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Dr. Joey
Dr. Joey, Board Certified
Category: Dog
Satisfied Customers: 4914
Experience:  15 yrs in practice, specialist canine/feline medicine
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My dog has recently been diagnosed with Arthritis which is

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My dog has recently been diagnosed with Arthritis which is being treated with hydrotherapy, Tramadol, Gabapentin, and green lipped muscle extract. Molly looks like she is walking very daintily and has an arched back sometimes. All of her joints seem to be affected but not all at one time. She has Portosystemic Hypertension and multiple acquired shunts as well as a blood clot in her liver. She is currently receiving Ampicilin, Destolit, Plavix, Lactulose for her liver and making sure that toxins don't build up in her system as well as Prilactone to ensure that fluid does not build up in her tummy. Is it possible that Molly has polyarthritis which has been brought on my one or more of her medications. If so, do you think that any of them could be changed to lessen the Arthritic symptoms she currently displays. I have chosen not to have x-rays or any intrusive tests done as these would cause Molly to be sedated or put under anaesthetic which I feel is too risky.
Any thoughts, advice or general ideas that you have would be gratefully received.
Dr. Joey :

Hello I am Dr. Joey. Thanks for trusting me to help you and your pet today. I am a licensed veterinarian with over 15 years of experience. I look forward to working with you.

Dr. Joey :

No, arthritis should not be a side effect of any of the medications that you are currently administering to her. Polyarthritis is very concerning. THis may not be related at all to the PSS, but instead be immune-mediated or rhumatoid arthritis. I assume radiographs (xrays were taken) and your vet may have spoken about doing a joint tap to sample what is going on there (that helps us rule out that it is a bacterial arthritis). There is a clear difference on xrays between immune-mediated and rhumatoid arthritis. You can also do a blood test for a rhumatoid factor to know if this is what is going on. If you have immune-mediated or rhumatoid arthritis then it will require different medications to treat or at least help

Dr. Joey :

I'm sorry, it looks like she may not have portosystemic shunt (PSS) but regular liver disease; regardless her condition is potentially unrelated to the arthritis. It would be nice to link them.

Dr. Joey :

I see xrays were not taken. They actually could be very useful, but if you elected not to do this, then as a minimum I would discuss doing a rhumatoid factor (blood test) with your vet to perhaps get an idea if rhumatoid arthritis needs to be considered. This is a progressive and painful process that does not carry a very good prognosis.

Dr. Joey :

Overall she is a very complicated patient. It sounds like her liver disease is controlled, but we do not know for how long we may have control of this if you are to a point of already using two diuretics to control the ascites. I would probably agree that conservative management is probably the way to go, but I would pursue the arthritis a bit further. she is too young to have age-related arthritis. This is probably an immune system problem. That is going to require a drug other than pain relief to help such as prednisone.

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Customer: replied 3 years ago.
Sorry Dr Joey this is the first time I have used this site and I have emailed you instead of using this box. Are you able to access the emails?
I am unfortunately not able to access the email. :(
If you could, please copy/paste your replies into the text box below this.
Dr. Joey
Customer: replied 3 years ago.
Molly was diagnosed as having Portosystemic hypertension etc after many tests being carried out at the Dick Vet School in Edinburgh and the medication that she currently receives are the exact tablets and doses that the consultant prescribed two years ago resulting in her condition remaining fairly stable apart from hospitalisation 18 months ago as a result of a nasty bug. During this period Molly received dog plasma. Is it possible that this treatment could have caused an immune related response resulting in Arthritis? The initial signs of Molly being lame was after her first season which was in December last year.
If Molly's condition turns out to be because of her immune system can it be treated effectively? How reliable is the blood test you described regarding rheumatoid arthritis? Is it possible to take x- rays without the patient being sedated? There is information available regarding stem cell treatment for dogs with Arthritis. Do you have any knowledge of this treatment?
IT is always possible that her immune system was stimulated by something along the way. The illness that she experienced would probably be a more likely culprit. It is also possible that this is unfortunate and unrelated to her liver disease. In most cases we cannot identify the underlying causative disease process. I am please to hear she has been stable.
Immune-mediated polyarthritis is a very tough condition to treat. It can be treated with a variety of immunosuppressive drugs. Diagnosis is important and will require joint fluid analysis, radiographs of multiple joints, and possibly biopsy of synovium in the joint. I have successfully treated several patients with this problem. Sometimes it resolves on its own. If it is due to underlying systemic lupus then this would be a life-long therapy.
Rhumatoid arthritis is different. This is an erosive form of arthritis that causes extensive joint damage (in comparison immune-mediated polyarthritis is inflammatory but not erosive or destructive to the joints). Rhumatoid is tougher to control because the joints become so deformed over time.
Stem cell therapy is used for age-related arthritis only. I have had a few patients undergo this. The goal with stem cell therapy is to alleviate pain. I have heard of one patient experimentally treated with immune-mediated but I do not know the outcome. This is not generally an indicated form of therapy right now and with her other problems I would worry that it might cause other issues. If a dog has any infection it can worsen this. It would require consulting with the service that does the stem therapy to see if she would be a candidate. I woudl probably not recommend this.
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