Re: Recommendations for rheumatoid/polyarthritis case

[Guest guest]

Her radiographs are in the Photos area under Cue Ball - arthritis

[Guest guest]

Wow- watching that video made MY wrists hurt! I had a similar case several years ago, a miniature dachshund with polyarthriitis that affected all limbs, thoracic worse than pelvic. He did not have the rotation in the metacarpals that your case has, though-he walked pretty much back on his accessory pads. At first, I molded some thermoplast splints, similar to the Ortho Pet splints, for his front feet, but when I placed them on his feet, he immediately rolled over on his back and stuck his feet up in the air! Even with treats and coaxing, he would not ever walk in them. I suggested a quad cart for him, to take some of the pressue off of his lower limbs/feet, but was concerned with the rigidity of the rear harnesses/rings that all the cart makers currently have-I was afraid that it would actually hamper his alternating gait pattern in rear. My husband ended up building a quad cart for him and we sewed a canvas harness that allowed room for his front legs to move, then came up along the ventral surface of the thorax and stopped at the caudal end of the abdomen, but kept his pelvis free. (I'll see if I can find any pictures of it to post). That allowed him to take longer walks with his owner without increased pain. We also worked in the UWTM and did a lot of gentle weight shift/proprioceptive work on balls and dynadiscs, with me manually helping to stabilize the metacarpals/metatarsals. Good luck with this case-

Bedenbaugh, PT, CCRP

Re: Recommendations for rheumatoid/polyarthritis case

Her radiographs are in the Photos area under Cue Ball - arthritis

[Guest guest]

Hi Bridget,

Regardless of whether there was originally errosive or non-errosive

polyarthritis, this is and stage collapse of the carpi and distal joints. It

was most likely an errosive form of polyarthritis which is most commonly

rheumatoid factor negative errosive polyarthritis. I am surprised your surg and

rad departments gave you the advice they did. The problem is that all these

immune mediated polyarthritis dogs have constant inflammation, just worse at

various times. Just because they are not limping does not mean there is not

acute or chronic inflammation happening. We have seen numerous dogs that were

minimally lame that have suppurative inflammation in their joints. The best way

to monitor the efficacy of the immunosupressants is to do serial joint taps in

addition to observing their comfort level during mobility. Additonally on this

case, at this stage, usually there is only chronic inflammation present but

regardless, immunosupressants will do nothing for the already c

ollapse and/or cartilage devoid joints. They can help the joints that still

have cartilage and still have active inflammation but the only way to gauge that

is to do joint taps of other structurally intact joints. Really at this stage

you could justify immunosupression if you had taps with suppurative inflammation

in other structurally intact joints. Pain meds are definitely indicated.

So what is the best treatment? In polyarthritis cases It really comes down to

does a patient have cartilage in the joint to save and is it immune mediated or

tick-borne polyarthritis. But in a dog with a collapsed joint it is safe to

assume, if it is due to errosive polyarthritis, that the joint surface is devoid

of most cartilage. Therefore, you cannot just create a brace that puts them in

a weight bearing position because it is likely going to be more painful that

walking on a collapsed, luxated joint at this point. The only real good

solution is arthrodesis but it is a poor choice in these guys at this point

because the bone is so abnormal and does not hold implants well. The other

choices are the quad cart, or letting him walk as is or, I mentioned this in a

post a year or so ago, amputate and create a custom prosthesis(es) for him. If

anyone has other solutions than those i would love to hear about it!

Mark Parchman, DVM, DACVS, CVA, CCRT

Bend Veterinary Specialists and Pawsitive Strides Physical Rehabilitation

Bend, Oregon

Recommendations for rheumatoid/polyarthritis case

> Greetings all --

>

> Cue Ball is an approximately 4 year old female spayed chihuahua.

>

> Here is her gait video on YouTube:

>

>

>

> I will try to post the radiographs as well.

>

> Client rescued her 1 year ago off the streets. Spayed her. Says her

> gait was essentially normal when he rescued her. A few months prior

> to presentation, she had an episode of pain that they could not

> localize. After the pain subsided, she started to show

> abnormalities in the carpi, metacarpi and digits, and it was not

> long before she looked as she currently does.

>

> On examination, she has mild to moderate crepitus in the front limb

> digits, metacarpal and carpal joints. Her left carpus is medially

> displaced and the right is laterally displaced. It appears that

> there is no liagmentous support from the distal radii to the

> digits. She essentially walks on her distal radii. Her rear limb

> digits are starting to splay, and have mild crepitus. The tarsi

> both are lax, especially medial/lateral.

>

> Amazingly, she allowed full examination and did not seem painful

> (protested the most when I tried to lift her gums and look at her

> teeth!). Most chihuahuas I handle tend to scream at the slightest

> perceived infraction, and the client reported that when she was

> painful, she was difficult to handle.

>

> Surgery and radiology depts said that this is rheumatoid/erosive

> poly-arthritis. I agree from what I know about the disease (which

> is n=2 now).

>

> Their recommendations were to see rehab (me) for recommendations,

> otherwise do nothing until she has another flare up, and start

> immunosuppressive drugs at that time.

>

> Any ideas/input? Custom orthotics? Fore-limb/quad cart? Any

> supplements?

> I advised to consider a stroller or doggie carrier, since she likes

> to go out, but to minimize walking as much as possible. Is that the

> right advice?

>

> Ok - I am going to attempt to post her radiographs after I post

> this message (last time I did this I lost the message...argh)

>

> Bridget

>

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