Lymes or Autoimmune Arthritis?

[Coveycoast]

Hi Everyone,
I am new here. I have a Beautiful Cocker Spaniel bitch named Lupo. She is four years old and weight is now 15kg.
About a fortnight ago now she went to bed her normal self and in the morning cane out on three legs and a totally different dog . She was showing no signs of swelling or injuries so the vet questioned a sprain and gave her Rimadyl.
Next morning she was really flat and depressed but using her leg when she went out for a pee ect. As the day went on her leg began to swell and she went downhill. Took her back to vets and they questioned lymes disease or autoimmune poly arthritis. Started her on antibiotics and Rimadyl. The swelling subsided in her leg but she is still walking very stiffly on it. She is losing weight and looks very bony. Depressed temperature and swollen lymph nodes in her groin. How do we deyermine what it is because the treatment for both things are totally opposites and if we choose the wrong one we will lose her.

[Jo CIMDA]

Hi and welcome

  I am sorry Lupo is very unwell.  It is worth pointing out that many cocker spaniels are geneticially predsiposed to autoimmune disease and therefore a diagnosis of IMPA is probably more likely than Lyme disease.  Has she recently had a vaccination or flea treatment etc., that may have triggered this problem?

A dog with immune mediated polyarthritis will have a high temperature and swelling around the joints and all four legs will be affected.  To get a definitive diagnosis of IMPA the vet will have to do joint taps to analyse the synovial fluid within the joints. Below is an excellent veterinary article:

http://veterinarymedicine.dvm360.com/recognizing-and-treating-immune-mediated-polyarthritis-dogs?id=&pageID=1&sk=&date=

Extract from my seminar notes:

Immune Mediated Polyarthritis  (IMPA)
Primary Immune mediated polyarthritis is the most common non-erosive polyarthritis in the dog. As with the previous Autoimmune diseases, IMPA can be primary or secondary to other Autoimmune diseases. Symptoms of IMPA can closely resemble Lyme disease or multiple, joint infection and this has to be considered in the differential diagnoses.
For a confirmed diagnosis of IMPA, joint taps need to be performed to obtain evidence of infiltrating  immune cells within the synovial fluid in the joints.   Clinical signs such as shifting lameness, soft tissue swelling around the joints, difficulty in rising to a stand, stiffness in the neck and back, and very high temperatures etc., can be vague and evident for several months prior to diagnosis. Clinical signs therefore can be intermittent and antibiotic and non steroidal anti-inflammatory drugs are usually given, but little improvement is seen. The disease continues to progress until the dog becomes quite overcome by the inflammatory process. It is not unusual for the dog to become depressed and anorexic and stand with its head held low, unwilling to move. This is understandable as it is a very painful condition.

Reference: Canine Medicine and Therapeutics by Neil Gorman
"Immune mediated polyarthritis cases may account for 40% of dogs presenting with pyrexia of unknown origin at referral centres." Chapter 76, Inflammatory Arthropathies by  C. May and D. Bennett.[/b]

"Increases in body temperature greater than 105°F (40.5°C) are generally not true fevers". Chapter 37, Fever of Unknown Origin by J.K.Dunn

Lyme disease is diagnosed by blood tests.  Here is an article about diagnosing and treating Lyme disease:
https://www.akc.org/expert-advice/health/lyme-disease-in-dogs/


Sometimes if diagnostic tests such as joint taps are not possible a vet will treat with the appropriate antibiotic for Lyme disease, and also give a shot of a steroid called dexamethasone.  If a positive response is seen to the steroid injection, then an assumptive diagnosis of IMPA is arrived at and immunosuppressive treatment is started.   The best immunosuppressive drug protocol I have come across is by Prof. Michael J Day (see below).  Alternatively, ask for a referral to a vet college.  The specialist clinicians will diagnose the condition without delay.

Jo

Example: Reduction Protocol for prednisolone:
Clinical Immunology of the Dog & Cat , 2nd Edition,  by Michael J Day
Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 

Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.
This example is based on a dog receiving an induction dose of 1.0mg/kg/q 12hrs (q = every)
Dose                           Duration (based on clinical effect)
1.0mg/kg/q 12h                          10-28 days
0.75mg/kg/q 12h                       10-28 days
0.5mg/kg/q 12h                         10-28 days
0.25mg/kg/q 12h                        10-28 days
0.25mg/kg/q 24h                        10-28 days
0.25-0.5mg/kg EOD                    at least 21 days
0.25-0.5 mg/kg every third day      at least 21 days

Every reduction is made after consideration to improvement of clinical signs, blood results and side effects of the drugs.

Note:  Prednisolone:  "Doses above 2.2mg/kg/day do not give more immunosuppression but do cause more side effects. Many internists believe that prednisolone doses should not exceed 80mg per day, regardless of the dog's weight."  Plumb's Veterinary Drug Handbook Eight Edition.