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Escola De Ciências E Tecnologias Clínica E Universidade de Évora – Escola de Ciências e Tecnologias Mestrado Integrado em Medicina Veterinária Dissertação Clínica e Cirurgia de Animais de Companhia Bárbara Reis Santos Orientador(es) Catarina Falcão Trigoso Vieira Branco Lavrador Filipe Esteves Pereira Évora 2019 Universidade de Évora – Escola de Ciências e Tecnologias Mestrado Integrado em Medicina Veterinária Dissertação Clínica e Cirurgia de Animais de Companhia Bárbara Reis Santos Orientador(es) Catarina Falcão Trigoso Vieira Branco Lavrador Filipe Esteves Pereira Évora 2019 A dissertação foi objeto de apreciação e discussão pública pelo seguinte júri nomeado pelo Diretor da Escola de Ciências e Tecnologia: • Presidente | Rita Payan Carreira (Universidade de Évora) • Vogal | David Orlando Alves Ferreira (Universidade de Évora) • Vogal-orientador | Catarina Falcão Trigoso Vieira Branco Lavrador (Direção Geral de Alimentação e Veterinária) Évora 2019 Agradecimentos Agradeço a todos os familiares e amigos todo o apoio ao longo dos anos de curso e em especial nesta reta final. Agradeço aos meus companheiros de quatro patas a inspiração para seguir esta profissão e, em especial aos companheiros felinos, a motivação para escrever este trabalho. Agradeço o apoio da minha orientadora, professora Catarina Lavrador, ao longo desta etapa. Agradeço ao professor Alfredo Pereira a disponibilidade e prontidão em ajudar na realização deste trabalho. Agradeço a toda a equipa do Hospital Veterinário da Mata de Santa Iria a oportunidade, apoio e confiança ao longo dos meses de estágio. Agradeço aos tutores e seus companheiros felinos a disponibilidade para participarem neste trabalho e a simpatia demonstrada durante todo o processo. I Resumo A osteoartrite é comum, particularmente em felinos geriátricos e a sua importância clínica tem crescido recentemente. Trata-se de uma doença crónica caracterizada pela degradação da cartilagem e neoformação de osso, o que origina dor articular. A deteção de dor crónica é desafiante nos felinos. Os sinais clínicos consistem em alterações comportamentais e da atividade, podendo ser erradamente interpretados como processo natural de envelhecimento. Assim, uma etapa essencial para o diagnóstico final, pode ser a realização de questionários aos tutores acerca da atividade dos seus gatos. Este estudo tem como objetivos determinar a prevalência radiográfica de osteoartrite numa população de felinos com idade superior a oito anos e correlacionar a presença de lesões e a deteção de sinais clínicos pelos tutores. Palavras-chave: osteoartrite, doença degenerativa articular, felinos, gatos, geriátricos. II Clinic and surgery of small animals Osteoarthritis is very common especially in old age cats. It´s a disease which has grown in importance recently. Osteoarthritis is a chronic disease characterized by cartilage degradation and bone neoformation. These changes will induce joint pain. The recognition of chronic pain can be challenging in cats. The clinical signs consist in activity and behavioral changes, which are frequently misunderstood as the natural process of aging. Thus, an owner- based questionnaire about activity changes can be helpful to achieve the final diagnosis. This study has the objective of determining the radiograph prevalence of osteoarthritis in a population of cats with more than eight years old and correlate it with the presence of lesions and the detection of clinical signs by the owners. Key-words: osteoarthritis, degenerative joint disease, feline, cats, geriatric. III Índice Geral Agradecimentos.............................................................................................................................. I Resumo ......................................................................................................................................... II Clinic and surgery of small animals .............................................................................................. III Índice Geral .................................................................................................................................. IV Índice de tabelas ......................................................................................................................... VII Índice de figuras ......................................................................................................................... VIII Índice de abreviaturas, siglas e símbolos .................................................................................... IX I. Revisão Bibliográfica ........................................................................................................... 11 1. Introdução ............................................................................................................................ 11 1.1. Osteoartrite .................................................................................................................. 12 1.2. Prevalência .................................................................................................................. 12 2. Etiologia e fatores predisponentes ...................................................................................... 15 2.1. Fatores genéticos ........................................................................................................ 16 2.2. Idade ............................................................................................................................ 17 2.3. Fatores sistémicos....................................................................................................... 17 3. Anatomia e fisiologia da articulação .................................................................................... 18 4. Fisiopatologia ...................................................................................................................... 22 4.1. Alterações bioquímicas ............................................................................................... 23 4.2. Alterações histológicas ................................................................................................ 24 4.3. Dor ............................................................................................................................... 26 4.3.1. Dor adaptativa ..................................................................................................... 27 4.3.2. Dor mal adaptativa .............................................................................................. 28 4.4. Características genómicas e proteómicas .................................................................. 29 5. Sinais clínicos ...................................................................................................................... 30 6. Diagnóstico .......................................................................................................................... 31 6.1. Anamnese e Questionário ao tutor.............................................................................. 31 6.2. Exame físico e ortopédico ........................................................................................... 35 6.3. Diagnóstico por imagem .............................................................................................. 37 6.3.1. Radiografia .......................................................................................................... 37 6.3.2. Tomografia Computorizada e Ressonância Magnética ...................................... 38 6.3.3. Ecografia ............................................................................................................. 40 6.3.4. Cintigrafia nuclear ................................................................................................ 40 6.3.5. Artroscopia .......................................................................................................... 40 6.4. Análise líquido sinovial ................................................................................................ 40 6.5. Métodos de diagnóstico objetivos ................................................................................... 41 IV 6.5.1. Imagem termográfica ........................................................................................... 42 6.5.2. Monitorização da atividade com acelerómetros .................................................. 42 6.5.3. Análise podobarométrica dinâmica ..................................................................... 43 6.5.4. Goniometria ......................................................................................................... 43 6.5.5. Biomarcadores .................................................................................................... 43 6.5.6. Teste sensorial quantitativo ................................................................................. 44 7. Tratamento .......................................................................................................................... 45 7.1. Adaptação do ambiente e atividades .......................................................................... 46 7.2. Farmacológico ............................................................................................................. 46 7.2.1. Anti-inflamatórios não esteroides ........................................................................ 46 7.2.2. Opióides .............................................................................................................. 52 7.2.3. Gabapentina .......................................................................................................
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