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Started by ann b, June 03, 2017, 11:15:45 AM

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ann b

Misty our springer  was diagnosed with auto immune mediated  disease 2 years ago in London. She has had her ups and down. Her main issue is in  her lungs with bronchitis. She can and does react to so many things we have been through so much with her, but as her symptoms started when she was 18 weeks old and she is now 4 yrs she gets by. She has been having issues with stiffness and lameness off and on since a collapse in 2015 but recently it has got more regular and is dragging her down - not sure where we go from here with this issue as she doesn't do too well with GA she tends to react but she is not in a good place at the moment.

Jo CIMDA

Hi and welcome

I am sorry Misty has had an immune mediated disease.  Do you know exactly which one was diagnosed?  Is she off all immunosuppressive drugs, such as prednisolone?

When a dog has had one AI disease there is a possibility, because they are genetically predisposed, that they will get another or they will relapse.  Dogs may also get more than one AI disease at the same time.  Have you recently had her vaccinated or used spot-on treatment that may have triggered a relapse or a different AI disease? Does Misty have high temperature?  Is her lameness 'shifting' or just on one or two legs?

I wonder if Misty has Immune Mediated Polyarthritis? Below is some information about AI diseases where lameness can be a clinical sign.

I understand your reluctance to give Misty a GA in order to do joint taps etc., in the hope of obtaining a confirmed diagnosis, so if your vet is willing he or she may assume an AI disease (as Misty is known to be genetically predisposed)  and treat Misty speculatively with immunosuppressive doses of steroids. Clearly infections etc., will have to be ruled out but sometimes, if the diagnosis is unclear but the dog is in pain and unwell and an AI disease like IMPA is strongly suspected, the vet can give one shot of a long acting steroid called dexamethasone to see if the dog responds favourably.  If the response is positive and good improvement is seen (often within 24 hours) then the dog may continue with an immunosuppressive course of steroids usually prednisolone (see Prof Michael J Day's immunosuppressive drug protocol in the files).   If the shot of dexamethasone has no good effect then you can assume that it is unlikely to be an AI disease and further investigations can be made.

See below for more information.  I do hope some action can be started to help Misty and alleviate her pain, alternatively can you get Misty to a referral centre? The RVC is just off the M25 and it is an excellent referral centre. There may be other referral places nearer to you.  Where in London to you live, N, S, E, W?

Jo




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.

Steroid Responsive Meningitis Arteritis

Not to be confused with bacterial meningitis.

SRMA is inflammation of the meninges (membrane covering the brain) and peripheral nerve roots, caused by immune mediated infiltration via the spinal cord.  The disease may acute or chronic and is cyclic in nature.   Relapse is not uncommon.
Clinical signs:
High temperature (up to 42C – 107.6F)
Neck and joint pain with stiffness.
Depression.
Diagnosis:  Evidence of immune cells via spinal tap and clinical signs.
Treatment:  Immunosuppressive doses of Steroids

SLE - Systemic Lupus Erythematosus


SLE is a multisystemic disease that can affect many parts and systems of the body.  It is categorised into major and minor signs.

Major signs can be:


Shifting lameness (polyarthritis), anaemia and thrombocytopenia(blood abnormalities), skin lesions, kidney nephritis (inflammation)

Minor signs can be:


Inflammation of the heart, lungs & muscles, mouth ulcers, enlarged lymph nodes, gastrointestinal signs (vomiting and diarrhoea), central nervous system may be affected causing: Behavioural changes, seizures, and staggering (ataxia).

Clinical signs can be extremely varied and not all dogs with SLE will show the same symptoms. An antinuclear antibody blood test (ANA) can be useful in diagnosis but a negative result still does not rule out SLE.

The dog will normally demonstrate signs of pain and stiffness in the joints and this may be accompanied with anaemia, skin lesions and one or more of the minor signs.  One would expect the dog to show other clinical signs such as high temperature, enlarged lymph nodes, thrombocytopenia, lethargy, depression, lack of appetite, muscle weakness (myosytis) sometimes causing weakness of the throat muscles (megaoesophagus).   Megaoesophagus is a serious complication and if this is present then the quicker correct treatment is started the more chance you have of limiting the effects.  A dog will have difficulty in drinking and eating and this can cause recurring aspirate pneumonia.  The primary autoimmune disease may have been brought under control but the effects of megaoesophagus may not resolve completely.

SLE can affect any body system/s. A definitive diagnosis may not be achieved, but it may be presumed, based on clinical evidence and response to treatment.  Again knowledge of breed predisposition and family history will be beneficial in obtaining a diagnosis.   Dogs can have periods of remission and relapse. 

ann b

The trouble with Misty seems to be she can throw in any of her systems. We live in Scotland and we have been through so much with her since puppyhood. She started with dry eye at 18 weeks  ( seemly an indicator for the disease)so we treat that. She was neutered at 6 months as her eye lids had to be released - she started coughing not all the time but regularly so we got treatment for that. At just over a year old her breeder came to see me to tell me her sister had died suddenly for unexplained reason her heart seems to have failed in what until that week had been a healthy dog and she knew Mist had been coughing off and  on for months. We got a referral to Glasgow vet school - misty has a slow but regular heart rate and pulse but the cough concerned them and she was diagnosed with bronchitis she was put on steroids but she never did that well with them but we continued. She produced 2 lumps both were diagnosed as tumours - but non malignant the second was actually a calcium leak in her one of her toes. Both operations gained a bad reaction The first operation triggered some sort of hyper -drive in her coughing and pneumonia was diagnosed and treated. After the second operation we went through 20 weeks of a range of things - her fur fell out, her coughing increased,  she broke out with scabs which leaked a white goo  from her skin belly, her guts went and we had yellow diarrhoea for 14 weeks and the start of this leg dragging on one of her back legs - we took her out of steroids and after a period her system started to calm. Her local vet at the time thought she may be auto immune and put an email round the country for assistance as she said this is complicated. In Scotland there are no specialists in this subject. The Royal College replied and wanted to see her that week I couldn't do that as I have a disabled husband which complicates matters. We got her to London in the November and her symptoms were calming by that time she by then was only 2years 6 months. They were great with her went through all her systems and she was diagnosed as having auto immune mediated disease. She flairs in a number of systems and they believe she has damaged and missing markers in her immune system and explains why she  can display so many symptoms. They believe the 2 systems which are at most risk are her respiratory system and her bone structure. I can't go to London regularly and she is cared for both by her local vet and by Glasgow vet school. WE got her fit but last summer she was having major gut problems and coughing she was diagnosed a mycroplasmatic  infection and she was treated as this can due to its nature travel thorough different systems also. We got her over that but since Xmas 2016 she has been ok but odd issues arise with her . She now on occasions takes asthma attacks as well as her coughing and sneezing. She is going into deep sleeps but I can wake her, she is having issues across her body with what looks like pain if you touch her. Recently she has become a bit lethargic this dog is still only just over 4years old.  After her 2nd operation I said no more GA until some one could explain to me why we get these reactions - we did get an explanation in London- yes dogs like her can react - so absolute care needs to be taken with her. She does get steroid injections when required  - heavy dose fast acting and that works. We nebuliser her 2 /4 times daily with saline solution and that works it is a maintenance tool not a cure it was made clear there is no cure for this issue. Everyone who has dealt with Misty tries there  very best for her but I do find in some cases lack of knowledge is an issue. This currant issue does bother me as I think we need to know for sure what is up in her bone structure it goes from maybe a disc issue to arthritis but her coughing is up but not in hyper-drive and she is definitely off. It where we go from here  not wanting to trigger her further but getting her the help she needs. I have owned 8 Springers and up until the 2 I have at the moment - they were very all very healthy. These 2 are not - Misty has her problems  my other one who is only 5 now was diagnosed with null cell lymphatic cancer at 18 months - he is remission and doing fine both these dogs came from recognised good breeders who cared a lot about there dogs - it has been bad luck. All we try and do is the best for both of them when required. Sorry for the length of the email it like a saga. I just am not sure where we go from here with Misty 

Jo CIMDA

Wow!  You have all been through so much in Misty's short life.

Clearly a dog with a genetic predisposition to autoimmunity can also get other, non-immune related ailments and this always has to be considered, BUT you know that Misty has a multisystemic AI problem and this has the potential to be triggered at any time by so many things, so AI disease has to be at the top of the list and then ruled out.   I applaud you for going all the way to London from Scotland for Misty. 

Most AI diseases, and certainly the inflammatory ones, are treated the same regardless of which one (or more) the dog has, and this is by suppressing the immune system to enable it to return to normal function (but you know this already), so in a way the method of treatment is immunosuppressive drugs, and of course other treatment such as nebulisers, and eye cream etc., etc.   

The idea is to use high, immunosuppressive doses of a drug and gradually wean down to a low every other day or daily dose.  I once had a boy with SLE and I could never get him off steroids but he was maintained on a low dose of prednisolone with Azathioprine and he had a good quality of life.  He would relapse about every 9 months but he responded very well to the steroids and I got him back to a low maintenance dose again.

There are so many more immunosuppressive drugs used these days and even if prednisolone doesn't suit Misty then there are others that could be tried.  One, for joint problems, is leflunomide, but there is mycophenolate, cyclosporine, azathioprine and many more. If the fast acting steroid injection gives good results then once she is feeling better and in assumed remission,  would your vet consider keeping Misty on a low every other day dose of steroids for maintenance or perhaps adding azathioprine for maintenance?

You know she is very sensitive to GA's and it is almost a foregone conclusion that if she has a GA she will react, so treating speculatively has to be an option.  The other thing that might be considered is when a young dog has to have high doses of steroids for prolonged periods, this can cause osteoporosis, tendon and ligament problems.  Is this the cause of her current stiffness and lameness? If she currently had immune mediated polyarthritis her temperature would be high for much of the time, although this can grumble on for a while before it becomes acute. 

You say she is lethargic.  Many dogs with an AI disease will go on to develop hypothyroidism and this will make her lethargic with weak muscles making it difficult for her to get to her feet.  A thyroid blood panel might be worth having done.

Glasgow is a very good vet school and head of Small Animal Medicine and Endocrinology is Prof. Ian Ramsay, a very experienced specialist vet, and I wonder if it might be worth trying to get an appointment with him. 

Autoimmune disease is a genetic predisposition and at least your breeder is willing to discuss things with you - some breeders won't.  Breeders who have AI disease in their line have to be very careful about breeding on.  An AI dog informs the breeder that both parents are, at least, carriers of AI disease and if either parent goes on to develop a disease themselves then their status changes to 'affected' and affected dogs pass on more of the deleterious genes to their offspring.  If a mating has produced AI disease in the litter then that mating should never be repeated.  In general, pedigree dogs are inbred or line bred and there is a danger of a genetic bottleneck - and unfortunately this is occurring in most pedigree dog breeds.   I feel very sorry for the caring breeders because it is a very difficult situation and if it is ignored it will only get worse.

I do hope you find a way of helping Misty to improve.  I am so sorry you have had problems with your other dog.  It is so stressful.

Jo