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Immune Disorders of Dogs
Symmetrical lupoid onchodystrophy
Autoimmune thyroid disease
Lymphocyic thyroiditis
Nose crusting and Myositis
Vasculitis in Greyhound
Immune mediated skin disorders
Immune Problems
IgG deficient and demodex
Immune mediated joint disease
Autoimmune disorders and drug problems
Immune disorder, inflamed joints, sudden deathalso see Prednesone
also see Thyroid problems
also see Immune Mediated Hemolytic Anemia
also see IMHA
also see Thrombocytopenia
also see CIKS
also see Demodex
also see Lupus
also see Pemphigus
also see Blood and Lymph
Symmetrical lupoid onchodystrophy in Rottweilers and Greyhounds
Question: Dear Dr. Mike,
I have enjoyed being able to use the free portion of
your website for quite some time now and am very glad
you are doing it. I have found it to be an excellent
place to go for more information when something is
going on with my dogs.Now that I am a subscriber, I have been going through
the newsletter archives and found a short article
about symmetrical lupoid onchodystrophy, and the fact
that it affected your rottie.I have a greyhound who may have the same thing. At
this point it is hard to know because we just got him
from the track a few weeks ago and after having him
for only a few days I noticed that his nails looked
odd. The very next day he completely lost one and bled
all over. The nail basically just crumbled and left
the live, exposed quick. Poor fellow! And he is a
young dog yet and really needs exercise, so it's been
a bit difficult for him having a big bandage on his
foot until the thing heals enough to leave it
unprotected (the vet had to remove the remainder of
the nail under sedation).He's had a fungal culture done, but the results will
not be back for awhile yet. Our vet feels it could be
fungus, SLO, or maybe even both. Right now the boy is
on Keflex until the nailless toe heals over, and has
also been put on 2 3VCaps per day, plus 500 mg. of
niacainamide 3 times a day. We have been told he may
need the oil caps and the niacinamide for the rest of
his life. The next step will be to soak the toe after
the bandages come off and then treat with a fungal
ointment if the fungal test comes back positive. Most
of all, she has told us to be patient because the
nails grow so slowly it is going to take time to see
if anything works.The questions I had to ask where these: is there any
new information around about SLO? Our vet is a recent
graduate and seems to think there is a component of
nutritional deficiency in all this, and the little bit
of info I could come up with about this condition
seems to treat it as an immune-mediated thing similar
to pemphigus - some vets even seem to feel it is a
limtited form of pemphigus. Is it? or is it something
new? Or something old no one really paid much
attention to before?So I'm a bit confused about what this condition may
really be and what the best thing we can do for our
dog. The only thing I know for sure is that if this
stays limited to the toenails only and he can still
live a comfortable life after losing the diseased
nails and growing new ones, I definitely don't want to
put him on steroids. We have had bad experiences with
that in our older dogs and this one is definitely too
young to have to go that route.Add to that the complicating factor that we just found
out today that he has a moderate positive titer to
babesia canis. Is this something that could be
adversely affecting his immune system?Thanks for any time you can give providing some
information.Sincerely, Nancy
Answer: Nancy-
The breeds that appear to be most commonly affected by lipoid
onchodystrophy are rottweilers and greyhounds, so given this it is a good
idea to maintain a high degree of suspicion for this condition. German
shepherds and giant schnauzers may also be affected more commonly than
other breeds. The nails are usually painful prior to falling off and the
toe remains painful for a few days to several weeks after the nails fall
off, at least in the cases we have seen. I don't know about all dogs, but
our dog was pretty sensitive about having her toes touched for the rest of
her life, although it didn't seem like they were constantly in pain. More
like she remembered the pain for a long time.The only way that I know of to diagnose the problem is to biopsy an
affected nail bed. There is a description of how to do this in one of the
Clinics of North America and that would be worth looking into if you would
consider biopsy, because the alternative technique is removal of the last
digit of an affected to to get a biopsy specimen and I would be really
reluctant to do that. If this does progress to other nails it is also
reasonable to assume that this condition is present and treat for it, at
least in my opinion.I have not seen any indication that this is a nutritionally related
problem, except that some dogs with food allergies are reported to lose
toenails if there is severe inflammation of the feet but I don't think that
just nail bed inflammation occurs much with food allergies. Treatment could
be considered to be nutritional, though. Many dogs are reported to respond
to high doses of omega n-3 fatty acid supplementation. High dose is about
18mg/lb of body weight or about 1 capsule of most of the fatty acid
supplements per 10 lbs of body weight. This is a usually much higher than
the dose recommended on the label.Other treatments that sometimes work, and are currently used in addition to
fatty acid supplementation are pentoxyfilline (Trental Rx) administration
at 10mg/kg or 400mg/dog once a day or once every other day; niacinamide
and tetracycline administration (usually 500m of each medication given two
to three times a day) and corticosteroids at immunosuppressive dosages. The
corticosteroids should be a last resort because often the other medications
work if given for at least a couple of months.Antibiotics are not usually helpful but it is hard to resist using them,
especially for the first one or two nails when it is tempting to hope that
the problem is a nail bed infection.My impression is that this is a discrete condition that is an immune system
disorder. This would put it in the same class of problems as systemic lupus
erythematosus and phemphigus disorders but I think it is considered to be a
completely separate entity. I'm not absolutely certain of that, though.I don't know what to tell you about the long term situation with this
condition. We did not keep our rottweiler on medications long term because
we didn't see much response to the tetracycline/niacinamide protocol and
the dosage of fatty acids we used was too low by today's standards and
perhaps consequently they didn't seem to help much, either. I didn't want
to keep her on steroids, so we just treated her when the nails were
painful. She lost all her nails over the course of about a year or two and
and then was comfortable but nail-less for the rest of her life. So our
experience with treating one dog was that she did OK without long term
medication as long as you consider having almost no toenails (she had short
stubs) acceptable. I am not sure that this would be acceptable in a
greyhound since they seem to dig their toes in more when they walk, but
again I am not sure of this, either.Mike Richards, DVM
6/23/2001
Autoimmune thyroid disease, lymphocytic thyroiditis, Pred, Breeding
Question: Hi,
I have a 2 1/2 old male basset hound who just earned his conformation
championship. As a result, I took him to a breeding specialist to have his
semen checked for future breeding prospects. He did collect the semen and
what little sperm there was, was dead. He suggested a thyroid test which
we did. The Thyroid test showed that he has borderline autoimmune thyroid
disease. My vet started him on 40mg pred for 2 weeks than 20mg for 2 more
weeks at which point she collected and the sperm was thriving. She
repeated the thyroid panel (currently waiting for results) and reduced the pred to
20mg every other day. She said the pred is necessary to suppress the
immune system to get viable sperm and the goal will be to work down to the lowest
dosage of pred but still maintain his ability to breed.My questions are as follows:
I'm concerned about the long term use of pred. What are your thoughts on
this treatment plan?Are there reasons other than breeding that he should be treated for this?
I understand that if we do not treat, his thyroid will eventually burn itself
out and he will require lifetime thyroid meds. Will this happen regardless
of treatment?Is he prone to other autoimmune problems because of this?
Should we breed a dog with this potential problem? Our vet says it may not
be genetic. Another option is to collect and freeze the semen while he is
producing. My thought is to do this and get him off the pred as soon as
possible unless there are other reasons to keep him on it.Thanks for your response. Brian
Answer: Brian-
I am sorry about the delay in responding to your question. It is difficult
to answer questions without knowing exactly how conclusions were drawn and
without being certain of the whole situation. There are some things about
your note that are hard for me to understand but perhaps they will be more
clear after you have a chance to discuss them further with your
veterinarians.It is not unusual when collecting semen samples from dogs, especially from
inexperienced dogs or with inexperienced collectors, to get as sample that
has few sperm in it and when this happens there is often reduced mobility
of the sperm, as well. This usually happens because the dog does not fully
ejaculate or the person collecting the semen does not get the sperm rich
fraction of the ejaculate. Dogs normally have three portions to their
ejaculate. The second one is the sperm rich fraction. For these reasons,
most breeding specialists recommend against interpreting fertility based on
a single collection of ejaculate from a male dog.So truthfully, I have to question whether or not there is anything wrong
with your dog, at all, at least as far as semen viability goes. It seems
more likely to me that the first collection was not meaningful and the
second one is more indicative of your dog's ability to produce sperm. The
best measure of breeding ability are test breedings, in which the male is
bred to a known fertile female (or at least a female with a fertile track
record). Production of puppies is a the conclusive sign of fertility.Clinically significant hypothyroidism would be unusual in a dog as young as
yours and infertility resulting from hypothyroidism in a male dog of this
age would be rare. However, there is evidence that immune mediated
hypothyroidism, lymphocytic thyroiditis, can be passed genetically so it
seems reasonable to think about whether you wish to take a chance of
passing this trait on.This leads to the question of how likely the diagnosis of hypothyroidism is
to be correct. The best current test for hypothyroidism is measurement of
thyroxine (T4) by equilibrium dialysis. If this value was tested for and
was within normal ranges, hypothyroidism is unlikely. If it was tested for
and was lower than normal, hypothyroidism is likely, if there is no other
concurrent illness. The presence of autoantibody titers against T3 and T4
does not reliably correlate with development of hypothyroidism (not all
dogs with autoantibodies develop the disorder) but dogs that are producing
autoantibodies are more likely to develop hypothyroidism than dogs without
the antibodies.I have never heard of using prednisone to treat hypothyroidism, including
the lymphocytic thyroiditis type of this disease. Hypothyroidism is
treatable using thyroxine supplementation and this is much less likely to
cause side effects than corticosteroids.Since you are really trying to discover whether your dog is a suitable
candidate for breeding purposes, it really seems to me that it would be
best to slow down and figure out whether hypothyroidism and low sperm
production are actually present and then decide what the best course of
action is. One of the old issues of the VetInfo Digest is on thyroid
disease and it has more information on this disorder.Please feel free to write for clarification if you need it on any part of
this note.Mike Richards, DVM
1/25/2001
Autoimmune thyroiditis, lymphocytic thyroiditis, Breeding
Question: Hi,
Thanks for your response. The original diagnosis is autoimmune thyroiditis
aka "Hasa Moto's" (spelling?) disease. He is not hypothyroid yet, but the
vet says he will be eventually since the thyroid is producing more than
normal to supplement those hormones being killed off by the autoimmune
disease and the thyroid will eventually burn itself out.The reason he was started on the pred was to suppress the immune system to
see if his reproductive capabilities would recover. After he was on pred
for 6 weeks, the sperm sample was good. The vet reduced his pred and we
tested him 2 weeks later to discover the sperm sample was not good at all.
Now we have increased the pred again to try to see if he will produce usable
sperm.Before the pred was started his test results were as follows:
TT4 32
TT3 1.1
FT4 27
FT3 18.9
T4 Autoantibody 5
T3 Autoanitbody 9
Thyroid Stimulating Hormone 23
Thyroglobulin Autoantibody 221After being on Pred for 6 weeks the results were as follows:
TT4 22
TT3 0.8
FT4 18
FT3 Quantity not Sufficient
T4 Autoantibody 1
T3 Autoantibody 3
Thyroid Stimulating Hormone 0
Thyroglobulin Autoantibody 174I would appreciate any additional insight you might have for us.
Brian
Answer: Brian-
The newer tests for antithyroglobulin antibodies (thyroglobulin
autoantibodies) is a pretty good indicator of the presences of lymphocytic
thyroiditis. This is the condition that leads to hypothyroidism in many
dogs. Hashimoto's Disease is one of the names of this condition in humans.
Some dogs appear to be able to tolerate lifelong lymphocytic thyroiditis
without ever developing hypothyroidism, though. Many dogs will have
elevated levels of thyroglobulin antibodies for a very long time prior to
the onset of hypothyroidism. For these reasons, it is important to
understand that elevated thyroglobulin antibody levels do not necessarily
indicate that hypothyroidism is present and are not a sure indication that
it will ever be present, at least with the information we have available in
veterinary medicine to date. Over time, a clear picture of which dogs will
be affected may emerge. The original concept behind measuring for
antibodies against thyroglobulins was to try to determine which dogs should
not be used for breeding among the breeds in which this condition is known
to be inherited, or suspected to be inherited, including golden retrievers,
dobermans, beagles, Borzois, great Danes, Irish setters and Old English
sheepdogs. The original theory was that if a dog could be shown to have
high levels of thyroglobulin autoantibodies it should not be bred. At the
present time, the lab values do not support a diagnosis of hypothyroidism
for your dog but they do support a diagnosis of lymphocytic thyroiditis,
which may eventually lead to hypothyroidism. If you follow the original
thinking, you should not breed a dog with high levels of thyroglobulin
autoantibodies, as this condition may be inherited. There is no absolute
proof of this for most breeds and so it may be reasonable to breed a dog
that has other really outstanding qualities, at least until more is known
about how lymphocytic thyroiditis progresses in the majority of dogs and
what the true mechanism of inheritance is.Your vet may be much better than I am at collecting semen samples but the
most common cause of poor sperm numbers and poor sperm motility in my
practice is the difficulty in obtaining a good sample for analysis and then
being able to analyze it without causing cold shock or other problems with
the sample before it is examined. It is hard to keep the equipment warm
while waiting for the dog to decide to produce a sample and while going
through the manipulations necessary to collect the sample and then to
collect the proper portions of the semen from an only semi-willing patient.
I know that I am not the only vet with this problem, because almost all of
the information on reproduction in dogs mentions that test breedings are
the only really reliable way to determine fertility in dogs. I can not say
what the situation is in your vet's practice, but in my practice, obtaining
two poor semen samples out of three collections is only slightly below our
expectations for normal dogs. So still think that you have to maintain a
strong suspicion that there is not a problem with your dog's sperm
production, even with the progression of things, so far.This does cause sort of a "Catch-22" situation. You can't know with
certainty whether your dog can breed successfully without giving him the
chance. However, you may not want to give him the chance because he has a
condition that may be inherited and could possibly be reduced or eliminated
in the breed by choosing not to breed affected individuals. This sort of
dilemma occurs often in breeding situations and there are no absolutely
clear cut answers about what the best course of action is. You just have to
decide if the value of this dog's total makeup outweighs the risk of
furthering a condition like lymphocytic thyroiditis in the breed.Mike Richards, DVM
1/26/2001
Question: Hi:
I am wondering what caused the nose of my dog to become cracked and
crusty? My samoyed is on medication for myositis (prednisone 15mg every
other day) and I noticed her nose was getting crusty. I went to the vet
and he put her on niacin and tetracycline. The crusting has gone away.
I am wondering if, since she has an auto immune disorder, this was
related to that or something else.Thanks!
ps: I also have her on B2, L-carnitine and CO-Q10 to help with her
myositis. Have you heard of these supplements being helpful or not?
Her condition seems to have stabilized and she is playful and has good
energy again. Unfortunately, she has gained so much weight! I have her
on a regulated diet (morning and evening feedings with LIMITED snacks)
but the weight has stayed on. Is this due to the pred?
Answer: P.-
The weight gain is very likely to be due to the prednisone. Increased
appetite and increased fat deposition occur with corticosteroids, so this
is an expected but unwelcome side effect.I have not seen any recommendations specific to masticatory myositis for
using B2, l-carnitine and coenzyme Q10, but these are recommended for a
variety of neurologic and muscular disorders. All are unlikely to cause
problems at reasonable dosages, so I see no reason not to try them. But you
can't really count on a beneficial effect.Crusting of the nose can occur with prednisone usage based on observations
of patients in our practice. I have been assuming that this may be due to
an increased tendency to get secondary skin infections and general thinning
of the skin associated with prednisone but have no evidence to back up
those thoughts. Severe cracking of the nasal planum or ulcerated sores
around it are more likely to be from a disorder such as phemphigus or
discoid lupus. Your vet is treating with medications that are recommended
for phemphigus (an immune mediated disorder), so the improvement makes that
a little more likely --- but doesn't necessarily prove the diagnosis. That
may not matter at this point since things are improving.In general, having one immune mediated disorder doesn't seem to predispose
dogs to getting other ones. Hopefully, this generality will hold true for
your Samoyed, too.Mike Richards, DVM
2/1/2000
Question: Dr Richards-
My almost 7 year old greyhound has been diagnosed with vasculitis, which
has occurred on the inside of her right rear leg. My vet performed tests for
rickettsial diseases and routine lab work, which all came back normal. She
has no additional symptoms and it has not spread. Do you know of any ailment
that this might be symptomatic of? We are not currently treating this.
thanks for any assistance you can provide,
Deborah
Answer: Deborah-
Vasculitis occurs for several reasons and your vet is looking for the more
likely ones with the testing already done. It can occur due to tick borne
(rickettsial) infections, due to some other infectious diseases, as the
result of E. coli food poisoning, from vaccine or drug reactions, in
association with systemic problems like kidney disease and hormonal
diseases and for a number of other reasons. Many of these would be ruled
out by normal chemistry values on a routine blood panel and by negative
titers on a rickettsial disease panel. In many instances it is not
possible to find a specific underlying cause for this problem, in which case
it is referred to as idiopathic vasculitis.If you do decide to treat for this problem, the usual medications used are
the immunosuppressive medications. Pentoxifylline (Tental Rx) seems to be a
popular choice for this right now, along with corticosteroids and
niacinamide/tetracycline combinations. I'm sure that other
immunosuppressive or anti-inflammatory medications have been used
successfully, too.I haven't seen too many references to this problem in Italian greyhounds
but vasculitis seems to be somewhat of a problem in the retired racing
greyhound population and sometimes it does seem like it only affects one
small area, making it hard to figure out whether to use systemic
medications to treat a localized problem that sometimes doesn't seem to be
causing too much discomfort. I don't have any advice about how to make that
decision, I think it has to be made by the vet who can see the effects and
the owner's assessment of the dog's response to the problem.I wish I could be more helpful.
Mike Richards, DVM
9/7/2000
Immune mediated skin disorders
Question: Hi Mike,
Let me start by saying I'm a member. The problem of Montanna's started a year
ago. The skin on the bridge of his nose &down just a little bite had small pin
hole sores.The vet did a scraping and looked at the area with a ultra violet
nothing showed up. He gave me some cortizone ceram, it dryed the sores up but
left him hairless in this area. A year later the hair loss is advancing down
his nose and the scabs have returned. I,m going to see a dermatoligist soon as
I can get an app. ,any Idea what this is?Marge
Answer: Marge-
This sounds like it may be one of the immune mediated disorders, such as
discoid lupus or one of the phemphigus disorders. Going to the
dermatologist is a good idea. Skin biopsies are usually necessary to
confirm whether one of these conditions is present.If this has been a seasonal problem, worse in the summer and better in the
winter, there is a stronger chance of discoid lupus. This condition does
often respond to topical cortisone creams but it is usually necessary to
use a very potent corticosteroid cream. Sometimes it is necessary to use
oral medications to control difficult cases of this disorder.Phemphigus is more likely to be non-seasonal. Sometimes there are localized
skin infections, contact allergies or other problems that can lead to these
sorts of signs, too.The first step is to get a diagnosis of the condition, if possible. Going
to the dermatologist is a good way to start that process.Mike Richards, DVM
8/22/2000
Q: I need some information as my dog is very ill with some kind of immunity problem. All the areas
of the tissue where inner lining of the skin and the outer skin is getting scab like leisions. What I thought
was a sunburn on the nose is now one big scab. The dog is also crippled with the way she is walking.
Please let me know if there is some information I can get to?
A: Glen-
You might be able to find information relating to your dog by searching our site, and other veterinary Internet
sites for the words "phemphigus" and "lupus". There are several types of phemphigus and lupus is can occur
as systemic lupus erythematosus or discoid lupus but you should get most of the references using lupus and phemphigus to search. On the big search engines you might have to add canine as a search term so you don't
get thousands of replies relating to humans.Mike Richards, DVM
Oliver .. IgG deficient and Demodex
Q: Dr. Richards -
Update on little Oliver. Since we last corresponded, Oliver was
diagnosed with Demodectic Mange. He has been dipped once and did not do
well at all. He was sick for several days and was very lethargic. I
called various vet schools and eventually determined, with advice from
vets, that my current internist is one of the best in the area and is
highly recommended. So, we have remained under his care. Dr. D
sent Oliver's blood in for immune testing. Oliver is IgG deficient, I
do not know which subclass.Clearly I am upset. We are going to put him on a 12 week/once a week
immune stimulater (injection). I do not know what it is. If that
doesn't work we may consider treating him with injections of IgG.
Apparently IgG for dogs is not easy to find and is extremely expensive.
We have decided to keep him with us until he longer enjoys life, right
now he loves life. He is funny, active and very affectionate.If possible, I would be interested in hearing your thoughts on the
matter, what I can expect in terms of Oliver's life span, whether an
immune booster has been proven to work (I understand a dogs immune
system continues to develop until 3 years old). Any comments are truly
appreciated.We are going to try accupuncture and accupressure.
Thanks.
A: Suzanne-
I don't have a lot of faith in immune stimulant medications. There have
been lots of these that have been promoted over the years but most don't
seem to really help all that much. They do seem to be relatively safe (at
least most of the newer ones), though. So I use them sometimes when the
situation seems appropriate and when we aren't having much success doing
other things. Once in a while I do think that there is a beneficial
response but am never completely sure it wouldn't have happened without the
medications.In general, I figure that anything that isn't likely to cause harm and that
the client can afford is worth trying.We have several dogs in our practice with immune deficiency problems that
we have been able to document fairly well. Most of them do OK as long as
the problems they do come down with are treated early and aggressively. We
have a dog in our practice whose white blood cell count has never been
above 3000 and several times has been below 1000 when we have taken it,
which is pretty scary, but he is eight or nine years old and has survived
several pretty severe infections with the help of his owners and aggressive
medical care.I know it is frustrating but if you keep up the good work and pay attention
to his needs I think that Oliver's chances may be reasonably good.I hope so.
Mike Richards, DVM
Oliver continued..plus Aspergillus
Q: Dr. Richards:
I just got a call from Oliver's internist who has informed me that a
test that he finally received from the endoscope shows that Oliver has
a fungus called Aspergillus. I am so tired right now I cannot stand it.
Poor Oliver has had so many problems I don't know what to do. He seem
so incredibly healthy and happy but I am so sad all of the time. The
specialist seems to think that this clearly tells us his immune system
is not so terrific, the question becomes one of what do we do? Ollie
has to go on a medication called Spornox that is $400.00/month and he
will likely be on it for 3 to 4 months. The money is not the issue,
its the love we have for Oliver and the concern of losing him. I'd rather
be the one to be sick. I am not sure what I am seeking to find out
from you, I just thought I would keep you posted because you have been so
wonderfully responsive and helpful to me during this difficult time.
A: Suzanne-
I know that this advice might not be what you are looking for, but if
Oliver were mine and he seemed to feel fine and to be acting pretty good
I really think that I would take him to a veterinary school or large
referral center. I am not familiar enough with the specialists in Chicago to tell
you if there is a referral center there but I would be surprised if
there isn't one. There are veterinary schools in Urbanna, IL., Ames, Iowa and
Madison Wisconsin. The advantage of a school is that there are going to
be two or three specialists in different fields involved in the diagnosis
of a case most of the time (such as an internal medicine specialist, clinical
pathologist and radiologist). When the patient is saying "I'm fine" and
the labwork is saying "You're sick" there is a strong justification for
someone to review the case before spending a whole lot of money on medications.
There is obviously a big chance that you would end up with the same
exact diagnosis and options but considering the expense of Sporonax it might
be worth thinking about getting yet another opinion. If this option isn't
practical the good news is that Sporonax can usually be used without too
much risk of adverse effects and so it is at least not a highly
dangerous option.You're doing your best to help Oliver. I know it gets frustrating
sometimes but he is lucky to have you.Mike Richards, DVM
Q: I have a 6 year old female rottie. 5 weeks ago I noticed she was limping and took her in to the vet. X-rays were taken; arthritis and some pain & swelling in the joint area were noted. A shot of cortisone was given, 10 days of antibiotics for any possible infections, and rimadyl were prescribed and we were to return in 3-4 weeks. We did, she was still limping, but the pain and swelling had gone down. It was written off as arthritis settling in and a prescription of cosequin was given to aid in the discomfort. 5 days later I noted a bump in her back leg (the same leg she had been limping on) so back to the vet we went. It was a swollen lymph gland-I had it removed and sent in for a biopsy, while she was under, my vet decided to draw fluid from the joint on that leg. I got the results back yesterday from the joint fluid - 1)septic arthritis or 2)immune mediated joint disease. The biopsy results from the lymph gland will be back next week. I was given an antibiotic after the surgery and was instructed to make sure I give them to her. What is immune mediated joint disease, is it treatable, how painful is it for the dog, and what can be done to aid the discomfort?
A: Lumpy - Immune mediated just means that the immune system is involved in producing the clinical symptoms. I think that it can be said fairly that almost all vets use this term to indicate inappropriate immune responses since the immune system is involved in most disease situations. So, in its general use the term "immune mediated" in front of the description of an illness, such as immune mediated synovitis or immune mediated hemolytic anemia, means that the immune system is inappropriately causing a a disease process.
Immune mediated arthritis occurs when the immune system causes an inflammatory response in a joint. It is painful. Sometimes terribly painful. It includes a number of possible underlying causes, including rheumatoid arthritis, lupus, drug reactions (sulfa antibiotics in particular), immune reactions to systemic diseases or subclinical joint infection and unexplained instances of immune mediated inflammation. Sometimes, immune mediated arthritis occurs and the response is "sort of" appropriate. An example would be Lyme disease. The immune system may be doing its best to attack the problem but causing a secondary problem in the joints at the same time. This can happen with several infectious agents.
Most of the immune mediated arthritis diseases are treated with corticosteroids or other immunosuppressive medications. As you can well imagine, suppressing the immune system if an infectious agent is present is not a very good idea so it is important to differentiate between septic arthritis and immune mediated non-septic arthritis prior to initiating treatment with immunosuppressive medications if possible. This can be difficult to do and sometimes it is just necessary to treat with antibiotics while awaiting joint culture results and to try to judge the response. At some point it generally becomes apparent that antibiotic therapy is not the answer and that immune mediated disease is appropriate to treat for, either through testing for diseases like lupus, rheumatorid factor testing, through repeated joint fluid evaluation or response to therapy.
The hardest question to answer is whether or not these conditions are treatable. The answer depends on the cause. Immune mediated arthritis due to Lyme disease may respond to continued antibiotic therapy and pain relief medications. We have several patients with unexplained immune mediated arthritis conditions that have responded very well to corticosteroids. Rheumatoid arthritis is extremely difficult to treat successfully long term but can sometimes be managed. In my experience arthritis associated with systemic lupus erythematosus is not very responsive to treatment -- but this is based on limited experience.
I hope that some progress has been made in making your dog more comfortable by now.
Mike Richards, DVM
Autoimmune disorders and drugs
Q: Dear Dr. Mike, Autoimmune disorders are in my line of old english sheepdogs, and we must exercise great caution in using many drugs because of this. I nearly lost one of my males several years ago by giving him one ascriptin twice a day for two days for mild arthritis. His gums paled, and his platelets dropped below 50,000. He responded well to prednisone therapy. He does take thyroid medication as well. My question is, now that he is nearing 12 years old, and does have arthritis in an old knee injury, I would like to give him more than the natural glyco-flex and glucosamine that I have been giving him. I have seen considerable improvement with these natural remedies, however, as he ages, I can see where something stronger is in order. I have heard some wonderful stories about dogs using Rimadyl, but I do not know if it has been tested on dogs with known blood problems. The manufacturer does warn not to use on dogs with von wildebrands disease, however, I am uncertain as to whether there has been any mention of side effects by vets using it on dogs with other blood problems. Other than adding prednisone to his regimen, I do not know what other course to take. My second question regards Interceptor. Friends who have several of our dogs (one of which recently had anemia and thrombocytopenia) need to have their dogs on heartworm preventative because they live in Va. Beach. Their vet swears by the interceptor and says he has never heard of not using it on dogs with blood disorders. I have been cautioned by a veterinary specialist not to use the once a month heartworm preventatives as well as Program on our line of dogs--rather to use the once a day filarabits. Their vet says the interceptor is safer than filarabits. We are between a rock and a hard place as to what to do to give them the best prevention against heartworm infestation but not bring on a bleeding episode in the process! Also, is there a www that one can contact regarding side effects of drugs for dogs where one can get the opinion of many vets on side effects? My vet is most receptive to reviewing all warnings or side effects of meds before dispensing to any animals, like in this case with the rimadyl, but I don't know where to look other than the manufacturers' label; perhaps we won't know more until Rimadyl has been in use longer. Please help! Thanks, B.
A: I am not an expert, nor a specialist -- just a general practitioner with a web page. But I think that milbemycin (Intercpetor Rx) is as safe, or safer, than diethylcarbamazine/oxibendazole (Filaribits Plus Rx). Plain Filaribits (no oxibendazole) have a long history of safe use but I am not aware of problems with milbemycin that would make me believe it is not safe, too. Neither of these medications has been shown to worsen coagulation disorders to the best of my knowledge.
Carprofen has been approved in other countries for some time but the U.S. is by far the biggest market. Side effects that are rare tend to show up here even if they don't show up in other countries where medications are approved. Still, carprofen (Rimadyl Rx) seems to be a relatively safe medication and I do not know of problem with coagulation and its use.
I am not aware of a www site that deals with drug interactions but if there is one, it will probably be listed on the NetVet site. We have a link to them on our web page or you can find them with web search engines.
Mike Richards, DVM
Autoimmune disorder, joint inflammation, death in Rottie
Q: I have a 5 year old Rottweiler who just died a week ago. I am still trying to find information on the cause of his death and I hope you could suggest some reading. I was told that my dog died from an autoimmune disorder which caused deadly inflamation in my dogs joints. The first signs my dog exhibited (4 weeks ago) where weight lose, a dry cough, and yellow mucus in the eyes, temp of 103.5, and sluggishness. First vet gave us keflex and told us our dog had a cold. After 2 weeks our dog was no better and began to limp (back leg) so we took him back to first vet. We were given more keflex and a distemper test was done (negative). After about four more days there is no improvement and our dog is now also limping in the front. Took him to second vet and a lyme test was done (negative).We were given amoxicillin. No improvement. Four days later our dog is in an almost comatose state. Eyes have a milkey film over them, he does not respond to our voices, he will not get up and wants to eat very little but does drink a lot of water. Within 3 days our dog has died. One week before he died his white bloodcell count was 27. His autoimmune test was slightly abnormal. Is there any reading I can do about dogs that die from autoimmune arthritis? Or do you think it was something else? Thanks P.
A: I am out of town and do not have access to my reference books. I can not think of a specific immune mediated disease causing polyarthritis and affecting Rottweilers off the top of my head. There are a lot of possible problems with the signs you describe, including ehrlichiosis, Lyme disease, systemic lupus erythematosus, Rocky Mountain spotted fever and cancer. Distemper could cause the signs you describe and sometimes serologic testing is not very accurate for that disease. Were his vaccinations current?
Mike Richards, DVM
Last edited 01/30/05
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