Other Arthritides

Chapter 90

Charles D. Newton


 


Hemarthrosis

Hemarthrosis can result in progressive synovial change and arthritis. While its occurrence is not significant in the normal postoperative arthrotomy patient, it is an important consideration in the hemophiliac patient (including the patient on anticoagulant therapy). Daily intraarticular injection of autologous anticoagulated blood over a 12-week period can produce an animal model for the study of hemarthrosis. (6-12)

Canine Hemophilia

Canine hemophiliacs demonstrate recurring lameness with painful and occasionally swollen major joints of the extremities. All dogs with hemophilia show joint disease at some point in their lives.(l1)

The major joints involves in the dog are the shoulder and elbow. They are affected more commonly than the hip and stifle. The smaller joints of the feet are least likely to demonstrate diseased The earliest evidence of disease is small synovial or subsynovial tissue hemorrhage in the villi. Hematomas never form, since the hemorrhage ruptures into the joint cavity. Such villi are slightly larger than normal and have hyperplastic surface cells, increased fibrous tissue, lymphocytic and plasma cell infiltration, and bits of adherent clot. Adhesions may occur between adjacent villi.(11)

Hemosiderosis is evident in the synovium, but a variable degree of pigmentation of articular cartilage may occur also. The pigment is a coarse orange brown containing no stainable ion.(11)

In more chronic disease, inflammation, with infiltration of lymphocytes, macrophages, and plasma cells, results in fibrosis and thickening of synovial tissue.(10) Dense scar may eventually develop as a result of the subsynovial fibrosis.

In severe hemophiliac arthropathy, articular portions of bones often show changes of the type occurring in degenerative joint disease. The cartilage may show fibrillation, roughening, pitting, or focal erosion. Newbone formation may occur, producing osteophytes.

Neoplastic Arthritis

Arthritis may be associated with primary or secondary neoplasms involving the joint or periarticular soft tissues. Synovial cell sarcomas in many instances are slow growing and produce synovial inflammation resulting in pain, restricted range of motion, and secondary new-bone formation. Slow growing tumors of the bone, usually metastatic lesions, may produce bony defects that collapse and result in secondary degenerative arthrosis.

Diagnosis of intra-articular neoplasia can be difficult, especially if secondary degenerative joint disease preexisted. Whenever the status of a joint changes abruptly in an animal and neoplasia is suspected, biopsy is necessary. Even if neoplasia is not primary on a list of differential diagnoses, biopsy should be considered.

Arthritis Associated with Chronic Infectious Disease

Chronic infectious disease can produce monoarticular or polyarticular arthritis. The arthritis has been associated with bacterial endocarditis(10) ;chronic Actinomyces infections of the chest, abdomen, or paravertebral muscles(l0);canine Brucella infection;(10) or chronic dental infection (2) .The disease produced is similar to the nonerosive synovitis seen in systemic lupus erythematosus. In all previously mentioned etiologies except Brucella canis infection, no causative organism can be recovered from the joint. This leads to the conclusion that this may be another example of immune-complex disease. Mycoplasmal infection can result in polyarthritis in pigs, rats, and other domestic species.(9) The disease has not been documented in dogs or cats. Typically it is very difficult (if not impossible) to recover organisms from the involved joints. In many animals, following a period of acute inflammation, the joint or joints return to near normal. Such a disease may be responsible for monoarticular or polyarticular arthritis in dogs. The disease tends to be transient, lasting from 1 to 4 weeks. The synovium appears proliferative and infiltrated with inflammatory cells. The disease is nonevasive and may also be an immune-complex disease, reflecting subacute mycoplasmal infection of the lungs, gut, or genitourinary system. Although dogs respond to corticosteroids, eacerbation of the disease may occur later. The elbow and carpus seem more likely to be affected.

Arthritis Associated with Chronic Inflammatory Disease

Some dogs have a nonerosive, noninfectious polyarthritis that occurs in association with chronic inflammatory disease.

Pedersen and Pool (10) have described polyarthritis in dogs associated with chronic ulcerative colitis and fulminating enterocolitis. They have called the disease enteropathic arthritis. Their description states "changes in the synovial membrane and synovial fluid are indistinguishable from those described in idiopathic polyarthritis or systemic lupus erythematosus of the dog."(10) The cause of this disease is unknown; only the association with chronic gut disease has been recognized.

Metabolic Joint Disease

Gout is a disease resulting from disturbed metabolism of uric acid. It is characterized as a painful, inflammatory condition that results from the deposition of sodium urate monohydrate crystals(13) in synovial fluid, articular cartilage, and periarticular tissues. Urate deposits (tophi) may become prominent swellings in humans.(7)

This condition has never been accurately documented in the dog or cat despite many articles claiming to describe a goutlike syndrome.(4,8) "Even the dalmatian dog, which normally has a higher serum uric acid content than other dogs and is known to develop urate calculi,(3) has not been reported to be affected by gout.(4,5)"


 

References


1. Clegg FG, Rorrison JM: Polyarthritis in canine brucella infection. Res Vet Sci 9: 183, 1968

2. Cook TG, Hardenbergh JG: A case of recurrent synovitis and myositis in the dog associated with dental infection. North Am Vet 8:30, 1927

3. Finco DR: Current status of canine urolithiasis. J Am Vet Med Assoc 158:327, 1971

4. Gibson JP, Austic RE, Cole RK: Gout. In Andrews, Ward, Altman (eds): Spontaneous Animal Models of Human Disease, vol 2, pp 246-249. New York, Academic Press, 1979

5. Gibson JP, Roenigk WJ: Pseudogout in a dog. J Am Vet Med Assoc 161:912, 1972

6. Hoaglund FT: Experimental hemarthrosis: The response of canine knees to injections of autologous blood. J Bone Joint Surg 49A:285, 1967

7. MacAusland WR, Mayo RA: Gout in Orthopedics: A. The Concise Guide to Clinical Practice, pp 68-70. Boston, Little, Brown & Co, 1965

8. Miller RM, Kind RE: A gout-like syndrome in a dog. Vet Med/Small Anim Clin 61:236, 1966

9. Newton CD, Schumacher HR, Halliwell RE: Arthritis: Rheumatoid-like. In Andrews, Ward, Altman (eds): Spontaneous Animal Models of Human Disease, vol 2, pp 253-257. New York, Academic Press, 1979

10. Pedersen NC, Pool R: Canine joint disease. Vet Clin North Am 8:265, 1978

11. Swanton MC: The pathology of hemarthrosis in hemophilia. In Bunkhous KM (ed): Hemophilia and Hemophiloid Disease, pp 219 224. Chapel Hill, University of North Carolina Press, 1957

12. Wolf CR, Mankin HJ: The effect of experimental hemarthrosis on articular cartilage of rabbit knee joints. J Bone Joint Surg 47A: 1203, 1965

13. Wyngaarden JB: The etiology and pathogenesis of gout. In Hollander (ed): Arthritis and Allied Conditions, 8th ed, pp 1071-1111. Philadelphia, Lea & Febiger, 1972