multiple joint osteoarthritis_navc2005

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Proceeding of the NAVC

North American Veterinary ConferenceJan. 8-12, 2005, Orlando, Florida

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Small Animal - Orthopedics

721

MULTIPLE JOINT OSTEOARTHRITIS

WHICH JOINT IS THE CAUSE OF LAMENESS?

L. Brunnberg DVM, E. Bauer DVM, F. Forterre ECVS DVMSmall Animal Clinic Free University of Berlin, Germany

H.Waibl DVMAnatomical Institute TiHo Hanover Germany

INTRODUCTION

In Germany 20% of all dogs suffer from a painful disease ofthe locomotor apparatus, 13% suffer from Osteoartritis(Gesellschaft fr praktische Epidemiologie mbH, Berlin, 1977).

There is the primary osteoarthritis (OA), with no underlyingdisease and the secondary form following joint diseases suchas hip dysplasia, luxation of the patella, osteochondrosisdissecans or after fractures and rupture of ligaments (Alexander1980, Flores et al.1988, Spreng 1997).

Examination of the lame dog included orthopedic andradiographic examination, but radiographs are not very useful inthe early stages of the disease process.

Synovial fluid changes during OA (Johnston, 1997), so itmight play a more important role in the future.

In this study we analysed the synovial fluid and measured itscontent of myeloperoxidase (MPO). MPO is a highly reactiveenzyme of the phagozytic cells that reaches synovial fluidthrough degranulation of neutrophils and active secretion(Edwards et al., 1988; Weiss, 1989; Nurcombe et al., 1991).MPO catalyses the reaction of hydrogen peroxide and chlorideions to hypochloric acid. This product is even more aggressivethan hydrogen peroxide and attacks synovial fluid and cartilage(Baker et al., 1998; Green, 1990; Grootveld et al., 1991; Schilleret al., 1996).

MPO seems to measure for changes in dyostotic joints. Thisenzyme is used in human medicine to diagnose rheumatoidarthritis (Schiller et al., 1996).

MATERIAL AND METHODSIn this randomised study, 104 dogs that underwent surgery at

the clinic for small animals at the Free University Berlin becauseof a lameness of orthopedic origin were chosen. Dogs that hadreceived any antiinflammatory drugs and those who had lessthan 0.8 ml synovial fluid in the joint, were excluded.

Eight dogs free from clinically or radiographical from anymusculo-skeletal disease and were euthanised for any otherreason, were included. These dogs were of different breed, sex,age and size. The synovial fluid was collected under sterileconditions.

COLLECTION AND EXAMINATION OF SYNOVIAL FLUID

After radiographic examination, the joint was punctured

general anaesthesia before the capsule was incised. Thesynovial fluid was then aspirated.

We examined viscosity, total protein, specific weight,complete cell count and MPO content.

Viscosity was measured by dripping synovial fluid from the tipof a needle. The cell count was performed after the methoddescribed by Sawyer (1963).

The specific weight and the total protein was measured with arefractometer (Fa. Krss, Mod. HRM 18).

The content of MPO was measured in the cell freesupernatant fluid of synovial fluid. The content was measuredwith an o-dianisidine assay at the Laboratory of the institute ofphysiological chemistry of the Phillips University Marburg. The

examination was performed twice and the average wascalculated.

Stifle radiographs and hip were interpreted by the methodsBrunnberg described 1987, those of the elbows in the methodsof Brunnberg and Viehmann (1999) and those of the shouldeaccording to Morgan et al. (1987), Carrig (1997) and Martinez(1997). They were divided into different categories ranging from0 (normal) to 3 (highly changed).

During surgery the joints were examined and divided into

three different categories according to the changes on cartilagebone and capsule.The statics were performed with SPSS for Windows, release

6.1. The patient groups were compared with the "Man-WhitneyU-Tests".

RESULTS

Differences could be seen on the body weight of the dogsDogs with rupture of the cranial cruciate ligament had a meanbody weight of 36.6 kg, those with fragmented processuscoronoideus had a weight of 34.5kg, those with hip dysplasiaweighted 33.2 kg, the mixed patient group had a mean weighof 32.7 kg and the controll group had a mean weight of 33.5 kgThis shows that heavier dogs tend to have orthopedic disease

that need surgery.The age was as expected. The dogs with fragmented proccoronoideus had a mean age of 13 months, the dogs with OCDwere 9.2 month in mean, those with rupture of the craniacruciate ligament were 57.3 month, those with hip dysplasiawere 22.8, the dogs of the mixed patient group were 40.4 monthand the dogs of the control group were 55.6 month old.

The was no statistical significant difference in the of thedistribution of sexes.

RESULTS OF THE ANALYSIS OF THE SYNOVIAL FLUID

Patients of the mixed patient group were not included in thestatistic because of the small number of cases.

The complete cell count was higher in all patients with the

different diseases than in the control patients.The viscosity was normal in 5 of 11 joints with OCD, in 5 of 24joints with fragmented Proc. Coronoideus and in one with arupture of the cranial cruciate ligament. In the other joints theviscosity was more or less reduced.

The Protein was significantly high in all affected joints excepof the joints with OCD.

There was significant difference in the specific weight of alaffected joints to the controll joints.

The content of the MPO was significantly higher in everyaffected joint than in a healthy joint. It was at least twice theresult of the healthy joint.

RESULTS OF THE RADIOGRAPHIC AND INTRA SURGICAL

FINDINGS:

Dogs with ruptured cranial cruciate ligament and seven of 24joints with fragmented proc. coronoideus had no radiographicchanges. The other patients had slight changes.

Ten dogs with ruptured cranial cruciate ligament had no signsof osteoarthritis during surgery. All of the others showed at leaschanges of one of the joint structures.

Coincidential-check of single findings in the synovial fluidradiographs and during surgery

We found correlations between the MPO activityradiographs, the findings in the synovial fluid and the surgicafindings by applying different statistical methods.

The reliance test with regression analysis showed nocorrelation between MPO activity and complete cell count.

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The North American Veterinary Conference 2005 Proceedings

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The patients with normal viscosity of the synovial fluidshowed a significant lower MPO activity.

The coincidental check of specific weight, protein content toMPO activity showed no correlation in the regression analysis.

The comparison of radiographic and surgical findings did notshow correlation to the MPO activity in the Kruskal-Wallis-Test.As a result you cant predict a high MPO activity in joints withsurgical or surgical findings.

The aim of this study was to analyze the synovial fluids of

dogs suffering from painful osteoarthritis. These results werecompared to radiographic and surgical findings. We paid specialattention to the activity of MPO in order to use as it a potentialmarker for OA.

104 dogs that were not treated with antiphlogistic drugs wereincluded in this study. This dogs underwent orthopaedic surgerybecause of one of these reasons: rupture of the cranial cruciateligament (RCCL) n=56; fragmented processus coronoideus(FPC) n=16; Coxarthrosis following hip dysplasia n=11;Osteochondrosis dissecans (OCD) n=11 and single differentdiseases n=10.

The controll group consisted of dogs that were euthanised forany other reasons and did not show signs of dejenerative jointdisesase. Synovial fluid was obtained under sterile conditions.

The complete cell count in healthy synovial fluid is quoteddifferently in literature. It ranges from

multiple joint osteoarthritis_navc2005

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