Steroid Responsive Meningitis ?

[Jo CIMDA]

Hi Elaine

That is really promising.  It should respond quickly, so very good news.  I think they can tolerate the side effects much better if the dose is split into two.
Jo

[Elaineb1624]

Hi Jo,
     Lois is good, i am posting to enquire regarding her exercise regime, at present we are doing 10-15 minutes( which she is horrified by! ) she is only two weeks in her relapse, has been countersurfing, chatting and generally very normal. Obviously im aware she is still fragile but i wonder if you can give me any pointers towards her increase in exercise. She is is still on 20mg until 29th february which will be 30 days, this is what the vet prescribed. I wont increase her exercise till she is on 15mg but she lives to run and i know we had her off lead last time but cant remember when! I am NOT suggesting she is off lead soon merely enquiring for pointers.
Also would the imfammation have gone now or is it still early days. She gives nothing away this time thankfully. I am just curious.
Thanks again.
   Elaine.

[Jo CIMDA]

Hi Elaine

She gives nothing away because she feels so much better.  Steroids really do work like a miracle drug at times and dogs can be so stoical.

SRMA responds very well to steroids and this is why you can see a remarkable improvement in her so quickly - but don't be fooled, it takes a while for the immune system to fully return to normal and just because she is raring to go doesn't mean she is at the stage where a relapse is unlikely. 

The first reduction is probably the most worrying time because the drug protocol is only a guide and you are working blind. It is only when the steroids are successfully reduced eg., without a relapse, that you can be sure remission has been achieved. It is a bit of a 'suck it and see' approach.

I would let her off the lead for a short period and build-up to full exercise, perhaps increasing it on a weekly basis.  You hope that they will let you know when they have had enough but that is not always the case and sometimes you have to think for them, like you say she gives nothing away.

Try to avoid well populated dog areas because she is vulnerable to lurking infections at the moment.

She is doing well though.
Jo

[Elaineb1624]

Hi Jo, though i would pop back in to say Hello and all is well with Lois, we are in week 7 of relapse and she is good, countersurfing again and stealing food off her sister! We are due to drop in 10 days down to 10mg.
Every cloud has a silver lining because normally she is a poor eater and right now we dont have that problem in fact quite the opposite. Jokes aside, just wanted you to know she is fine.
She has had a few little runs off lead but we are still keeping her away from  populated areas and as we live in  a town that generally means road walking. We will get there eventually but right now her health is more important.
    Elaine.

[Jo CIMDA]

That is great news Elaine.  What a relief for you. 

Lois has responded so well.

Good news is so refreshing. Thanks for the update.

Best wishes
Jo

[Elaineb1624]

Hi Jo,
   All is well with Lois. Am I right in reading the next drop down on Michael Days Protocol  for her will be from 10mg to 5mg, we reduced slower last time due to problems we were having but this time all is going to plan so can you kindly clarify i have that right please? Still find it a tad scary and dont want to get it wrong!
    Thanks in advance
     Elaine.

[Jo CIMDA]

Hi Elaine

Great to hear Lois is doing well.

What dose is she  on and how long as she been on this dose?

Jo

[Elaineb1624]

Hi Jo
       Apologies i didnt make it easy for an answer did i?
Lois is on 10mg at present which we split, she has been on this dose for one week so we wont be reducing for another 3 weeks yet.
     Thank you.
Elaine.

[Jo CIMDA]

Hi Elaine

I would reduce by 25% to 7.5mg a day.  This is in line with the M J Day protocol. You can give it once a day if you like and you may get a little more out of the dose because it is more beneficial if given when the body's own cortisol is at its highest, in the morning around 8am.

I'm so pleased she has responded well.  As long as she is coping with the side effects of the preds you can take the reduction as slow as you like.

Jo

[Elaineb1624]

Hi Jo,
     Thanks for that info, yes she is doing really well. I am very proud of my little whippet.
       Elaine.

[Elaineb1624]

Hi Jo,
    A couple of quick questions or reassurances if I may? Lois has a little dry flaky skin on her underside, its not sore or angry looking, would this be side effects of steroids and if so can i put anything on it? Also i know its documented that these drugs can change personality, i have noticed Lois is less tolerant of dogs when we are out if she comes across any, will this revert back to normal when drugs become  a lower or non existant dose?
   Thank you for your help as always, she is on 10mg still till saturday then drops to 7.5 she will then take that in the single dose at 8am. She is also seeing the vet saturday for a check up  and i will get them to take a look at her skin. It is only on underside of her not all over.
       Elaine.

[Jo CIMDA]

Hi Elaine

Lois' behaviour is very typical of dogs who have had immunosuppressive doses of steroids, and like you say it makes them intolerant, and aggressive in a defensive sort of way.  People on high doses of preds will say they make them feel irritable and irrational, so that is useful to know. When the dose is very low, down to every other day or less, then it should no longer have this effect and she will be back to her old self again.   

Likewise, preds can make the skin become thin and flaky and this also should recover when the steroids are low or withdrawn.  I would ask your vet about giving Lois essential fatty acids and natural Vit E.  EFA's such as evening primrose oil and fish oil are known to be steroid sparing meaning that when used in therapeutic doses the effect they have on the immune system allows the steroids to be reduced more effectively, so it is good for IM disease too.  Natural Vit E encourages new cell growth and is an excellent supplement for skin conditions. Synthetic Vit E does not have the same beneficial effect as the natural form.  You don't have to buy these supplements from your vet, you can buy them from supermarkets, health food shops or on line.

I am so please you are on a reducing dose.   Weaning down is such a good place to be.

Jo

[daledale]

My now 11 month old Whippet was diagnosed 5 weeks ago with Steroid Responsive Meningitis Arteritis.  Our family vet was unable to do this as was the emergency vet clinic (ordered CT scans thinking it an acute injury/spinal disease).  Ultimately we were referred to a vet neurologist:  spinal tap gave definitive diagnosis (very high neutrophils in his spinal fluid).  Riley was started on prednisone 10 mg twice a day.  Now 5 weeks later there are no signs of the disease - just those of prednisone side effects.

We have moved 2,000 miles from the diagnosing vet.  The new one wants to taper very slowly over 12-18 months; and says he will probably never come off them altogether.  The first vet wanted to start tapering after one month. 

I AM CONFUSED!  Is there a correlation between the speed of tapering and the rate of reoccurrence of the disease symptoms?

[Catherine]

I have no experience with SRMA but my dog had AIHA and she was on medication for a year and then came off it altogether. If a dog is coping okay with the steroids then I feel it is better to reduce slowly to lessen the risk of a relapse.

Have you seen the information here?: http://cimda.co.uk/smf/index.php/topic,25.0.html

[Jo CIMDA]

Hi

SRMA responds very well to prednisolone - as the name suggests - and Riley is no exception, which is great news.

Relapses of SRMA are not uncommon and it is better to wean the steroids down more slowly at the end stages.  It becomes a balancing act between the side effects of the drug and achieving long term remission. The best protocol I have come across which can be used as a guide is by Michael J Day - a world leading pathologist and immunologist.

Whatever protocol used, there are no guarantees that a relapse won't happen but the wrong protocol is very likely to be ineffective and relapses are to be expected.

It is more important to control the serious side effects of the steroids at the start of treatment when the dose of steroid is very high.  If a dog is on the high doses for longer than necessary then the side effects can become overwhelming and dangerous. Steroids should be given at the lowest dose to control the disease, and for the minimum duration of time, but this does not mean that the dose should be so low that it is ineffective and the steroids are reduced before they should be.

If you look at the protocol below you will see that the dose is started at 1mg/kg/12hrs.  This is an immunosuppressive dose for a dog and in most cases this is high enough to bring the disease under control.  The side effects must be taken into consideration at all times.  If the side effects are tolerable and not a problem and the dog's clinical signs are good, then after 3-4 weeks the dose should be lowered by 25%.  The monitoring of clinical signs, side effects and blood results, if appropriate, carries on throughout each pred reduction. When the dose is low then the reduction can be taken much slower if that is preferred, because the disease is in remission (hopefully) and the side effects of the drug is significantly reduced too.  There is no way of knowing if a dog will relapse or not.  The best you can do is to follow a good protocol and hope.

In answer to your question, there can be a correlation between the speed of tapering and reoccurrence of the disease. SRMA and IMPA (immune mediated polyarthritis) often occur in young dogs and relapses are not uncommon, but relapses often seem to become less frequent as the dog matures (a bit like juvenile arthritis in humans).  It is very likely that long term remission can be achieved with SRMA without the dog remaining on steroids for life.  I have known lots of dogs to have SRMA and have one or two relapses but then achieve long term remission. Some have not relapsed at all.  It is one of the AI diseases that can be treated very successfully. 

When a dog has an AI disease they are genetically predisposed to autoimmunity and this should be a major consideration in how your dog is managed.  Keep your dog as free as possible from chemicals, vaccines, spot-on treatment etc.,  and many other potential environmental  triggers. There is no cure for an AI disease but drug free, long term remission can be achieved in many cases. Prof Brian Catchpole at the RVC, said at a recent seminar that dogs that have had an AI disease should not be vaccinated again nor receive spot-on treatments.  The risks of a relapse or developing a different AI disease outweigh the benefits.

If Riley has been on immunosuppressive dose of steroids for 5 weeks then the dose should be reduced now.   The clever aspect of immunosuppressive treatment is knowing when to lower the dose. More doesn't necessarily mean better.  I hope you find the protocol useful.

Be positive because Riley is over the worst and you are now on the road to remission, which is great news.

Jo




Immunosuppressive Protocols for Oral Prednisolone in the Dog.
Ref: Clinical Immunology of the Dog & Cat by Michael J Day  – Professor of Veterinary Pathology, University of Bristol, UK and WSAVA - Chairman of Scientific Advisory Committee.

Professor Michael DayBSc, BVMS(Hons), PhD, DSc, DiplECVP, FASM, FRCPath, FRCVS 

This example is base on a dog receiving an induction dose of 1.0mg/kg/q12hrs

Dose                Duration (based on clinical effect)

1.0mg/kg/q12h             10-28 days
0.75mg/kg/q12h         10-28 days
0.5mg/kg/q12h             10-28 days
0.25mg/kg/q12h          10-28 days
0.25mg/kg/q24h          10-28 days
0.25-0.5mg/kg/ Every other day-at least 21 days
0.25-0.5 mg/kg/ Every third day-at least 21 days