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Ch07 Final.Qxd 7/2/07 13:55 Page 87 Ch07 final.qxd 7/2/07 13:55 Page 87 87 CHAPTER 7 ARTHROLOGY Feline arthrology has been an overlooked subject in term osteoarthritis is reserved for the specific type of the past with most reviews of joint disease in small DJD that affects diarthrodial synovial articulations. animals focusing on the dog. However, cats are now Diseases of synovial joints can conveniently be known to suffer from many different types of joint divided into degenerative arthritis and inflammatory disease and, although there are many similarities with arthritis on the basis of the predominant pathologic the dog, there are also many features that are unique process (Table 20). Degenerative arthropathies are the to the feline patient. most common types and include traumatic arthritis and osteoarthritis. Inflammatory arthropathies are less CLASSIFICATION OF JOINT DISEASE common than degenerative arthropathies and have The terms arthritis and arthropathy literally mean joint either an infective or immune-mediated etiology. inflammation and joint disease, respectively. These terms Infective arthritis caused by bacterial infection (septic are used interchangeably in this chapter to describe arthritis) is the commonest type of inflammatory arthritis a number of well defined joint diseases characterized in the cat. Septic arthritis is classed as an erosive type of by a combination of inflammatory and degenerative arthritis because there is destruction of articular cartilage changes. The terms degenerative joint disease (DJD) in joints infected by bacteria. Immune-mediated and osteoarthritis are also often used synonymously. In arthropathies can be subdivided into both erosive this chapter, DJD is used as a general descriptive term to and nonerosive forms. Differentiation between the encompass degenerative changes in any joint in the infective and immune-mediated forms of inflammatory axial or appendicular skeleton, including synovial, arthritis is essential since the therapeutic approaches cartilaginous, and fibrous types. When DJD affects the to these conditions are diametrically opposed. fibrocartilaginous intervertebral joints of the spine, it is Inappropriate treatment of an infective arthritis with known as spondylosis deformans (see Chapter 11). The immunosuppressive drugs will have disastrous results. TABLE 20 CLASSIFICATION OF JOINT DISEASE. Degenerative Inflammatory Miscellaneous arthritides arthritides joint disorders Infective Immune-mediated Synovial sarcoma Osteoarthritis arthritides arthritides Secondary neoplasia Traumatic Primary Bacterial (septic) Systemic lupus erythematosus Hypervitmainosis A arthritis Secondary Bacterial L-form Polyarthritis/meningitis Osteochondroma Mycoplasmal Idiopathic Synovial osteochondromatosis Calicivirus Periosteal proliferative Synovial cysts Lyme disease Rheumatoid Patellar malformation Tubercular Meniscal calcification Fungal Osteochondritis dissecans Osteochondrodysplasia in the Scottish Fold cat Ch07 final.qxd 7/2/07 13:55 Page 88 Arthrology 88 89 INVESTIGATION OF JOINT DISEASE then to stop interpreting the radiograph before the occurs with erosive immune-mediated or infective example joint sprain, whereas thickening is a SYNOVIOCENTESIS whole film has been assessed. All three components of arthritides, osteomyelitis, and joint neoplasia. chronic change most often associated with joint For details of synoviocentesis and analysis of synovial the joint should be evaluated radiographically: the Localized areas of sclerosis and remodeling of the instability, such as chronic cranial cruciate fluid see Chapter 2. bones, the soft tissues, and the joint space. The specific subchondral plate may be seen at the margins of ligament (CrCL) rupture. It is not possible to features that should be examined are the bony anatomic destructive lesions, such as osteomyelitis. differentiate between thickening and swelling RADIOGRAPHY relationships, subchondral bone plates and subchondral However, sclerosis is more commonly seen as a radiographically. Mineralization of periarticular Radiography is the most frequently used ancillary bone of the epiphyses, the width and contents of the generalized change in chronic osteoarthritic joints tissue is a rare occurrence. It is occasionally seen diagnostic aid in the investigation of joint disease. joint space, the articular margins and periarticular where there is loss of articular cartilage and as a sequela to chronic inflammation, for example Radiographs should be interpreted in the light of the regions, and the periarticular soft tissues. The eburnation of the opposing joint surfaces. bacterial infective arthritis, and is also a feature of clinical findings and not used as a substitute for a radiographic appearance of some disorders that are • The subchondral bone of the epiphysis synovial osteochondromatosis. correctly performed clinical examination. Radiography familiar to the canine clinician may differ in the cat. For subadjacent to the subchondral plate should have is usually used to confirm a suspected clinical diagnosis example, the predominant radiographic signs of feline a homogenous appearance. In comparison with Contrast arthrography or to differentiate between two or more joint diseases hip dysplasia are a shallow acetabulum with remodeling the dog, the cancellous bone of cats has a coarse Contrast arthrography is rarely performed in the cat. that have similar clinical characteristics. However, of the craniodorsal margin but with minimal trabecular pattern. Osteomyelitis, neoplasia, and Positive contrast arthrography involves the injection of radiographic surveys of multiple joints might be remodeling of the femoral neck (55)1. articular fracture will cause an alteration in the a contrast agent into a joint space so that it mixes with indicated to evaluate the overall status of the patient in • The anatomic relationships of the bones making internal architecture of the trabecular bone. the synovial fluid and delineates the internal margins of conditions that are frequently polyarticular, such up the joint may be altered with joint luxation, Subchondral cysts are occasionally seen in the joint. The contrast agent of choice is iohexol as osteoarthritis or immune-mediated arthritis. subluxation, and intraarticular fracture. Reference osteoarthritic joints in cats as discrete radiolucent (Omnipaque 300; Nycomed), which is diluted 50:50 Radiographs of other body regions may be indicated; to a radiographic atlas, a file of normal cat defects in the subchondral bone. with sterile water to give a concentration of 150 mg of for example, in cats with joint trauma or neoplasia or radiographs, or a radiograph of the contralateral • Joint space width may be increased with joint iodine per ml. The technique is most useful for some of the immune-mediated arthritides to check for joint may be helpful, especially for the smaller subluxation or luxation. Narrowing of the joint investigation of shoulder joint pathology. The volume evidence of lesions elsewhere. more complex joints of the distal extremities. space is indicative of loss of articular cartilage but of contrast agent required for suspected articular Feline joints are small so it is essential to obtain high • The subchondral bone plate should appear as a cannot be appreciated on normal nonweight- cartilage lesions (0.5–1.0ml) is less than that required quality radiographs if they are to be of diagnostic value. thin radiopaque line parallel to and adjacent to bearing radiographs. to detect capsular defects or to outline the biceps Radiographs of joints should be correctly collimated to the joint space. Erosion of the subchondral plate • Joint space structures are contained between the tendon of origin (2.0–3.0ml). minimize scatter and obtained using fine detail screens subchondral bone plates of the opposing bones in two orthogonal planes (i.e. at right angles to that comprise the joint. This space, therefore, SONOGRAPHY each other). Human mammography film/screen includes the articular cartilage, synovial fluid, and Ultrasonography has potential value for the combinations are especially useful for radiographs of the 55 intracapsular fat (and intraarticular ligaments, investigation of joint disease but there are few reports distal extremities. Additional stress views may be menisci, and synovial effusion when present). of its use in cats3–5. The evaluation of bone is limited performed in the evaluation of joint instability. Oblique Intraarticular structures are only visible when they because of the inability of ultrasound to penetrate projections and special views to outline certain become mineralized2 or when increased joint mass osseous tissues. However, sonography may be useful structures are performed less frequently in the cat than results in distension of periarticular soft tissues or in the identification of joint effusion, joint in the dog. It is often useful to radiograph the alteration of other intraarticular structures. An thickening, articular or bone destruction, and joint contralateral joint to provide a normal radiograph for example of the latter would be a reduction in size instability using a dynamic examination. Periarticular comparison or because some conditions occur of the infrapatellar fat pad in the stifle, associated soft tissue structures that may be examined with bilaterally. General anesthesia or heavy sedation is usually with a synovial effusion. Differentiation between ultrasound include muscles, tendons, abscesses, cysts, required for optimal positioning. increased joint mass associated with the
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