Immune mediated polyarthritis and possible SDF rupture

February 23, 2012

6 year old female spayed Bouvier that travelled to France last summer presented

to me with a history of urinary incontinence and left hock swelling, in november

2011.The swelling in the hock was present dorsally, laterally and there was

some swelling on the talus as well. Lateral and medial collateral ligament felt

normal. The gastrocnemius and Achiles tendon also felt normal.

Blood work showed a decreased WBC, but rest was normal. Radiographs were done

and she has mild DJD in both hocks,mild spondylosis through out the lumbar

spine.UA showed UTI and she was treated with clavamox for 21 days. Tick panel

was negative, joint tap showed mononuclear cell exfoliation and no correlation

with suppurative and septic inflammation or neoplasia. Culture and sensitivity

negative.

She did not respond to NSAIDS for the swelling or laser therapy and

manipulation of the joint.

Referral was recommended but declined because of cost. We elected to to treat

with docycyline and cephalexin for 21 days. There was no change. At this point,

the swelling seemed to have increased and the owner wanted to do a trial of

prednisone. Swelling decreased within 2 days of prednisone therapy and I assumed

that she has an immune mediated polyarthritis.She is having issues with the

prednisone in terms of being urinary incontinent despite being on propalin so I

am hoping to add azathioprine to decrease the does of prednisone. The owner

decreased the dose on her own, but swelling came back immediatly.

I saw her on February 22 2012 and noticed that she seems unable to extend her

toes on her left hind to stand correctly, despite trying hemi stands or lifting

the right hind leg.

I read a description on this list that called it " claw foot " and it sure seems

to look this way. So potential SDF rupture, partial rupture.

I am unsure of what to do at this point. I have referred to a more experienced

canine rehab therapist who was also unsure of what exactly was going on, but

able to recommand more aggressive manipulations to try and break down adhesions

potentially at the talus.

I will try and attach pictures of her stance. Right now, we are trying to find a

brace that could help keep the foot in the correct position. I am not sure what

else to do for this dog - Help!

Thanks

Nathalie Fortier

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