Septic or immune-mediated arthritis in a 7yo staffy

Re: Septic or immune-mediated arthritis in a 7yo staffy

Anthony Dennison — Sat, 28 Sep 2013 19:58:08 GMT

I've had experiences (mainly from ear swabs) that if the animal is already on antibiotics when swabs are taken they often don't grow anything succesfully. I had a chat with IDEXX and they said this can happen fairly frequently.

Could go for the same approach as treating a dog with GME: antibiotics first, if no improvement steroids, but keep on antibiotics just in case...

Re: Septic or immune-mediated arthritis in a 7yo staffy

Bob Russell — Sat, 28 Sep 2013 11:12:19 GMT

I would second testing for Lymes if you are in a tick area. Not sure what preds would do if there was an active Borrelia infection but would be a bit concerned about using them until it had been ruled out.

Unfortunately I don't have great confidence in the lab tests for Lymes, we get universal negatives despite classic symptoms and massive infected tick numbers!

Re: Septic or immune-mediated arthritis in a 7yo staffy

Richard Talbot — Sat, 28 Sep 2013 10:56:30 GMT

Thank you all for your input.

Nothing was seen on chest x-rays, heart sounded fine and LNs all normal.

With regards to the suspected cocci seen, I thought I saw some on an in-house smear made, but when sending off to the lab for their interpretation they didn't see anything. i'm inclined to go with their opinion.

thanks

Re: Septic or immune-mediated arthritis in a 7yo staffy

Christopher Saul — Sat, 28 Sep 2013 10:40:23 GMT

With regard to the cocci, I guess my approach would be to ring the lab and speak to the pathologist who reported them; (s)he will have an opinion on whether they are likely to be significant or not....

(but as in my first post, even if the pathologist thinks they were just contaminants and we are indeed dealing with an IMPA, do a hunt for primary infections before immunosupressing)

Re: Septic or immune-mediated arthritis in a 7yo staffy

John Flynn — Sat, 28 Sep 2013 10:28:00 GMT

[quote user="Hannah Wynne Richards"]

I'd say the exact opposite to John. Cocci seen says septic to me-even though no growth, so I'd avoid steroids like the plague. Make sure your antibiotic dose is high enough-you need to double that you use for soft tissue infections, and you also need an extended course. It wouldn't do any harm toadd another antibiotic which is also effective against Gm pos.

Wynne

[/quote]

I guess seeing is believing. If there's a photo of these cocci then I might be more convinced of their existence - otherwise I remain pretty skeptical...

Re: Septic or immune-mediated arthritis in a 7yo staffy

Hannah Wynne Richards — Sat, 28 Sep 2013 10:05:20 GMT

Wynne

Re: Septic or immune-mediated arthritis in a 7yo staffy

John Flynn — Fri, 27 Sep 2013 20:58:04 GMT

[quote user="Richard Talbot"]Should i assume that this is an immune mediated disease and start treatment with steroids[/quote]

Yes.

I'd start 1mg/kg pred q12hrs or equivalent, I'd probably leave 24hrs off meloxicam first (i.e. skip a day) but that's probably not necessary; gastroprotection of your choosing optional depending on how complicated a dosing regimen would be tolerated by owner and your own preferences.

I can see the logic in sticking on doxycycline or equivanent "just in case" lyme disease or equivalent, but unless you knowingly have had positive results in the local area in dogs with polyarthritis in the past then I personally wouldn't bother. Fun (unless you're footing the resultant bill) PCR testing for various pathogens at Bristol vet school lab always an option too.

If using Idexx for your intial bloods (reported as all normal), a CRP is cheap as an add-on and might have been worthwhile as a fair percentage of immune-mediated polyarthritis cases have normal haematology (including wbc morphology etc) but dramatically elevated CRP - to the extent that a normal CRP would stop me in my tracks and I'd have a serious rethink before starting down the line of preds.

Proper bacterial septic arthritis and radiographic changes would be more likely I'd think.

I don't think what you saw were likely to be cocci in the absence of degenerate neutrophils (unless you tell me that you were absolutely convinced).

Disclaimer: I have no special knowledge on the subject!

Re: Septic or immune-mediated arthritis in a 7yo staffy

Christopher Saul — Fri, 27 Sep 2013 20:48:30 GMT

Hi Richard

Please accept my apologies if you have already done the following....... Have you taken survey radiographs of thorax and abdominal ultrasound? Any murmur? Have you tested for borrelia (lyme's)? Urine culture?

I have to say from the fluid analysis I'm erring towards immune mediated polyarthritis (IMPA) however you need to be careful; even if the arthropathy is immune mediated in nature it may not necessarily by primary.

IMPA can occur secondary to extra-articular disease and it's vital to rule distant foci of infection out before immunosupressing. I have seen IMPA secondary to a grumbling pyothorax (itself probably secondary to an inhaled grass seed or similar). If you immunsupress in that situation then you can make things worse.

So in short, if you haven't already done so, I would do a thorough hunt for distant infectious foci (don't forget to check for borrelia) and if you can fairly confidently say there aren't any, then I would give steroids.

hope this helps a bit

Chris