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Canine Polyarthritis
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Introduction
The diagnosis of immune-mediated polyarthritis can be challenging but is borne of a clinical suspicion of the disease, exclusion of other causes of polyarthritis, and response to therapy.
Inflammatory arthropathies
Polyarthritis is either infectious or immune-mediated in origin. Clinical signs, radiographic and laboratory abnormalities overlap among the diseases in each etiology. Identification of infectious agents can be difficult and is beyond the scope of this presentation. Exclusion of infectious polyarthritis to the best degree possible is advocated before treating for immune-mediated polyarthritis.
History and Clinical signs
Lameness is the most common clinical complaint, but the history and pattern of clinical signs in patients with polyarthritis may be surprisingly variable. Other common complaints include a reluctance to move, lethargy, and inappetance. Animals may have a stiff or stilted gait; some are reluctant to move their head and neck. Some exhibit an arched or hunched posture.
Physical examination abnormalities can include swelling and pain of involved joints, and pain on palpation or manipulation of the spinal column. Some have no detectable joint pain or joint effusion. Animals that are painful in the thoracolumbar spine may appear painful in the abdomen during abdominal palpation. Fever is extremely common and in the author’s practice, polyarthritis is a common cause of fever of unknown origin or antibiotic-unresponsive fever, particularly in younger animals. Patients should have careful examination of mucous membranes, retinas, and skin for petechial hemorrhages that could signal an underlying multisystemic disease. Auscultation of a new heart murmur may raise suspicion of polyarthritis secondary to endocarditis. Deep palpation of the large muscle groups should be performed to assess myopathies that may present with complaints that overlap with polyarthritis. In juvenile dogs, palpation of the diaphysis and metaphysis of the long bones to rule out panosteitis and hypertrophic osteodystrophy which may mimic the signs of arthropathy. A neurological examination is advised for patients with clinical signs of spinal column pain and fever as meningeal disease may have a clinical presentation that may be hard to distinguish from that of polyarthritis.
Differential diagnoses
Infectious polyarthritis represents the biggest group of differentials for immune-mediated polyarthritis (Table 1). Many immune-mediated diseases can have joint involvement (Table 2). [...]
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