An approach to Feline Polyarthritis - A case of periosteal proliferative

polyarthritisGlynn Woods

8Yo M(n) DMSH Fully vaccinated

3m shifting lameness No trauma Weight loss Lethargy

Started of RIGHT hindlimb – metacam.

Bout of ILLNESS – blood panel. Steroids tapering

PELVIC pain – RADS and Virus panel – Steroids

Month later – LEFT forelimb lameness - coinciding with a reduction of his steroid dose

Deteriorated significantly, in comparison to referring vet letter

37.3 degrees, 186bpm and 36rpm

Dull, lethargic and unwilling to move

Painful in several limbs perceivable more so in his L fore

When he did stand his hind leg gait was very stiff

Joint effusion

Popliteal lymph nodes were palpable

No other significant findings on clinical exam

Clinical exam

Haematology - Neutrophilia and Monocytosis Biochemistry - Mild hyperglobulinaemia

Cytology –Lymphoid hyperplasia

IV line was placed for provision of hartmanns and methodone.

Initial investigations

.

Viral Testing - negative

Joint Culture Cytology

Radiographs ***

Ultrasound Abdomen

Further investigation

RADIOGRAPHS HERE

Periosteal Proliferative Polyarthritis

Immune mediated HS3

Linked to viruses

Males

Carpi and Hocks

1 – 5y

Fever, lethargy, stiff gait, joint pain and swelling

Lymph node hyperplasia

ClassificationJoint Disorders

Non inflammatory

Inflammatory

Developmental

Degenerative

Neoplastic

Traumatic Infectious

Immune mediated

Erosive Non - Erosive

Idiopathic IMPA

Reactive PA

Systemic Lupus

Feline PPP

Feline RA

Bacterial

Mycoplasm

Calici virus

Corona virus

Rickettsial

Lyme

Fungal

Based on Clinical / RAD

Clinical Exam - Non specific pain- Lameness- Stiff gait- Reluctance to walk- Owner percieved pain – “Just nae right!”

Radiographs

Arthrocentesis

Synovial analysis- Colour, viscosity and turbidity- Estimated cell count and differential leukocytes- More inflammation there is the greater the # of Leukocytes and greater proportion of neutrophils.- Affirmed diagnosis. - Submit for anaerobic and aerobic culture as well as mycoplasma.

Diagnostic approach

FIV and FeLV

Antibody titres

Must rule out a REACTIVE POLYARTHROPATHY

Haematology Biochemistry Urine analysis Thoracis and abdomenal RADs Abdominal ultrasound Urine/blood culture Lymphnode aspirates Inflammatory proteins - ______________________________________

Additional investigations

SEPTIC

Mycoplasma

Borrilia

Feline calici virus.

Corona virus

Infectious inflammatory joint disease

Highly prevalent in dogs. But considered RARE in cats

Non erosive IMPA is caused by deposition of immune complexes in the synovial membrane and the ensuing inflammatory response. Can occur primary (idiopathic), secondary to stimulation (reactive) or as a feature of SLE.

Reactive accounts for 25% pyenephritis, pneumonia, toxiplasmosisa dn enteritis, felv, fip, and CBA.

Rule out! Is so important.

Not responding to doxy – then glucocorticoid warranted.

Can use prednisone prednisolone, ciclosporin, leflunimide, chlorambucil, methotrexate...

Immune mediated inflammatory JD.

Uncommon immune mediated disorders can result in erosive damage .Periosteal proliferative PA marked periarticular . Second is a deforming arthritis resembling rhuematoid arthritis in humans.

Both deemed Chronic Progressive PA. Postulations that it was caused by Feline syncitum virus in genetically predisposed cats. But because that

virus is so far and wide spread its hard to associate in papers.

FPPPA. Male cats(intact or not), any age, fever lethargy, a stuff gait, joint pain, carpus and hock. Edema of skin and soft tissues. LN hyperplasia. RAD changes not noticable for first 10-12 weeks. Over time it worsens the periosteal changes. Synovial biopsy initally reeals a neutrophillic synoviitis and tendonitis but with time and chronicity plasma cells and lymphocytes increase.

Feline rheumatoid arthritis insidious, over weeks and months. Middle aged cats and siamese over represetned. RARE. Fever and systemic disease do not occur so these cats are rarely investgate before severe disease pathway. RADs – subchondral central and marginal erosiions and periarticular sof ttissue swelling.

Erosive immune mediated polyarthritis

Pred 2mg.kg q 12h PO 3-4 days

Same for 4 weeks

Assess clinical response and perform fluid cytology

Have they resolved?

Tapering dose, evaluating clinical response and performing synovial cytology before each reduction

Idiopathic immune mediated PA treatment strategy.

NAW

AYE

Treatment:- Doxycyline Synulox Prednisolone Famotidine

Check-up appointment- Doing great!- Blood glucose

Back tae Koshka

OA which is common in cats

Infectious > immune mediated in cats.

Suspect Calici virus

Don’t forget mycoplasma

Rule out reactive or infectious causes.

Don’t be scared of these cases!

The “Winning” points