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| + | (DJD) |
| − | Also known as: '''''DJD — Osteoarthritis — Degenerative Arthritis — Osteroarthrosis'''''
| + | [[Image:DJD horse.jpg|right|thumb|100px|<small><center>DJD in a horse (Image sourced from Bristol Biomed Image Archive with permission)</center></small>]] |
| | + | *'''Osteoarthritis, osteoarthrosis''' |
| | + | *Due to acceleration of normal ageing process - wear and tear |
| | + | *Destructive disease leading to: |
| | + | **Loss of weight-bearing [[Joints - Anatomy & Physiology#Articular cartilage|articular cartilage]] |
| | + | **Erosion, fibrillation of cartilage |
| | + | ***Clefts in the cartilage, perpendicular to the surface |
| | + | **Complete exposure of underlying bone |
| | + | ***Bone appears polishes, dense - [[Musculoskeletal Terminology - Pathology|eburnation]] |
| | + | ***Radiographically - joint space reduction due to loss of cartilage |
| | + | **[[Musculoskeletal Terminology - Pathology|Osteophyte]] formation at joint margins |
| | + | **Remodelling of adjacent bone |
| | + | **Brown/yellow discolouration |
| | + | **Synovial hypertrophy |
| | + | **Capsular fibrosis |
| | + | *May affect one or multiple joints |
| | + | *May or may not be symptomatic |
| | + | *Pathogenesis: |
| | + | **Not entirely clear but linked to loss of [[Joints - Anatomy & Physiology#Articular cartilage|proteoglycans]] and subsequent lubrication |
| | + | **Increased water content due to improper binding -> softening of cartilage = chondromalacia |
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| − | ==Introduction==
| + | *Predisposing factors: |
| − | [[Image:DJD horse.jpg|right|thumb|200px|<small><center>DJD in a horse (Image sourced from Bristol Biomed Image Archive with permission)</center></small>]] | + | **Persistent trauma |
| − | Degenerative joint disease is the '''progressive deterioration of articular cartilage''' and is characterised by hyaline cartilage thinning, joint effusion and periarticular osteophyte formation.
| + | **Joint instability / dysplasia |
| | + | ***[[:Category:Joints - Degenerative Pathology|Luxations and subluxations]] |
| | + | ***[[Hip Dysplasia|Hip dysplasia]] |
| | + | ***[[Elbow Dysplasia|Elbow dysplasia]] |
| | + | **Conformational abnormalities / congenital malformations |
| | + | **[[Osteochondrosis|Osteochondrosis dissecans]] |
| | + | **Intra-articular fractures |
| | + | **[[Calve Legg-Perthe's Disease|Calve Legg-Perthe's disease]] |
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| − | '''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.
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| − | '''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.
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| − | Normal joint function is altered by '''abnormal cartilage congruency''' and joint capsule anatomy.
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| − | '''Pain''', lameness and muscle atrophy develop secondary to joint dysfunction.
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| − | 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.
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| − | ==Predisposing Factors==
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| − | These include any condition causing:
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| − | :''joint trauma'': repetitive or acute trauma, intra-articular fractures
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| − | :''joint instability/dysplasia'': [[:Category:Joints - Degenerative Pathology|luxations and subluxations]], [[Hip Dysplasia|hip dysplasia]], [[Elbow Dysplasia|elbow dysplasia]], [[Cranial Cruciate Ligament Rupture|cruciate disease]]
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| − | :''joint incongruity'': conformational abnormalities, congenital malformations, [[Osteochondrosis|osteochondrosis]], [[Calve Legg-Perthe's Disease]]
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| − | ==Clinical Signs==
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| − | These include: '''lameness, pain, joint swelling, muscle atrophy, pericapsular fibrosis, crepitation and decreased range of motion'''.
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| − | ==Diagnosis==
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| − | A history of joint disease is common.
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| − | '''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.
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| − | '''Arthrocentesis''' is usually unremarkable, but may reveal slight changes in viscosity, colour and volume.
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| − | In horses, less severe cases may require '''arthroscopy''' for diagnosis.
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| − | ==Treatment==
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| − | Treatment should rely principally on '''rest, controlled exercise and pain relief'''.
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| − | In small animals, an important treatment parameter is '''weight reduction''' or control.
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| − | '''Exercise modification/physiotherapy''': animals should be put on an appropriate exercise regimen, using analgesia initially and to control flare-ups. Some dogs enjoy hydrotherapy.
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| − | '''Drug therapies''': should include NSAIDs and opioids in severe pain. In small animals, example include: carprofen and meloxicam systemically. In horses, systemic phenylbutazone can be given as well as intra-articular injections of steroids, hyaluronic acid and glycosaminoglycans.
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| − | Corticosteroids should only be given to severe, non-responsive cases and never combined with NSAIDs.
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| − | '''New therapies''': [[acupuncture]] has become more popular in small animals.
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| − | 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.
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| − | '''Surgical treatment options''' include:
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| − | :'''Joint lavage''': minimally invasive and may help remove inflammatory mediators and improve clinical signs for several months
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| − | :Salvage procedures such as:
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| − | ::'''Excision arthroplasty''': in small animals, for example Femoral Head and Neck Excision
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| − | ::'''Replacement arthroplasty''': total hip replacement and total elbow replacement in dogs
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| − | ::'''Arthrodesis''': in all species depending on the joint, carpal arthrodesis in dogs, pastern and hock joint arthrodesis in horses, fetlock as a last resort.
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| − | ::'''Amputation''' in small animals in cases of intractable pain or where financial issues prevent any other treatment.
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| − | Ultimately, DJD is an '''incurable disease''' and conservative treatment will only slow the progression of the disease.
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| − | ==Prognosis==
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| − | Prognosis depends on the location and severity of the arthropathy, but is usually guarded for return to athletic function.
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| − | {{Learning
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| − | |flashcards = [[Equine Orthopaedics and Rheumatology Q&A 10]]
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| − | [[Equine Orthopaedics and Rheumatology Q&A 13]]
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| − | [[Small Animal Orthopaedics Q&A 01]]
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| − | }}
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| − | ==References==
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| − | Kahn, C. (2005) '''Merck veterinary manual''' ''Merck and co''
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| − | Corr, S. (2009) '''Locomotor module: osteoarthritis''' ''RVC student notes''
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| − | Lewis, D. (1998) '''Small Animal Orthopaedics: self-assessment colour review''' ''Manson Publishing''
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| − | {{review}}
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| − | {{OpenPages}}
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| − | [[Category:Musculoskeletal Diseases - Horse]]
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| − | [[Category:Musculoskeletal Diseases - Dog]]
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| | [[Category:Joints - Degenerative Pathology]] | | [[Category:Joints - Degenerative Pathology]] |
| − | [[Category:Expert Review]] | + | [[Category:To Do - Manson]] |
