Arthritis

Basics

Overview
 Characterized by joint pain and discomfort associated with deterioration of the articular cartilage
of diarthoidial (synovial) joints.
 Common forms of arthritis are osteoarthritis, articular gout, and infectious arthritis.
 This is a typically progressive condition resulting in continued degradation of the joint and
increasing patient discomfort.

Signalment
Typically in middle-aged to geriatric birds of all species and both sexes but heavy breeds of chickens,
waterfowl, turkeys, and peafowl are commonly affected.

Signs
 Intermittent, persistent, and/or progressive lameness
 Falling
 Lethargy/reduced activity level; unwillingness to walk, step up, or fly
 Septic arthritis commonly associated with a history of a prior traumatic incident
 White nodules associated with any joint (owners are most likely to identify these in the feet and
digits)

Causes
 Non-infectious - Previous trauma or excessive wear to the joints results in damage to the
chondrocytes; also, low-grade wear and tear, instability, abnormal weight bearing
 Infectious – Typically either by direct inoculation or hematogenous spread but many infectious
agents reported, including Staphylococcus spp., Streptococcus spp., Pseudomonas spp.,
Salmonella spp., Actinobacillus spp., Mycoplasma spp., Escherichia coli, Pasteurella multocida,
Erysipelothrix rhusiopathiae, Mycobacterium avium, Chlamydia psittaci, Reovirus, and
microfilaria
 Gout – Hyperuricemia subsequent to primary renal disease of any etiology or prerenal or
postrenal causes
 Immune-mediated – Polyarthritis associated with granulomatous vasculitis reported in a
Mississippi sandhill crane
 Neoplasia – Unknown cause

Risk Factors
 Clinically obese birds and heavy-bodied breeds at high risk
 Previous trauma or fractures
 Wounds adjacent to or involving the joint

Treatment

Appropriate Health Care

 Patients that are self-sustaining and ambulatory are typically treated as outpatients
 Hospitalization may be appropriate for initiation of analgesic therapy and collection of baseline
diagnostic data
 Articular gout should be considered severely painful and the primary cause should be determined
 Debilitated patients may need extended periods of hospitalization for supportive care until stable
 Supportive care may include provision of padded substrates or supportive cushioning for non-
weight bearing patients, multimodal analgesia, fluid therapy (subcutaneous fluids can be
administered at 5-10% of bodyweight), and nutritional support (gavage feeding)

Activity
  Cage rest
 Modifications to the cage setup to minimize arthritis pain, reduce the risk of falling and continued
trauma to the joints, facilitate greater ease of access to food and water dishes, and help patients
compensate for reduced mobility
 Wire cages result in increased trauma to the legs, feet, and wings and permit climbing and
thereby greater risk of falls
 Plastic, glass, or plexiglass enclosures more appropriate with horizontal space emphasized over
vertical space
 Lowered perches, padded substrates, soft perches, platforms, and ramps used to aid mobility,
improve patient comfort, and reduce risk of injury from falls
 Food and water dishes should be easily accessible and placed in multiple locations
 Some birds will require permanently altered caging

Diet
 In cases of clinical obesity conversion to a lower-calorie or restricted-calorie diet to minimize fat
stores and continued degradation and erosion of the articular cartilage.

Surgical Considerations
 Bimodal analgesia should be considered for all procedures requiring restraint and positioning
 Arthrodesis of severely affected or unstable joints
 Amputation of affected limbs if the condition is non-responsive to medical management and
cannot be otherwise resolved surgically
 Surgical removal of urate crystals from gout lesions can be therapeutic, but does not address the
primary underlying cause

Medications
 Non-steroid antiinflammatory drugs (NSAIDS) – Inhibit prostaglandin synthesis by the COX
enzyme: meloxicam 0.5 - 2 mg/kg PO q12-24h, carprofen 1-5 mg/kg PO q12-24h, ketoprofen 2-5
mg/kg IM q12-24h
 Analgesics - Primarily functions as kappa antagonist: butorphanol 0.5 - 2 mg/kg IM q1-4h;
synthetic mu-receptor opiate-like agonist that also inhibits reuptake of serotonin and nor-
epinephrine: tramadol 20-30 mg/kg PO q8-12h
 Gabapentin – 10 - 30 mg/kg PO q12h
 Omega 3 fatty acids – 0.22 mL/kg PO q24h
 Antibiotic therapy – systemic and/or local; ideally based on culture and sensitivity results; can
include placement of antibiotic-impregnated poly(methyl methacrylate) (PMMA) beads within
affected joint(s)
 Articular gout: Allopurinol 10-30 mg/kg PO q12h; colchicine 0.04 mg/kg PO q12-24h (may not be
beneficial and could worsen disease)

Follow-Up

Patient Monitoring
 Initial follow-up primarily consists of physical examination and observation to evaluate for
resolving lameness, improved mobility, and reduction in pain and discomfort.
 Annual examinations should be performed to review for changes in nutrition and potential
increases in body weight, and to review husbandry (including cage setup).
 If NSAIDs are being used, serial biochemical evaluation of renal function should be performed.

Possible Complications
 NSAIDS should not be administered if renal pathology is known to be present or discontinued
immediately if clinical signs suggestive of renal dysfunction (such as polyuria/polydipsia) are
observed
  Adequan (polysulfated glycosaminoglycan) (PSGAG) has been used, but fatal hemorrhage has
been reported
 Arthritic changes commonly develop in contralateral pelvic limb joints as well as pododermatitis
of the plantar foot/digits owing to increased, compensatory weight bearing
 Repeated and progressive falling which may result in additional injuries
 Difficulty posturing preventing regular passage of droppings
 Difficulty accessing dishes/bowls to adequately meet food and water needs

Expected Course and Prognosis

 Managed over the life of the bird
 Periodic events in which clinical signs worsen, requiring at least temporary hospitalization for
supportive care

Key Points
 Arthritis is a typically progressive condition resulting in continued degradation of the joint and
increasing patient discomfort. Even with aggressive treatment, arthritis is typically progressive
and it can be challenging to maintain an adequate quality of life for the patient over the long term.
 Clinically obese birds and heavy-bodied breeds at high risk for developing arthritis.
 Typically present for intermittent, persistent, and/or progressive lameness or falling.
 Medical treatment is focused on bimodal analgesia consisting of non-steroid antiinflammatory
drugs (NSAIDS) and butorphanol 0.5 - 2 mg/kg IM q1-4h; synthetic mu-receptor opiate-like
agonist that also inhibits reuptake of serotonin and nor-epinephrine: tramadol 20-30 mg/kg PO
q8-12h.
 Arthritis is managed over the life of the bird with cage rest and modifications to the cage setup to
minimize arthritis pain and reduce the risk of falling and continued trauma to the joints.

NOTES