PREMIERE ISSUEEAGLE Update B A NESTLÉ PURINA PUBLICATION DEDICATED TO BEAGLE ENTHUSIASTS VOLUME 1 | FALL 2019
STEROID-RESPONSIVE MENINGITIS-ARTERITIS Painful Neurological Disorder Aects Young Dogs FALL 2019
BEAGLES ARE AMONG BREEDS PRONE TO STEROID-RESPONSIVE MENINGITIS-ARTERITIS Given his handsome looks and veterinarians, hoping someone outgoing charm, “JR” (GCH Pun would oer clinical suggestions. Kotzky Jolly Roger Of Sunbriar CD No one provided feedback.” BN RA CA TKI), a 15-inch tricolor Meanwhile, JR’s limping continued male Beagle, easily finished his to come and go. “One day he would show championship title. When he seem all right, and then the lame- 1 was 2 /2 years old, JR earned an ness would return,” says Sprout. invitation to the Top 20 competition Sadly, JR missed the 2015 National at the 2015 National Beagle Club Specialty because he was too lame Originally known as “Beagle (NBC) National Specialty. to compete and seemed to be in pain. “We were beginning to think pain syndrome,” SRMA was JR was on a path leading to a bad end,” Sprout says. “It appeared first recognized in Beagles that he was not enjoying life.” exhibiting signs of pain, Sprout and his wife, Susan, attend- ed the National Specialty that year lameness and fever. at Purina Farms in Gray Summit, Missouri, without JR. Querying fellow Beagle owners about JR’s mysterious condition, Sprout wasn’t getting anywhere — until he talked to Darlene Stewart, chair of the NBC Health and Genetics Committee. That conversation may have saved JR’s life. “JR,” a 15-inch tricolor male Beagle, “Darlene homed in on a likely pictured with owner Susan Sprout, was cause of the problem, and the successfully treated for SRMA. more we talked, it seemed more Months before the National, JR and more plausible,” Sprout says. started to limp in his right rear leg “As she described ‘Beagle pain and seemed “out of sorts,” recalls syndrome,’ an inflammatory neu- owner Brett Sprout of Alliance, Ohio. rological disorder in dogs now Soon he recovered and resumed known as steroid-responsive men- his winning ways only to become ingitis-arteritis (SRMA), it seemed suddenly lame again, this time that this could be the diagnosis. favoring his right front leg. As it turns out, Beagles are among “The veterinarian thought that the breeds predisposed to devel- JR had an orthopedic problem oping this condition.” aecting his legs,” Sprout says. When the Sprouts returned home, “He took X-rays of JR’s legs and they shared the information with had a specialist examine him. They JR’s veterinarian. After confirming posted JR’s radiographs on VetRad, that SRMA was a likely cause of
COVER PHOTO BY GAY GLAZBROOK a teleradiology internet site for JR’s pain, the veterinarian began
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treatment with a corticosteroid, prednisone. Within a day, JR was CLINICAL SIGNS OF better. STEROID-RESPONSIVE “We were concerned that JR’s MENINGITIS-ARTERITIS pain was becoming unbearable IN DOGS* and we might have to euthanize GLAZBROOK BY GAY PHOTO him, but after treatment he became • Neck pain a new dog,” Sprout says. • Lethargy Stewart (AlaDars) of Theodore, • Reluctance to rise or walk Alabama, was no stranger to SRMA. • Sti gait Nearly two decades earlier, her • Decreased appetite 14-month-old 15-inch tan-and-white • Kyphotic posture female Beagle, “Sandi” (CH AlaDars • Tremors Sandwitch), started moving hesi- • Diarrhea tantly as if in pain in her shoulders • Vomiting or neck. The veterinarian began • Inappropriate urination treating her with steroids for a *Source: Lau J, Nettifee JA, Early PJ, et al. perceived disc disorder. Sandi Clinical Characteristics, Breed Dierenc- responded well, so the cycle of treat- es, and Quality of Life in North American ing her with steroids for intermittent Dogs with Acute Steroid-Responsive Meningitis-Arteritis. Journal of Veterinary pain continued for many years. Internal Medicine. 2019;33(4):1719-1727. At age 8, Sandi suered a severe bout of pain and was so unrespon- sive to treatment that euthanasia seemed the only choice. Desperate Stewart says. “Sandi lived to be 16 for answers, Stewart scoured the and ultimately died of cancer.” veterinary literature and found an Through the years, Stewart has obscure article describing signs heard many stories of Beagles that fit Sandi perfectly. Her vet- experiencing clinical signs and erinarian followed the suggested pain similar to Sandi. The typical treatment, and Sandi improved scenario is a young hound that within a day. suddenly develops acute neck “She never had another severe pain and lethargy that may prog- episode, but at the first sign of her ress to whole body pain and often ‘headache look’ I would start her includes lameness and fever. on prednisone for about a week,” Veterinarians initially presume a dog has suered an injury or may diagnose disc disease or bacterial infection. Chronic cases may de- velop other neurological deficits, such as incoordination or weakness of the limbs. The disorder originally was known as Beagle pain syndrome because it was first recognized in Beagles exhibiting signs of pain, lameness and fever. An article published in 1989 in Toxicological Pathology on these dogs reported “Sandi,” a 15-inch tan-and-white female that veterinarians at Cornell Uni- Beagle, enlightened owner Darlene Stewart versity suspected this was an unusual about SRMA when she was diagnosed at age 8 after years of suffering from the neuro- syndrome in Beagles and that cases logical condition. as far back as 1973 seemed to match 3 FALL 2019
Beagle pain syndrome. In the 1990s, Health Foundation. “We are interested several large-scale studies reported in further supporting investigations on the syndrome occurring in various into this disorder of young dogs and breeds. Once such study was pub- raising awareness among breeders lished in 1994 in the Journal of Small and the veterinary community.” Animal Practice. “Our retrospective study included The good news is that the pain 61 dogs,” Dr. Lau says. “We sent an and other clinical signs of the disease online survey to the owners of 29 resolve with treatment. Antibiotics dogs identified through an AKC and rest are not eective in treating Canine Health Foundation survey dogs with SRMA. Rather, it is the and 32 dogs treated at the North anti-inflammatory benefits of cor- Carolina State Veterinary Hospital. ticosteroids that help to resolve Among the questions, we asked the clinical signs of SRMA. Not a owners to rate their dog’s quality lot is understood about the cause of life during treatment, during of SRMA, but it is believed to be clinical resolution and since being an immune-mediated condition. diagnosed with SRMA.” The first study of SRMA in dogs in “Clinical signs of SMRA are A NEUROLOGICAL DISEASE the U.S., the research was published resolved in most dogs with “Steroid-responsive meningitis- online in the June 7, 2019, issue of arteritis is a common inflammatory the Journal of Veterinary Internal treatment, but relapses disease of the nervous system of Medicine. The study provided insightful dogs involving the meninges, or information that included identifying may occur as treatment is membranes that cover the brain two breeds not previously recognized tapered or discontinued. and spinal cord, and associated as being susceptible to SRMA — arteries,” says Karen Muñana, Golden Retrievers and Wirehaired Little is known about what DVM, MS, DACVIM (Neurology), Pointing Grions. A review of the professor of neurology at North medical records of aected dogs triggers it.” Carolina State University. “Clinical looked at their age, breed, sex, signs are resolved in most dogs neuter status, body weight, length Karen Muñana, DVM, MS, DACVIM (Neu- with treatment, but relapses may of time between clinical signs and rology), North Carolina State University occur as treatment is tapered treatment, duration of treatment or discontinued. Little is known with corticosteroids, and results of about what triggers SRMA.” additional diagnostic tests. A recently completed study at All dogs in the study experienced North Carolina State University lethargy and neck pain. Many also evaluated clinical and treatment had decreased appetite and were dierences among breeds of dog reluctant to rise or walk and had with acute SRMA and surveyed a sti gait. Some dogs had a crouched owners to learn about the quality of posture or tremors. About three- life of aected dogs. The research, quarters of the dogs had fever, and led by neurology resident Jeanie 38 percent of dogs had a temperature Lau, BVSc, working with mentor greater than 104 degrees Fahrenheit. Dr. Muñana, was funded through The study charted four outcomes: the AKC (American Kennel Club) 1) clinical resolution, 2) relapse, Canine Health Foundation Clinician- 3) clinical remission, or 4) death Scientist Fellowship program. for reasons unrelated to SRMA. “The AKC Canine Health Foun- A relapse was defined as recurrent dation was excited to support this clinical signs that resolve completely important research, and we are after treatment with an increased thankful to the breeders who par- dosage of corticosteroids and the ticipated in the study,” says Dr. Diane addition of a second immuno- Brown, CEO of the AKC Canine modulatory drug or both. Clin- 4 BEAGLE Update
ical remission was the absence of clinical signs after beginning GLAZBROOK BY GAY PHOTO corticosteroid treatment, and clinical resolution was the absence of clinical signs after completing corticosteroid treatment. “We asked owners to rate their dogs’ quality of life on a scale of one to 10, with one being poor and 10 being excellent,” Dr. Lau says. “The mean quality of life for dogs during treatment was signifi- cantly worse than during clinical resolution and since being diag- nosed with SRMA. This was asso- ciated with the severity of pred- nisone’s adverse eects. When we asked owners to assess the severity of their dogs’ neck pain at onset, around 77 percent noted improvement of clinical signs within one to two days of starting prednisone.” Among the negative eects owners noted about continued use of prednisone were: poly- dipsia (excessive thirst), polyuria (excessive urination), polypha- gia (excessive hunger), panting, weight gain, thinning of hair coat, restlessness, sleeping more than usual, inappropriate urination, “pot belly” appearance, development of non-dermatological infections, diarrhea, dermatitis, and vomiting. “Any breed can develop SRMA, though a predisposition was previously recognized in several Other breeds with a high prevalence breeds,” Dr. Muñana says. were: Bernese Mountain Dogs with Breeds previously considered 10 dogs aected, Boxers with nine predisposed include: Beagle, Ber- dogs aected, and Beagles with nese Mountain Dog, Border Collie, six dogs aected. Boxer, English Springer Spaniel, “Our findings suggest that Golden Jack Russell Terrier, Nova Scotia Retrievers and Wirehaired Pointing Duck Tolling Retriever, Weimara- Grions should be included among ner, and Whippet. The two newly breeds recognized to develop SRMA,” recognized breeds prone to SRMA says Dr. Muñana. “Golden Retrievers were highly represented in the were included in a previous study study. Golden Retrievers had the of SRMA, but Wirehaired Pointing highest incidence with 12 dogs Grions had not been previously aected, and Wirehaired Point- described with SRMA. ing Grions had the third-highest “Further, we saw that the Wire- incidence with nine dogs aected. haired Pointing Grion had a 5 FALL 2019
prised 34 males, 18 intact and 16 neutered, and 27 females, six intact and 21 spayed. “Diagnosis is based on increased PHOTO BY GAY GLAZBROOK BY GAY PHOTO numbers of neutrophils, a type of white blood cell, in the cerebrospinal fluid (CSF) of aected dogs and exclusion of other infectious dis- eases combined with a positive response to corticosteroids,” Dr. Muñana says. “Some neurologists use magnetic resonance imaging (MRI) to rule out clinically similar conditions, such as intervertebral disc disease, though an MRI is a costly procedure and is not required to diagnose SRMA, particularly in a young dog with signs typical of SRMA.” A newer noninvasive, more aord- able test involves measuring the level of C-reactive protein (CRP), a substance produced by the liver in response to inflammation in the blood serum indicating systemic infection. In aected dogs, the CRP level is elevated parallel to that of neutrophils in CSF. “CSF analysis is useful for an initial diagnosis followed by CRP analysis to monitor a dog’s response to therapy,” Dr. Muñana says. “Since therapy is associated with side eects, significantly higher number of some of which can be quite serious, SRMA typically affects dogs prednisone-related adverse eects I do not recommend treatment unless compared to other breeds. This is it is supported by a diagnosis.” from 6 to 18 months of age. likely because they were treated The most eective treatment for with substantially higher prednisone dogs with SRMA is immunosup- The long-term prognosis dosages when compared to Beagles, pressive dosages of corticosteroids for young dogs with acute Bernese Mountain Dogs and Golden given over several months. “Most Retrievers. It also could be due to dogs improve dramatically within SRMA is fair to good. the dierence in their lifestyle as a one to three days, then continue on hunting breed or could reflect an daily high doses of prednisolone or increased genetic susceptibility to prednisone for four to eight weeks, corticosteroid-related adverse eects.” though some dogs may continue treatment for six months to a year,” DIAGNOSING SRMA says Dr. Muñana. “During this time, SRMA typically aects dogs dogs should have regular blood from 6 to 18 months of age. The work to ensure they are tolerating median age at which dogs in the the steroid therapy and to monitor North Carolina State study were CRP levels.” diagnosed was 8.5 months, with The long-term prognosis for young 95 percent of dogs being under dogs with acute SRMA is fair to good. 2 years of age. The study com- Most dogs — at least 80 percent — 6 BEAGLE Update
respond well to the initial course resolution, with remission and of steroids. About 10 to 15 percent resolution rates of 98.4 percent relapse during treatment, and about and 54 percent, respectively. “Most 20 to 30 percent relapse in the month dogs experience improvement within following discontinuation of treat- 48 hours of beginning treatment,” ment. A few dogs will relapse over says Dr. Muñana. a year after treatment ends. Some Reflecting, Dr. Lau says, “As a dogs require lifelong therapy. retrospective study, this had several Whereas acute cases respond well, limitations including that the accu- chronic SRMA is more challenging racy of the completeness of the to treat, says Dr. Muñana. “Chronic data collected was dependent on SRMA develops in dogs that are not the information available in the diagnosed and treated in a timely dogs’ medical records. We also manner or that have recurring were limited in the numbers of relapses. Chronic cases have fewer particular breed cases, and this LOOKING TO REPRINT? CSF abnormalities than dogs with restricted the power of the study.” Beagle Update articles may be acute SRMA, but the abnormalities Many questions remain. “I think reprinted provided the article is are consistent with chronic infection. the most pressing questions involve used in its entirety and in a positive Their treatment is the same — high- determining optimum treatment manner. To request permission to dose immunosuppressive cortico- and the cause of SRMA, including reprint this article, please contact steroids, and a second immuno- whether there is a genetic basis,” the editor at: Barbara.Fawver@ suppressive drug is usually needed.” Dr. Muñana says. “Our team feels purina.nestle.com. Reprints should “Our research included identi- further investigation is warranted include the following attribution: fying factors associated with the to learn the influence of individual Used with permission from the frequency of relapses and owners’ breeds on disease severity and its Beagle Update, Nestlé Purina assessments of the severity of clinical course and how it impacts PetCare. relapses in the 29 dogs that a dog’s quality of life.” relapsed,” Dr. Lau says. “Among Meanwhile, Sprout’s hound JR has the variables we studied were rebounded and resumed a busy the age at onset of clinical signs, performance career. At the 2017 prednisone dosage and treatment NBC National Specialty, JR earned duration, treatment with a second High in Trial in obedience with a immunomodulatory drug at initial score of 194, and he made the final diagnosis, and duration between cut for Best of Breed. At the 2018 and onset of clinical signs and initiation 2019 Rally National Championships, of treatment.” JR was the highest-scoring Beagle. Treatment results on prednisone “We recently started JR in agility, were excellent, with 29 dogs having and he has already earned two Q’s complete resolution of clinical signs out of two attempts,” Sprout says for a median of 37 months. In 25 dogs, proudly. “Plus, he is a bronze Grand remission was achieved, thus they Champion. Everything he has began a tapering schedule to achieved has been possible thanks reduce prednisone at follow-up. to a conversation with Darlene One dog was euthanized due to Stewart at the 2015 National.” n developing neurological problems during relapse. Purina appreciates the support LONG-TERM PROGNOSIS of the National Beagle Club, As with the success JR and Sandi particularly Darlene Stewart, chair of the Health and Genetics experienced, treatment results show Committee, for helping us to that dogs with SRMA have an identify topics for the Beagle excellent prognosis for remission Update. and a fair to good prognosis for 7