Immune-Mediated Arthritis

Rhea V. Morgan, DVM, DACVIM (Small Animal), DACVO

Mark C. Rochat, DVM, MS, DACVS

BASIC INFORMATION
Description
Immune-mediated arthritis develops when the immune system
attacks joint tissues, causing inflammation. This type of arthritis
commonly involves multiple joints (polyarthritis) and comes in
two forms. In the milder form, x-ray evidence of bony destruction is not present early in the disease. Common examples include
idiopathic polyarthritis, drug-induced polyarthritis, systemic
lupus erythematosus (SLE or lupus), and polyarthritis of chronic
disease.
In the more severe form (erosive arthritis), destruction of joint
surfaces and bone occurs throughout the disease. Examples include
rheumatoid arthritis (RA), erosive polyarthritis of greyhounds, and
chronic polyarthritis of cats. With the exception of the last disease,
all forms of immune-mediated arthritis occur more commonly in
dogs.

Causes
In many of these diseases, the precipitating cause of the condition
is unknown (idiopathic). In RA, the bodys own immunoglobulins are involved and are deposited on the lining of the joints. In
some cases, the immune system is activated by bacterial or viral
infections, such as in Lyme disease, staphylococcal infections,
and L-form bacterial infections. Sulfonamides may cause druginduced polyarthritis. Polyarthritis of chronic disease may arise
with discospondylitis, bacterial endocarditis, certain intestinal
problems, various cancers, and other conditions.

Clinical Signs
Lameness, stiffness, loss of appetite, fever, pain, and joint swelling
in one or more joints are common signs. Signs can be intermittent or
constant and can shift from leg to leg. The joints most often involved
are the carpus (wrist), hock (ankle), and feet. Other clinical signs may
be present in animals with SLE or polyarthritis of chronic disease. SLE
commonly affects other organs, including the kidneys and skin.
Adult, small-breed dogs develop RA most often. Erosive
polyarthritis of greyhounds usually occurs in young dogs (younger
than 3 years). Feline polyarthritis may affect cats 1-5 years of age.

Diagnostic Tests
Diagnosis of polyarthritis can often be achieved by a thorough
physical examination, but x-rays and joint fluid analysis are
needed to determine what type of polyarthritis is present. Erosive
arthritis produces the most visible joint damage on x-rays, especially early in the disease. Laboratory tests may be performed for
SLE, RA, and other potential underlying causes. Other organ tests
may be indicated in cases of chronic illness or SLE.

TREATMENT AND FOLLOW-UP

Treatment Options
Glucocorticoids (steroids), such as prednisone, are commonly
given in high doses initially and then tapered once the signs
improve. In mild cases, nonsteroidal anti-inflammatory drugs
(NSAIDs) may be sufficient for long-term control of the signs,
once the steroids have been discontinued. Steroids and NSAIDs
are not used together, because they can cause severe gastrointestinal irritation and even ulceration.
Examples of NSAIDs that are used in dogs include carprofen
(Rimadyl), deracoxib (Deramaxx), firocoxib (Previcox), meloxicam
(Metacam), tepoxalin (Zubrin), and etodolac (Etogesic). Meloxicam
is most commonly used in cats. It is important to note that NSAIDs
designed for people are often toxic to animals and should not be used.
In some dogs, these conditions do not respond well to prednisone alone, so more potent immune-suppressive drugs (such as
azathioprine, cyclophosphamide, or methotrexate) must be added
to the therapy. Response to therapy is evaluated by repeated joint
fluid analysis. Injectable aurothioglucose (gold salt therapy) has
been used with success in dogs with RA. Surgical fusion of the
joint (see the handout on Arthrodesis) may be considered in cases
of severe destruction and collapse of the joint.
Other treatments may be indicated based on concurrent illnesses or infections. Drugs that may be implicated in triggering
the polyarthritis (such as sulfonamides) are withdrawn.

Follow-up Care
Immune-mediated arthritis is commonly a chronic disease that
requires long-term treatment and follow-up. Signs associated with
severe erosive arthritis may take 3-6 months to resolve. Periodic
physical examinations and joint fluid analyses are often needed
to monitor progression of the disease and the response to therapy.
Periodic laboratory tests are required to identify bone marrow suppression, bladder inflammation (cystitis), hepatitis, and pancreatitis, which are occasionally associated with cyclophosphamide or
azathioprine therapy. Testing for feline leukemia virus may be done
yearly in cats on immune-suppressive therapy because they are
more likely to contract the disease while taking these medications.

Prognosis
Prognosis is good for cases of mild, nonerosive arthritis with no
evidence of joint destruction, especially if they respond well to an
initial course of steroids. Periodic flare-ups can occur, so therapy
is often continued long term. Prognosis is poor for cases of severe
erosive polyarthritis with joint destruction (especially in multiple
joints) and for greyhound polyarthritis.

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Copyright 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved.