PhD CertVR DSAS(orth) MRCVS
Dr Melvyn Pond BVMS MRCVS
Synonyms DJD, osteoarthritis, osteoarthrosis, secondary joint disease.

Introduction

  • Progressive disorder of movable joints characterized by degeneration of articular cartilage and production of new bone at articular margins - the end-stage of a variety of pathological processes.
  • The most frequently encountered joint disease - synonyms are osteoarthritis (emphasises the inflammatory nature of condition), osteoarthrosis (pathological process different from acute inflammatory process) and secondary joint disease (initiating factors have been identified, eg joint instability due to abnormal conformation, ligament rupture or intra-articular fractures).
  • Cause : often multifactorial.
  • Signs : insidious onset lameness of one or more limbs, pain on palpation/manipulation, thickened joints in advanced cases with crepitus.
  • Treatment : various - medical and surgical dependent upon stage and severity of condition.
  • Prognosis : surgery may remove signs but may not retain joint function.
  • In old animals, may be a major factor in the decision for euthanasia.
  • Osteoarthritis classification may be primary (idiopathic) or secondary (to an identifiable joint disease).

Diagnosis

Clinical signs

  • Pain in affected joint(s) on palpation/manipulation.
  • Thickened joints if advanced case - peri-articular new bone formation, fibrosis and synovial effusion.
  • Abnormal movement in joint, eg cranial draw movement Cranial draw test: stifle in stifle with rupture of cranial cruciate ligament.
  • Restricted extension or flexion.
  • Crepitus in severely damaged joint.

Diagnosis

Differential diagnosis

  • Inflammatory joint disease:
    • Infective.
    • Immune-mediated Arthritis: immune-mediated.
    • Crystal-induced.
  • Synovial neoplasia Synovial cell sarcoma.
  • Tendon injury.
  • Musculoskeletal disease.
  • Metaphyseal inflammation.
  • Hemarthrosis.

Sequelae

Prognosis

  • Guarded: medical treatment is unlikely to stop or slow progression of OA but may give good symptomatic improvement.
  • Most animals able to lead a good quality of life with appropriate management.
  • Poor: if conservative management alone because disease progresses to destruction of joint.
  • Euthanasia: if old dog and incapacitated by OA.
  • Worse prognosis for active working dogs than pet animals.

Expected response to treatment

  • Improved exercise tolerance.
  • Reduced joint pain.

Reasons for treatment failure

  • Misdiagnosis, eg synovial sarcoma, immune-mediated polyarthritis.
  • Unrecognized or untreated primary condition, eg cruciate ligament rupture.
  • Severe end-stage disease.
  • Owner non-compliance with weight reduction program or exercise regime.

Sources

Publications

Refereed papers

  • Recent references from PubMed.
  • Sanderson R O, Beata C, Flipo R-M, Genevois J-P, Macias C, Tacke S, Vezzoni A & Innes J F (2009) Systematic review of the management of canine osteoarthritis. Vet Rec 164 , 418-424 PubMed.
  • Neil K M, Caron J P & Orth M W (2005) The role of glucosamine and chondroitin sulfate in treatment for and prevention of osteoarthritis in animals. JAVMA 226 , 1079-1088.
  • Innes J F, Fuller C J, Grover E R, Kelly A L and Burn J F (2003) Randomised, double-blind, placebo-controlled parallel group study of P54FP for the treatment of dogs with osteoarthritis. Vet Rec 152, 457-460.
  • Boon G K (1997) Synovial fluid analysis - a guide for general practitioners. Vet Med 92 , 443-451.
  • Johnston S A & Fox S M (1997) Mechanisms of action of anti-inflammatory medications used for the treatment of osteoarthritis. JAVMA 210 , 1486-1492.
  • Michels G M & Carr A P (1992) Non-infectious, non-erosive arthritis in dogs. Vet Med 92 , 798-803.
  • Ellison R S (1988) The cytologic examination of synovial fluid. Semin Vet Surg 3 , 133-139.

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