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Also known as: '''''DJD — Osteoarthritis — Degenerative Arthritis — Osteroarthrosis'''''
Also known as: '''''DJD — Osteoarthritis — Degenerative arthritis — Osteroarthrosis'''''
==Introduction==
==Introduction==
[[Image:DJD horse.jpg|right|thumb|200px|<small><center>DJD in a horse (Image sourced from Bristol Biomed Image Archive with permission)</center></small>]]
Degenerative joint disease is the '''progressive deterioration of articular cartilage''' and is characterised by hyaline cartilage thinning, joint effusion and periarticular osteophyte formation.
Degenerative joint disease is the '''progressive deterioration of articular cartilage''' and is characterised by hyaline cartilage thinning, joint effusion and periarticular osteophyte formation.
'''Osteophytes''' form at the junction between synovium and bone. Joint inflammation leads to the release of factors which drive cells to multiply and differentiate into chondroblasts and osteoblasts. There is '''matrix deposition, mineralisation and growth''' of the osteophyte. Mineralised osteophytes develop a trabecular structure and retain a cartilage surface, and when mature may become incorporated into the metaphysis itself.
'''Chondrocyte necrosis''' is initiated, degradative enzymes are released and '''synovitis''', continued cartilage degradation and '''inflammation''' occur. There is loss of proteoglycans and lubrication in the joint.
'''Chondrocyte necrosis''' is initiated, degradative enzymes are released and '''synovitis''', continued cartilage degradation and '''inflammation''' occur. There is loss of proteoglycans and lubrication in the joint.
DJD is the '''end-stage''' to many common diseases of '''small and large animals''' and therefore prompt diagnosis and management of these diseases is critical in preventing the condition.
DJD is the '''end-stage''' to many common diseases of '''small and large animals''' and therefore prompt diagnosis and management of these diseases is critical in preventing the condition.
==Predisposing factors==
==Predisposing Factors==
These include any condition causing:
These include any condition causing:
:''joint trauma'': repetitive or acute trauma, intra-articular fractures
:''joint instability/dysplasia'': [[:Category:Joints - Degenerative Pathology|luxations and subluxations]], [[Hip Dysplasia|hip dysplasia]], [[Elbow Dysplasia|elbow dysplasia]], [[Cranial Cruciate Ligament Rupture|cruciate disease]]
:''joint incongruity'': conformational abnormalities, congenital malformations, [[Osteochondrosis|osteochondrosis]], [[Calve Legg-Perthe's Disease]]
==Clinical Signs==
==Clinical signs==
These include: '''lameness, pain, joint swelling, muscle atrophy, pericapsular fibrosis, crepitation and decreased range of motion'''.
These include: '''lameness, pain, joint swelling, muscle atrophy, pericapsular fibrosis, crepitation and decreased range of motion'''.
A history of joint disease is common.
A history of joint disease is common.
'''Radiography''' will reveal: joint effusion, periarticular soft tissue swelling, osteophytosis, enthesitis, subchondral bone sclerosis and narrowed joint space.
'''Radiography''' will reveal: joint effusion, periarticular soft tissue swelling, osteophytosis, enthesitis, subchondral bone sclerosis and narrowed joint space. It is important to note that radiographic changes do not always correlate with clinical signs and not all degenerate joints are associated with lameness.
It is important to note that radiographic changes do not always correlate with clinical signs and not all degenerate joints are associated with lameness.
'''Arthrocentesis''' is usually unremarkable, but may reveal slight changes in viscosity, colour and volume.
'''Arthrocentesis''' is usually unremarkable, but may reveal slight changes in viscosity, colour and volume.
Corticosteroids should only be given to severe, non-responsive cases and never combined with NSAIDs.
Corticosteroids should only be given to severe, non-responsive cases and never combined with NSAIDs.
'''New therapies''': acupuncture is become more popular in small animals.
'''New therapies''': [[acupuncture]] has become more popular in small animals.
Neutraceuticals such as glycosamide sulphate, chondroitin sulphate and pentosan polysulphate might improve signs, however few controlled studies in dogs and horses are available to support any claims.
Neutraceuticals such as glycosamide sulphate, chondroitin sulphate and pentosan polysulphate might improve signs, however few controlled studies in dogs and horses are available to support any claims.
'''Surgical treatment options''' include:
'''Surgical treatment options''' include:
:'''Joint lavage''': minimally invasive and may help remove inflammatory mediators and improve clinical signs for several months
:Salvage procedures such as:
::'''Excision arthroplasty''': in small animals, for example Femoral Head and Neck Excision
::'''Replacement arthroplasty''': total hip replacement and total elbow replacement in dogs
::'''Arthrodesis''': in all species depending on the joint, carpal arthrodesis in dogs, pastern and hock joint arthrodesis in horses, fetlock as a last resort.
::'''Amputation''' in small animals in cases of intractable pain or where financial issues prevent any other treatment.
Ultimately, DJD is an '''incurable disease''' and conservative treatment will only slow the progression of the disease.
'''Replacement arthroplasty''': total hip replacement and total elbow replacement in dogs
==Prognosis==
Prognosis depends on the location and severity of the arthropathy, but is usually guarded for return to athletic function.
{{Learning
|flashcards = [[Equine Orthopaedics and Rheumatology Q&A 10]]
[[Equine Orthopaedics and Rheumatology Q&A 13]]
[[Small Animal Orthopaedics Q&A 01]]
}}
==References==
==References==
Corr, S. (2009) '''Locomotor module: osteoarthritis''' ''RVC student notes''
Corr, S. (2009) '''Locomotor module: osteoarthritis''' ''RVC student notes''
Lewis, D. (1998) '''Small Animal Orthopaedics: self-assessment colour review''' ''Manson Publishing''
{{review}}
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[[Category:Musculoskeletal Diseases - Horse]]
[[Category:Musculoskeletal Diseases - Dog]]
[[Category:Joints - Degenerative Pathology]]
[[Category:Joints - Degenerative Pathology]]
[[Category:To Do - Manson]]
[[Category:Expert Review]]