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[[Image:DJD horse.jpg|right|thumb|100px|<small><center>DJD in a horse (Image sourced from Bristol Biomed Image Archive with permission)</center></small>]]
[[Image:DJD horse.jpg|right|thumb|100px|<small><center>DJD in a horse (Image sourced from Bristol Biomed Image Archive with permission)</center></small>]]
Also known as: '''''DJD — Osteoarthritis — Degenerative arthritis — Osteroarthrosis'''''
==Introduction==
Degenerative joint disease is the '''progressive deterioration of articular cartilage''' and is characterised by hyaline cartilage thinning, joint effusion and periarticular osteophyte formation.
'''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.
Normal joint function is altered by '''abnormal cartilage congruency''' and joint capsule anatomy.
'''Pain''', lameness and muscle atrophy develop secondary to joint dysfunction.
DJD is the '''end-stage''' to many common diseases of the '''small and large animals''' and therefore prompt diagnosis and management of these diseases is critical in preventing the condition.
==Predisposing factors==
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==
These include: '''lameness, pain, joint swelling, muscle atrophy, pericapsular fibrosis, crepitation and decreased range of motion'''.
==Diagnosis==
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.
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.
In horses, less severe cases may require '''arthroscopy''' for diagnosis.
==Treatment==
Treatment should rely principally on '''rest, controlled exercise and pain relief'''.
In small animals, an important treatment parameter is '''weight reduction''' or control.
'''Exercise modification/physiotherapy''': animals should be put on an appropriate exercise regimen, using analgesia initially and to control flare-ups. Some dogs enjoy hydrotherapy.
'''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.
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.
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:
'''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.
'''Prognosis''' depends on the location and severity of the arthropathy, but is usually guarded for return to athletic function.
==References==
Kahn, C. (2005) '''Merck veterinary manual''' ''Merck and co''
Corr, S. (2009) '''Locomotor module: osteoarthritis''' ''RVC student notes''
[[Category:To Do - Helen]]
[[Category:To Do - Review]]
[[Category:Joints - Degenerative Pathology]]
[[Category:Joints - Degenerative Pathology]]
[[Category:To Do - Manson]]
[[Category:To Do - Manson]]