Keeper update

[Keeper]

It's been a while and all was going well! Sunday a swift visit to the out of hours vet on our morning walk he's stops dead in his tracks his leg is hurt, to cut a long sorry short the vet and I thought his focal GME had come back, referred back to Andersonmoore and this morning we arrived it's not his GME thankfully but they think it could be Polyarthritis he's been lame on the back left leg on and off and now lame on the front right leg or its a disc in his neck..

He's so special that he can't decide what's wrong and is really not happy in himself we have been give Metacam and short walks on a harness and to call back in 2 weeks, basically I'm ask for more info on Polyarthritis?

[Jo CIMDA]

Hi

I am so sorry to hear that Keeper is having these problems.

Unfortunately, because  immune mediated diseases only develop in a dog that has a genetic predisposition,  it is not uncommon for a dog who has had one immune mediated disease to get another at a later date.

When a dog is in remission and then a relapse occurs, or a different immune mediated disease develops, the dog has recently met a 'trigger' which has caused the immune system to respond and attack, in the case of IMPA, the synovial fluid within the joints.

Keeper did so well with GME and I don't see why he wont respond this time too.  The treatment for polyarthritis is more straight forward than for GME.  Usually immunosuppressive doses of prednsiolone have a very quick and positive effect. 

Extract from my seminar notes:

IMPA - Immune Mediated Polyarthritis
Primary Immune mediated polyarthritis is the most common non-erosive polyarthritis in the dog. IMPA can be primary, or secondary to other diseases such as SLE, myositis or meningitis. 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 initially 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. Also, it is not unusual for the dog to become depressed and anorexic and stand with its head held low, unwilling to move. This is a very painful condition.


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.

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.

The clinicians at AndersonMoore are very experienced in treating AI disease, so I have no doubt if the Metacam doesn't improve Keeper's clinical signs then they will treat him appropriately.   One clue to aid a diagnosis of IMPA is a very high temperature.  Usually joint taps confirm a diagnosis but if you are not keen to put keeper through a lot of tests and a general anaesthetic then you could ask the vet to  give him an immunosuppressive shot of dexamethasone.  This is a long acting (48-72 hours) glucocorticoid, like prednsiolone.  If it is IMPA then I would expect Keeper to feel much brighter within 24 hours and if this is the case then a presumptive diagnosis could be made and starting an immunosuppressive protocol with prednsiolone might be the way forward.

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.
"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

I do hope you see and improvement in Keeper now he is on Metacam, but if you don't, and it is likely to be IMPA, the sooner you start treatment the better.

I look forward to an update and hope he feels much better very soon.


Jo