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Author Topic: Immune Mediated Polyarthritis  (Read 636 times)

KaajalTiwary

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Immune Mediated Polyarthritis
« on: January 03, 2021, 11:29:14 PM »

Hello Jo:

Diesel got diagnosed with IMPA two days ago. He was limping for the past 8 weeks. He is going on Tuesday so we can run more tests to figure out  if there is an underlying cause. He also has a Neurologist consult scheduled.

Question: what tests should we absolutely run besides CBC, tick PCR, ultrasound?

Current Medications started 2 days ago:
Atopica 100 mg twice a day
Prednisolone 10 mg once a day
Gabapentin twice a day

He currently weighs 65lbs.

History: Diesel has Addisonís disease, Hypothyroidism. He is in remission from AI Neutropenia (diagnosed in June 2017) and a mild case of IBD diagnosed in November 2019.

Please advice. What should I do? What am I missing? What alternative therapies can I consider?

Appreciate and thank you for your help.

All my best,
Kaajal
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Jo CIMDA

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Re: Immune Mediated Polyarthritis
« Reply #1 on: January 05, 2021, 12:29:06 PM »

Hi Kaajal

I am sorry to hear that Diesel has IMPA on top of all the other problems.  I doubt that it is caused by anything other than an autoimmune response, so a primary IMPA. 

The most used, primary treatment for IMPA is immunosuppressive doses of prednsiolone eg., 1mg/kg/12hours.  A dog that weighs 28kg should be on a minimum of 28mg twice a day of prednsiolone, unless there is good reason not to.  The response to treatment is usually rapid - within 24-48 hours the dog is feeling so much better and not in the terrible pain that this AI disease causes.  10mg once a day isn't enough to significantly suppress the immune system to stop the destruction of the synovial fluid within the joints, so I would question why Diesel is on such a low dose.  Atopica can take up to a couple of weeks before the full effect is seen and even then it is not really used as a primary drug to treat IMPA, but it is a good secondary drug to use along side an immunosuppressive drug regimen of prednsiolone. What could be a consideration is to increase the pred dose to immunosuppressive for a few weeks, in order to control the immune system, and then the Atopica is at its full effect, reduce the preds.  You may be able to reduce the preds a little quicker then.

Alternative therapies can be other immunosuppressive drugs such as Leflunomide or mycophenolate.   Diesel may benefit from a gastroprotectant.   

Poor boy.  I do hope this is brought under control very soon and he starts to feel much happier and well again.

Jo
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KaajalTiwary24

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Re: Immune Mediated Polyarthritis
« Reply #2 on: January 11, 2021, 05:42:04 AM »

Thanks Jo. Appreciate your detailed response. Diesel was on high doses of steroids 3 years ago when he was diagnosed with AI Neutropenia. His body doesnít handle prednisolone well. Even at 5mg for Addisonís disease in 2014 - he steroid induced alopecia.

Heís been on Atopica (100 mg twice a day) since the 31st of December and Prednisolone (10 mg once a day) since the 2nd of January for IMPA. He is not limping at the moment.

1. Should I still talk to the IM Specialist about increasing his prednisolone?

2. With IMPA, at what point would you actually consider reducing the dosage gradually?

3. Stomach Protectant - Sucralfate and Prilosec?

Thank you for your help and guidance. Appreciate it so much. Hope all is well in your world.
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KaajalTiwary24

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Re: NEED ADVICE URGNTLY: Immune Mediated Polyarthritis
« Reply #3 on: January 17, 2021, 06:30:33 AM »

Hello everyone:

Can someone please advice? Diesel was diagnosed with IMPA on the 31st of December. He weighs 65 lbs.

His meds are:

Starting Dec 31: Atopica 100mg twice daily
Starting January 2nd: Prednisolone 10 mg once daily
Starting January 12th: We started alternating Prednisolone between 10mg and 5 mg

I've attached his bloodwork. Hopefully the excel sheet will come through to review. I am a little concerned about his WBC, RBC, HGB and Neutrophils.

                           January 5th   January 15th
WBC             4.9-17.6                9               17.8
RBC            5.39-8.70              6.29        5.9
HGB            13.4-20.7              14.6       13.9
Neutrophil    2940-12670     5.346      12638

Can someone please tell me what should I do? Thank you for any help you can offer. I don't understand why his numbers are trending like this and what I should so about it. I have a follow up with the IM Specialist on the 19th.

Waiting in anticipation,
Kaajal

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Jo CIMDA

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Re: Immune Mediated Polyarthritis
« Reply #4 on: January 17, 2021, 01:17:44 PM »

Hello Kaajal

I have only just seen your last two postings.  Sorry.

Different laboratories have different reference ranges, so with this in mind, and assuming that the reference range that you have given is relevant to the lab that your vet uses, then the results are all within, or around about, the reference range and I would say that there is nothing for you to be concerned about especially if Diesel is not limping or appears to be in pain.   Good clinical signs suggests that the dose of Atopica is suppressing the immune system sufficiently enough to bring the IMPA under control.  This is particularly good because Diesel doesn't tolerate preds very well.  In fact the low dose of preds isn't doing anything to assist the IMPA treatment, but if Diesel is Addisonian then it is very likely that he will be needing a small replacement dose of preds for his Addison's disease. 

An article that you may find useful:

https://todaysveterinarypractice.com/oral-cyclosporine-use-in-dogs/

It seems as though everything is going according to plan and therefore I wouldn't be in a hurry to do anything drastic and the dose of Atopica can be reduced over time. 

I trust you will have a good meeting on the 19th. 

All the best

Jo

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KaajalTiwary

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Re: Immune Mediated Polyarthritis
« Reply #5 on: January 19, 2021, 12:09:24 PM »

Hello Jo:

Thank you for your timely help always. I am so sorry I have so many questions.

Diesel had bad poo 2 nights ago. He didnít poop until tonight and it was bad again. Do you have any insight on what I can do? Is it time to taper his meds a bit? He is also on stomach protectant.
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Jo CIMDA

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Re: Immune Mediated Polyarthritis
« Reply #6 on: January 21, 2021, 12:30:14 PM »

Hi Kaajal

When you say bad poo, do you mean runny?  What colour is it? Is it blackish?  Is his Addison's being well controlled? 

If Diesel has diarrhoea then you must make sure that he is well hydrated. It could be, as Diesel is immunosuppressed, that he has picked up a bacteria so taking a poo sample to the vet might be a way forward, or ask your vet if he or she would treat speculatively and prescribe Metronidazole.  This is a very good antibiotic for gastric issues and it has the ability to remove water from the faeces as it passes through the gut, thereby making the stools firmer.   

Probiotics are also a good remedy for some causes of diarrhoea, and kaolin.  You can buy Prokolin from the internet without a prescription.  Meanwhile give Diesel very bland food and make sure he is drinking sufficiently, and if he isn't then syringe some water into his mouth if he has watery stools.

I hope this resolves very soon.

Jo



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KaajalTiwary24

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NEED URGENT ADVICE: Immune Mediated Polyarthritis
« Reply #7 on: January 22, 2021, 09:33:49 PM »

Hello Jo:

Sorry for the delayed response. We hit a curveball with Diesel.

1. The neurologist did the MRI (spine and neck) yesterday. She found a few bulging discs (minor - she doesn't think these are causing any symptoms) and some fluid in the spine.

2. The Spine CSF tap shows slightly elevated WBC. She is sending his blood for an infectious disease panel. She is wondering if his IMPA is secondary to AI Meningitis.

His PCV yesterday was 39%. It's fallen from 41% from the 5th of January.

What are we missing? Please help! They can't seem to understand what's going on with him.

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Jo CIMDA

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Re: Immune Mediated Polyarthritis
« Reply #8 on: January 23, 2021, 06:05:59 PM »

Hi Kaajal

I have emailed you with a few suggestions and I hope yo will be able to have a good discussion with your vet very soon.

Best wishes
Jo
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