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Inflammatory Joint Diseases and Inflammatory Joint Diseases and

Alfonso LpezAlfonso LpezAtlantic Veterinary CollegeAtlantic Veterinary College

January 13, 2010January 13, 2010


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Inflammatory Joint DiseasesInflammatory Joint Diseases

EtiologyEtiology: : Bacteria (very common)

,

Virus (rare) Parasites (rare) Trauma (common)

Port ofPort of entry of bacterial infections of joints:entry of bacterial infections of joints:1. Hematogenous

.3. Spread from adjacent soft tissue4. Diagnostic or therapeutic Procedures5. Penetrating injury

Pathology:Pathology:

From Huether SE, Mc Cance, KL. Understanding Pathophysiology ed 2,St. Lous, 2000 Mosby

Destructive (osteolytic) or productive (osteosclerotic)


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Inflammatory Joint Diseases Inflammatory Joint Diseases Arthritis and Arthritis and SynovitisSynovitis

Infectious etiologyInfectious etiology

Less common in dogs/cats

Hematogenous bacteria (+++) Omphalitis, sepsis, FPT Several joints (polyarthritis)

LesionsLesions Synovial effusion

xu ate suppurat ve, r nous, etc.

Most common bacteria causingMost common bacteria causing arthritisarthritis

. . .

S. suis II H. parasuis (Glassers H. somni

R. equi M. hyosynoviae M. bovis


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Fibrinous ArthritisFibrinous Arthritis

Acute, Fibrinous arthritis (mildAcute, Fibrinous arthritis (mild) in a ) in a

calf.calf.

Note abundant synovial fluid and few possible

fibrin strands suggestive of fibrinous arthritis.

with intra-articular fat. If in doubt, it is

recommended to aspirate some fluid into a

syringe and carefully check against a sourceof light for fibrin strands as shown in a petri

dish (see insert in top right ).


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Fibrinous ArthritisFibrinous Arthritis

Acute,Acute, Severe Fibrinous arthritisSevere Fibrinous arthritis

of sepsis.

Remember, fibrin is an exudate that

denotes severe changes in vascular

permeability that allows fibrinogen to

escape into the affected tissues. Once

outside of the vasculature, fibrinogen is

.

yellow color. It is expected that an aspirate

of a joint with fibrinous arthritis would have

abnormally high protein contents. Note a mat of fibrin (Note a mat of fibrin ( arrowsarrows ) on the) on the

synovial membranesynovial membrane


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Acute Fibrinous ArthritisAcute Fibrinous Arthritis

Large amounts of fibrin (arrows) on the synovial membrane.Large amounts of fibrin (arrows) on the synovial membrane.

At the early stages the articular cartilage is normalAt the early stages the articular cartilage is normal


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Chronic Fibrinous ArthritisChronic Fibrinous Arthritis

Joint of another young calf with history ofswollen and painful joints

synovial membrane.

Neonatal infections often involve more than one

commonly used in veterinary pathology. When joints, peritoneum, pericardium and meningesare affected the term Poliserositis is

.

Do not forget to check the status of umbilicalvessels in young animals since omphalophlebitis

.

Joint aspirate in the live animals could be sentfor bacteriology.


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Acute Purulent ArthritisAcute Purulent Arthritis

Chronic, severe, purulent(suppurative0 arthritis. Pig.

Bacteriologic analysis of exudate in this pigwas positive for Actinomyces pyogenes .

Other common bacteria in

Hemophilus suis

Erysipelothrix rhusiopathiae

Streptococcus suis II Escherichia coli

M co lasma h orrhinis joint. joint.Mycoplasma hyosynoviae .


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Chronic Fibrinous Arthritis and Chronic Fibrinous Arthritis and OsteomyelitisOsteomyelitis

Chronic, severe, suppurativearthritis-osteomyelitis (severe).

When cartilage becomes ulcerated in septicarthritis, offending organisms may reachsubchondral bone and bone marrow resultingin osteomyelitis.

On the other hand, organisms may alsoreach the joint structures from a primaryunderlying osteomyelitis. Some times it isdifficult to tell what structure was firstaffected such as in this slide.

Note abundant exudate, mark thickening of joint ( arrows ) and large bone abscesses inthe epiphyses of long bones ( asterisks ).


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BursitisBursitis

ursas are cus ons e w synov aursas are cus ons e w synov a - - uu s ra eg ca ys ra eg ca y oca e aroun some en onsoca e aroun some en onsvulnerable tovulnerable to frictionfriction--injury. Bursas are lined by a synovial membrane andinjury. Bursas are lined by a synovial membrane and undergoundergo inflammationinflammationin responsein response to injuryto injury or hematogenous infections as synovial joints.or hematogenous infections as synovial joints.

Etiology of BursitisEtiology of Bursitis Infectious (hematogenous) Traumatic Undetermined

Bursitis in HorsesBursitis in Horses Poll Evil (Atlanto-occipital bursa)

Bursitis in Ruminants

Caprine Arthritis Encephalitis (CAE) Brucellosis

Lesions:Lesions: Swollen bursa

Synovial effusion


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Equine Bursitis / Fistulous WithersEquine Bursitis / Fistulous Withers

Note a large fistula ( arrows ) and swelling of underlying soft tissue. The" " " " 1-2 1

still controversial, but it is a purulent bursitis caused by bacteria (Brucella

spp.) and/or parasites (Onchocerca cervicalis) .


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Carpal Bursitis / BovineCarpal Bursitis / Bovine

Note swelling in thecarpal region

(arrows ).

The term hygroma refers to a cystic structure filled with fluid often mixed with blood which issurrounded by a fibrous capsule. Hygromas are severe form of serous bursitis in which synovialfluid accumulates over time. H romas are enerall associated to infectious diseases such asbrucellosis (Brucella abortus ) and Caprine Arthritis-encephalitis (retrovirus). There are alsoacquired false bursa in giant breeds of dogs that develops over bony protuberances at pressurepoints such as the lateral elbow, the greater trochanter of the femur and the tuber coxae.


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LaminitisLaminitis

H o r ses a n d Ca t t l eH o r ses a n d Ca t t l e Acute Chronic

E t io lo g yE t io lo g y Nutritional Endotoxin Histamine

Traumatic

P a th o g e n e s i s Decrease vascular perfusion of lamina (P 3 )

Separation from hoof Hyperplasia of epidermal lamellae Penetration of sole

Osteomyelitis


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Equine LaminitisEquine Laminitis

Note rotation of P 3 (asteriskasterisk ) due to hyperplasia of lamina that is shown as a wedge shape white tissueinterposed between hoof wall and anterior aspect of P 3 (ArrowsArrows ). Compare to normal hoof where the hoof laminaand P are parallel. The pathogenesis of laminitis is still controversial, however, it is well accepted that the basicunderlying mechanism is an abnormal vascular perfusion and edema of lamina (acute laminitis). Hyperplasiadermal tissue and rotation of P 3 (chronic laminitis) are secondary to these vascular changes.

A close-up of this photograph is shown in the next slide.


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Equine LaminitisEquine Laminitis

P1P1

P2P2

P3P3


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Bovine LaminitisBovine Laminitis

Note hyperplasia of lamina shown as a wedgeNote hyperplasia of lamina shown as a wedge

shape white necrotic tissue interposed betweenshape white necrotic tissue interposed betweenhoof wall and anterior as ect of Phoof wall and anterior as ect of P arrowsarrows ..

As result of hyperplasia and separation of lamina, P 3 deviates. The weight bearing and pulling

force by flexor tendons, increase rotation of P 3 and penetration of sole. Finally, exposed bone iseasily infected and osteomyelitis may evolve in P 3.


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GoutGout

Articular Gout:Articular Gout: Animals and humans High intake of protein Chickens genetic impaired secretion of uric

acid Lesions:

Crystals and granulomas in synovium

Bone destruction

Visceral Gout:Visceral Gout: Primary kidney failurePrimary kidney failure

KidneyKidney HeartHeart Serosal surfaceSerosal surface


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Avian GoutAvian Gout

Gout.Gout. Toes. Avian.Toes. Avian.

o eo e swe ng o so ssue. n cu

surface large amounts of whitish, chalkymaterial (urates) are present in joints andperiarticular tissues

Gout occurs in species which lack uricaseenzyme such as humans, aves andreptiles.

1. Articular gout from genetic inability toexcrete urates, deposition of crystals isonly in synovial tissues.

2. Visceral gout from renal disease andinability of kidney to excrete urates. Thereis with deposition in joints and periarticulartissues (subcutaneous) and in serosalsurfaces kidney and other viscera.


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Visceral Gout SnakeVisceral Gout Snake

NoteNote large deposits of urate crystals in

the kidney ( arrowsarrows ).


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Immune Mediated ArthritisImmune Mediated Arthritis

Erosive Arthritis (rare)Erosive Arthritis (rare) -- ..

Dogs: Toy / Shetland breeds.Dogs: Toy / Shetland breeds. Clinical signs: Lameness, pain, morning stiffness.Clinical signs: Lameness, pain, morning stiffness. a ogenes s:a ogenes s:

IgGIgG/ /IgMIgM Complex (rheumatoid factor)Complex (rheumatoid factor)

C activation, neutrophils, lymphocytesC activation, neutrophils, lymphocytes,,

NonNon--Erosive ArthritisErosive Arthritis

Chronic infections:Chronic infections: Heartworm,Heartworm, metritismetritis, otitis, lupus,, otitis, lupus, glomerulonephritisglomerulonephritis


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Tumors of Bones and JointsTumors of Bones and Joints

domestic animals.domestic animals. ..

Tumors may arise from osseous, cartilaginous,Tumors may arise from osseous, cartilaginous,, ., .

Benign (Benign (- -omaoma) or Malignant () or Malignant (- -sarcoma).sarcoma).

Histopathology is always required.Histopathology is always required. Bone tumors are common biopsy specimens.Bone tumors are common biopsy specimens.


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OsteochondromasOsteochondromas

Multiple nodules in the skeleton

Cartilage capped ( arrowsarrows ) Stop growing at the same time as the

skeleton


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OsteochondromasOsteochondromas

Multiple Cartilaginous Multiple Cartilaginous ExostosisExostosis

Osteochondromas also known as

cartilage-capped bony protuberances whichstop growing when the rest of the skeletondoes.

It is still arguable if osteochondromas aremultiple polyostotic tumors or dysplasia

affecting the growth of cartilages. It is most.Grossly, appear as multiple bony nodulesnear the growth plates. These uniquetumors are most commonly seen in dogs,

.

Note large osseous masses in the vertebralprocesses (top) and ribs (bottom).


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OsteogenicOsteogenic Sarcoma (Osteosarcoma)Sarcoma (Osteosarcoma)

Most common skeletal neoplasm in dogs (large breeds),cats.

.

Can be Osteosclerotic or Osteolytic. Frequently metastasizes to the lungs.

eop as c ce s yp ca y pro uce os eo .


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OsteogenicOsteogenic Sarcoma (Osteosarcoma)Sarcoma (Osteosarcoma)

Osteosarcoma (Osteogenic Sarcoma) isthe most common skeletal neoplasm of dogsand cats 80% of all skeletal tumors .

Osteosarcoma is most commonly found inlarge breeds with a mean age of 7.5 yr.

Most osteosarcomas arise from long bonesand to a lesser extent from other bones orfrom extra-skeletal sites (see figure).

Osteosarcomas arise from osteoid producingcells but some neoplastic cells may alsoproduce cartilage (osteoblastic, fibroblastic,chondroblastic, or mixed t e .

Note well-delineated osteosarcoma in leg.

Osteosarcomas t icall do not row into the joint or articular cartilage.


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OsteogenicOsteogenic Sarcoma / Dog Sarcoma / Dog

The leg was amputated and microscopicexamination confirmed the diagnosis of

.

It is documented that osteosarcomas mayarise from sites of previous fractures or

from sites with metal pins used to reducerac ures.

tumoral mass.


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TypesTypes of Osteosarcoma /of Osteosarcoma / RadiographsRadiographs

OsteoscleroticOsteosclerotic typetype OsteolyticOsteolytic typetype


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OsteogenicOsteogenic Sarcoma Sarcoma

Lun

MetastasisLun

MetastasisOsteosarcomas frequently metastasize toother organs, particularly to the lung.

Note numerous metastatic tumorsNote numerous metastatic tumorsscattered throughout the pulmonaryscattered throughout the pulmonary

..

nce osteosarcomas o ten metastas ze to t elung, radiographic examination of lungs isalways recommended.

Metastasis / Lung HE section/ Low MagnificationMetastasis / Lung HE section/ Low Magnification

o eo e umora no u eumora no u e as er sas er s n e pu monaryn e pu monaryparenchymaparenchyma


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Osteosarcoma.Osteosarcoma. HemotoxylinHemotoxylin- -eosineosinOsteogenicOsteogenic Sarcoma / Dog Sarcoma / Dog

Note neoplasticNote neoplastic cells)cells) some of which aresome of which areproducingproducing osteoidosteoid ( (asteriskasterisk ). The). The osteoidosteoidhas a palehas a pale eosinophiliceosinophilic appearance and inappearance and in **some areas this matrix is forming somesome areas this matrix is forming someimmatureimmature trabeculartrabecular bone (bone ( bb )./ )./

Histopathological diagnosis ofosteosarcomas is not easy, particularlywhen small or fine needle biopsies aretaken. In some instances reactive bone

**

can be morphologically deceiving. Whentaking a biopsy of a suspected tumortake several samples and ensure tohave some material from the core andperiphery of the mass.


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ChondrosarcomaChondrosarcoma

Most commonly seen in dogs and sheep Single expansive lobulated mass ,

grossly visible Neoplastic cells produce cartilage but not

osteoid **

This shee had histor of ataxia. Note tumoral mass with cartilaginous appearanceinvolving the vertebrae ( asteriskasterisk ).

Also note the tumor and causin

compression of the spinal cord ( arrowsarrows ).


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ChondrosarcomaChondrosarcoma

Chondrosarcoma.Chondrosarcoma. HemotoxylinHemotoxylin- -eosineosin

Note neoplastic cells producing cartilaginousm a r x arrowsarrows .

Chondrosarcomas are malignant tumorsarising from chondrocytes. Neoplastic cells

roduce cartila inous matrix but unlikeOsteosarcoma, never produce osteoid.

Chondrosarcomas are most commonly seen

in dogs and sheep and the pelvis, nasalv y, umost common sites.

RareRare in animalsin animals


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Some images were acquired from veterinary colleges ofSome images were acquired from veterinary colleges ofCanada, United States and Mexico and the names ofCanada, United States and Mexico and the names ofpathologists who contributed with some slides arepathologists who contributed with some slides areknown. Their valuable contribution is sincerelyknown. Their valuable contribution is sincerelyacknowledged.acknowledged.

I would like to thank Adriana Lpez, University ofI would like to thank Adriana Lpez, University ofWestern Ontario, and Eileen Kinch for editorialWestern Ontario, and Eileen Kinch for editorial

. ,. ,College, for critically reviewing these modules.College, for critically reviewing these modules.


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Inflammatory Joint Diseases andInflammatory Joint Diseases andTumors of Bones and JointsTumors of Bones and Joints

Inflammatory Joint Diseases andInflammatory Joint Diseases andTumors of Bones and JointsTumors of Bones and Joints

If you have any comments, criticisms or suggestions about this or anyIf you have any comments, criticisms or suggestions about this or any..

Also, if ou find an errors or t os lease let me know too. Thanks !Also, if ou find an errors or t os lease let me know too. Thanks !

[email protected]@upei.ca

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