Can you advise on these swollen right fore carpus xrays?

RE: Can you advise on these swollen right fore carpus xrays?

smb — Tue, 05 Dec 2023 10:12:09 GMT

Thank you Andy.

RE: Can you advise on these swollen right fore carpus xrays?

smb — Tue, 05 Dec 2023 10:08:51 GMT

Thank you Mayank

RE: Can you advise on these swollen right fore carpus xrays?

smb — Tue, 05 Dec 2023 10:07:43 GMT

Thank you Beats.

RE: Swollen Carpus Right Fore advice xrays

Andy Moores — Fri, 01 Dec 2023 09:31:22 GMT

Hi, I would echo Beats' and Mayank's comments which are all valid. Joint fluid cultures are often negative -cytology is the most important diagnostic test (and can also be used to assess response to treatment, if infection is indeed the cause here, which seems likely). My first-line Ab whilst I wait for cytology results is co-amox and if a culture comes back negative and assuming there is a good clinical response then this is what I would continue with for at least 4 weeks. If there is a poor clinical response then I would be considering additional joint taps but also joint lavage and synovial membrane biopsy (for histopath/culture).

RE: Swollen Carpus Right Fore advice xrays

Mayank Seth — Thu, 30 Nov 2023 11:35:40 GMT

I would agree.

In a case series of 31 dogs (Clements et al 2005), ony 11/31 had bacteria identified on cytology and 16/31 had positive joint fluid cultures. Interestingly, in that study synovial membrane biospy had a higher positive culture rate and prior antibiotics did not seem to be asosciated with culture yield.

If the first sample wasn't in a blood culture bottle, then it would be worth trying again (+/- biopsy if you are feeling adventurous). The litereature on the benefit of lavage etc is not convinicng as far as I am aware (but the I don't tend to deal with these cases beyond diagnosis). Amoxiclav is a perfectly reasonable first choice antibiotic pending sensitivity unless thre is any other antibiotic history etc to raise suspicion for an MDR. If there is no significant improvement in response to antibiotics then I would consider repeating radiographs (to look for boney progression) and tapping a couple of other "normal" joints (in consideration of IMPA) before you thought about steroids etc.

Keep us updated :-)

RE: Swollen Carpus Right Fore advice xrays

Beats — Thu, 30 Nov 2023 07:14:39 GMT

I think cultures often come back negative. in presence of infection. If I think how often I send urine where I can see the bacteria myself and get a negative culture, I imagine even higher for joint fluid.

I would do a fresh joint tap and culture (in blood culture bottle) prior to starting antibioitics if that was viable to do, however in a very swollen joint I am sometimes put off sticking a needle through.

Otherwise, I'd start on amoxicillin/clavulanate as my standard if I thought possible septic arthritis due to being a single joint and assess again in 1-2 weeks, while still on amox/clav, to try to assess myself if in vivo response or not, and likely continue longer if in doubt,with regular repeat exams.

I'd maintain on meloxicom also.

I'm not an expert, so perhaps wait for one of them to comment as I might be totally wrong.