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Polyarthritis 803

Technician Tips a telephone question regarding constipation SUGGESTED READING
• Any client who calls with concerns about likewise warrants an immediate evaluation Cooper ES: Controversies in the management of
VetBooks.ir about the risk of urethral obstruction and • Immediate, careful palpation of the bladder AUTHOR: Claire M. Weigand, DVM, DACVIM Diseases and Disorders
to rule out urethral obstruction.
pollakiuria/stranguria should be advised
feline urethral obstruction. J Vet Emerg Crit Care
25:130-137, 2015.
urged to bring the pet in for exam without
to rule out obstruction should be done as
delay. Owners often misidentify stranguria
as constipation (both involve straining), and soon as possible on presentation. EDITOR: Leah A. Cohn, DVM, PhD, DACVIM

Polyarthritis Client Education
Sheet

BASIC INFORMATION ○ Associated with SLE ○ After joint inflammation has occurred,
○ Idiopathic autoantigens (e.g., altered collagen) are
Definition • Infectious, erosive and nonerosive arthritis produced that perpetuate the inflammation.
Inflammation of multiple joints • Noninfectious erosive arthritis (rare) ○ With SLE, autoantibodies to nuclear
○ Feline progressive polyarthritis: periosteal material, immune complex formation, and
Epidemiology new bone formation and bony erosions; subsequent deposition in tissues cause mul-
SPECIES, AGE, SEX acute (more common, young cats) or chronic tisystemic disease that commonly manifests
• Dogs and cats of any age and either sex (less common, slower onset, older cats) with nonerosive polyarthritis, dermatitis,
• Rheumatoid arthritis: usually middle-aged ○ Canine rheumatoid arthritis (p. 888) and/or glomerulonephritis (GN).
dogs ○ Polyarthritis of greyhounds • Recognized causes of infectious polyarthritis
• Polyarthritis of Akita dogs < 8 months old ○ Vector transmitted: Lyme disease (Bor-
• Infectious polyarthritis in dogs: male > female HISTORY, CHIEF COMPLAINT relia burgdorferi), ehrlichiosis (Ehrlichia
• Feline chronic progressive polyarthritis: male • Difficulty walking; weakness, inability to ewingii), Anaplasma phagocytophilum,
> female rise, stiffness, lameness Rocky Mountain spotted fever, Hepato-
○ Owners may not recognize lameness when zoon, Leishmania, Bartonella
GENETICS, BREED PREDISPOSITION multiple limbs involved ○ Other: calicivirus, Streptococcus, Staphylo-
• Certain histocompatibility alleles are associ- • Inappetence coccus, Corynebacterium, Escherichia coli,
ated with rheumatoid arthritis, usually in • Lethargy, weight loss, vomiting, diarrhea L-form bacteria, Mycoplasma, and systemic
small-breed dogs. • Idiopathic IMPA typically is sudden onset fungal infections
• Juvenile-onset polyarthritis is seen in the with multiple symmetric joint involvement. ○ Nonvector-transmitted bacterial infection
Akita. occurs after joint penetration (surgery,
• Familial amyloidosis is a cause of polyarthritis PHYSICAL EXAM FINDINGS trauma, bite wound, arthrocentesis) or
in the Shar-pei. • Joint pain, swelling from hematogenous spread. Bite wounds
• Sulfonamide-induced polyarthritis has been ○ May be difficult to localize source of are common in cats, whereas hematogenous
seen mostly in Doberman pinschers. stiffness; sometimes articular pain may spread from an unidentified source of infec-
• Systemic lupus erythematosus (SLE) is be absent initially. tion can occur in dogs. Pre-existing damage
overrepresented in certain breeds (p. 955). ○ Firm, complete flexion of carpi should be to a joint may predispose to infection.
performed and may reveal signs of pain Single joint involvement is more common,
RISK FACTORS that otherwise would escape notice. but infection may spread to other joints.
• Dogs: recent vaccination, treatment with ○ Distal, symmetrical joint involvement ○ Multiple joint involvement can occur with
sulfonamides or other drugs, exposure to (commonly carpi and tarsi) in IMPA systemic bacterial infections (e.g., bacterial
ticks (e.g., tick-transmitted Lyme, ehrlichiosis, ○ Usually one (monoarthritis) but occasion- endocarditis), which may also cause IMPA.
anaplasmosis), infection (e.g., bacterial endo- ally two or more proximal joints involved • Noninfectious erosive IMPAs include rheu-
carditis, pyometra, discospondylitis, urinary with septic bacterial polyarthritis matoid arthritis (rare in cats) and periosteal
tract infection, neoplasia), and intestinal • Fever; in some cases of IMPA, fever may be proliferative polyarthritis (common in cats).
disease such as inflammatory bowel disease the only sign. Least common causes of polyarthritis:
• Cats: calicivirus vaccination (especially • Lymphadenopathy ○ Rheumatoid arthritis is usually associated
kittens) • Other signs of underlying disease (e.g., heart with autoantibodies to immunoglobulin
murmur, arrhythmia, neck pain) G (rheumatoid factor).
ASSOCIATED DISORDERS ○ Periosteal proliferative polyarthritis is
Immune-mediated polyarthritis (IMPA) may Etiology and Pathophysiology characterized by periosteal new bone
occur in association with meningitis (steroid- • Noninfectious, nonerosive IMPA is common. formation and bony erosions. It affects
responsive meningitis arteritis), SLE, and other ○ Most IMPA cases are idiopathic. young adult cats, often castrated males,
systemic disease. ○ Breed-associated polyarthritides may have and is usually acute in onset. Chronic
a genetic basis. progressive polyarthritis is a milder form,
Clinical Presentation ○ Possible mechanisms for reactive polyar- is insidious in onset and affects older cats.
DISEASE FORMS/SUBTYPES thritis include immune complex deposi-
• Noninfectious, nonerosive IMPA tion in joints in response to infection or DIAGNOSIS
○ Breed-associated (e.g., Akita, Weimaraner, inflammation remote from the joint (i.e.,
Shar-pei) type III hypersensitivity reaction), and Diagnostic Overview
○ Triggered by an immune response to molecular mimicry, in which antibodies to Polyarthritis can be suspected from the history
antigens outside the joint (reactive bacteria, viruses, tumors, drugs, vaccines, and physical exam alone. Fever, lethargy, lame-
polyarthritis) (see Risk Factors) or diets cross-react with joint antigens. ness, and painful or swollen joints (especially
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