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Degenerative Joint Disease (DJD) - Coggle Diagram
Degenerative Joint Disease (DJD)
Irreversible damage to articular cartilage
Signs:
Joint Effusion
Heat
Swelling
Pain
Lameness
Periarticular swelling
Dx:
Lameness exam
Dx analgesia
Imaging (rads, US, CT/MRI)
Tx:
Rest
Bandaging
Proper Shoeing
Therapeutics: Topical, Systemic, IA
Topical:
Cold
Bandage
NSAIDs
DMSO
Extracorporal shockwave therapy
Laser
Physio
IA IRAP
IL-1 R antagonist protein
Oral Therapeutics
NSAIDs
Neutraceuticals
Parenteral Therapeutics:
NSAIDs
PSGAG
Hyaluronic Acid
Biphosphopnates
IA:
Corticosteroids
Hyaluronic Acid
PSGAG
IRAP
Systemic NSAIDs
Phenylbutazone (PBZ)
SID
Good analgesia
Flunixin
Do NOT give IM (myonecrosis)
Lasts longer than PBZ
IV & PO
Ketoprofen
Low toxicity
Give more to baby foal
Naproxen
Low Toxicity
Oral
Better than PBZ for pain
Carprofen
Dz modifying
Firocoxib
COX2 inhibitor
Decrease chronic lameness
Better ROM than PBZ
Effective visceral analgesia
Extracorporal Shockwave Therapy
Pulsed, high energy waves
Analgesia
Topical
DMSO
Decreases edma and superoxide radicals
Increase penetration of steroids
Diclofenac Cream
Decreases lameness and sclerosis
Increases cartilage GAG
Neutraceuticals
Glucosamine
Component of cartilage matrix
Chondroitin Sulphate
Component of cartilage matrix
Used alone not beneficial
ROM increased
ASU
Less erosion & hemorrhage, increases GAG that's it
Systemic or IA Hyaluronic Acid
Part of ECM
Causes steric hinderance--> anti-inflammatory effect
Decreases lameness and cartilage thinning and surface fibrillation
Must be: 0.5-2.0x 10^6d *
Can give IV
Polysulfated glycosaminoglykan Systemic or IA
Inhibits degradative enzymes
Anti inflammatory role
Drawback for IA admin is increased risk of sepsis, incidence lower when w amikacin
Inhibits complement
Systemic Biphosphonates
Decreases osteoclastic bone resorption
IA Steroids
Inhibit synthesis and release of inflammatory mediators
Reduce cap dilitation, margination, migration and accumulation of inflammatory cells
Pain relief
Also dz modifying
Low dose is better because at low dose it suppresses IL-1 (big trouble maker that you want gone)
Must rest after admin!
3 common ones:
Methylprednisolone acetate (depomedrol)
Triamcinolone acetonide
Betamethasone acetate
Common Location:
High load, low motion joint (hock and interpharyngeal)
High motion, low load joint (fetlock, carpus, stifle)
Interpharyngeal DJD
Signs:
Lameness M1- M3
Acute or insidious
Dx Analgesia
Sesamoids, coffin, pastern
Tx:
Rest, NSAIDs, IA, trim, shoes, sx, maybe alcohol
DJD of Distal Tarsal
Most common cause of HL lameness
Lame, but then they move around and it goes away
X ray findings:
Remodelling
Decrease in joint space
Fractures
Tx:
Rest, NSAIDs, sys & IA meds
Sx:
Transarticular drilling
Transarticular laser ablation
Arthrodesis using small bone plates
Prognosis
Easily managed early on, but varies
DJD in Fetlock
Signs:
Lameness (variable)
Joint effusion
Tx:
Early: Rest, NSAIDs, sys & IA meds
Palliative by the time you see it on rads
Sx:
Arthroscopy: debride chip
Dx Analgesia:
Low palmar (plantar) nerve block
IA local
Villonodular Synovitis
AKA chronic proliferative synovitis
Hyperemia, edema, fibroplasia, hemorrhage
Osteoclastic resorption
Proximal Distal P-1
Remodelling and osteophyte formation
Fragments
Palmar MC-3 and Plantar MT-3
Erosive lesions
From excessive shear force
Assoc w maladaptive subchondral remodelling
Carpus (Knee)
Big race horse issue
Dorsal is more common
Poor conformation can predispose
Common Locations:
Radial Carpal Bone
3rd Carpal bone
Intermediate carpal bone
Distal radius
Palmar intercarpal ligaments
Signs
Lameness
Joint effusion
Those w chip fractures have M1 to M2 lame, those with slab fractures are severe
Usually bilateral
Lesions
Remode/Osteophytes
Chip Fractures
Subchondral sclerosis & osteolysis
Palmar intercarpal desmitis
Slab fractures
Enthesopathy at joint capsule insertions
Tx:
Rest, NSAIDs, sys & IA meds
Sx:
Debride
Remove small fractures
Screw large fractures
Prognosis:
Single chip= fair- good
Chronic= guarded
For slab fracture: fair- good
Stifle Injuries
Cruciate ligament
Signs:
M3 Lame
M3 Effusion
Dx: PE, signs, rads, arthroscopy
TX:
Debride
Prognosis: Poor with complete rupture and guarded with al other
Meniscal Tears
Signs:
M1 to M3 lame
Dx: US or arthro
Tx: debride & IA meds long term
Prognosis: Guarded to fair for M3 cases