Leflunomide with prednisone or nonsteroidal anti-inflammatory drug therapy is safe and tolerated for long-term treatment of immune-mediated polyarthritis in 27 dogs.

OBJECTIVE: To retrospectively evaluate safety and tolerance of leflunomide for long-term treatment of canine idiopathic immune-mediated polyarthritis (IMPA). ANIMALS: 27 dogs with clinical signs and synovial fluid cytology supportive of IMPA with ≥ 6 months' follow-up after starting leflunomide. METHODS: Medical records were reviewed to identify dogs prescribed leflunomide for treatment of IMPA from February 2012 to May 2022. Initial leflunomide doses of 2 to 4 mg/kg once daily were prescribed and were titrated to the lowest effective dose with concurrent anti-inflammatory therapy. Complete blood count, serum chemistry, and clinical signs were monitored throughout the course of treatment. RESULTS: Adverse effects potentially attributable to leflunomide noted in 9 of 27 dogs (33%) included vomiting, diarrhea, lethargy, decreased or absent appetite, polyuria and polydipsia, and secondary antibiotic responsive infection and were self-limiting or resolved with outpatient therapy. Alkaline phosphatase (ALP) and alanine aminotransferase (ALT) elevation were documented in all dogs prescribed leflunomide plus prednisone, with persistent liver enzyme elevation in 6 of 9 dogs (67%) and normalization after antibiotic therapy in 3 of 9 dogs (33%). The majority of dogs prescribed leflunomide plus NSAID (11/17 [65%] dogs) did not experience liver enzyme elevation; 2 of 17 (12%) dogs developed transient antibiotic-responsive liver enzyme elevations, and 4 of 17 (23%) dogs had persistent liver enzyme elevation. CLINICAL RELEVANCE: Leflunomide was well tolerated for long-term management of IMPA. A significant difference in liver enzyme elevation was identified between dogs prescribed prednisone versus NSAID in combination with leflunomide. Leflunomide with NSAID therapy resulted in less hepatotoxicity compared with leflunomide with prednisone.

Increased risk of select glucocorticoid adverse events in dogs of higher body weight.

There are limited data on glucocorticoid treatment in dogs. The purpose of this study was to investigate whether dogs of higher body weight experienced more adverse events when receiving glucocorticoid therapy. Data pertaining to glucocorticoid therapy was abstracted from the records of 61 dogs that were prescribed glucocorticoids for treatment of immune-mediated thrombocytopenia or hemolytic anemia from 2014 to 2019. The odds of developing muscle atrophy and polyphagia during therapy were increased by 30% for each 5 kg of additional body weight. Almost half of the dogs (44.3%) fluctuated > 15% from baseline weight during therapy. Dogs whose body condition scored as above ideal were at increased risk (odds ratio = 4.2) for being diagnosed with urinary tract infection. Our findings suggest that standard linear glucocorticoid dosing may place higher body weight dogs at increased risk of developing adverse events. Accelerated glucocorticoid tapering and/or alternative dosing schemes in dogs with higher body weights may be prudent in efforts to improve tolerance and client compliance.

Risque accru d'événements indésirables liés aux glucocorticoïdes chez les chiens de poids corporel plus élevé. Les données sur le traitement par glucocorticoïdes chez le chien sont limitées. Le but de cette étude était de déterminer si les chiens de poids corporel plus élevé présentaient plus d'événements indésirables lorsqu'ils recevaient un traitement par glucocorticoïdes. Les données relatives au traitement par glucocorticoïdes ont été extraites des dossiers de 61 chiens auxquels des glucocorticoïdes ont été prescrits pour le traitement d'une thrombocytopénie à médiation immunitaire ou d'anémie hémolytique de 2014 à 2019. Les risques de développer une atrophie musculaire et une polyphagie pendant le traitement ont augmenté de 30 % pour chaque 5 kg de poids corporel supplémentaire. Près de la moitié des chiens (44,3 %) ont fluctué > 15 % par rapport au poids de base pendant le traitement. Les chiens dont l'état corporel était supérieur à l'idéal présentaient un risque accru (rapport de cotes = 4,2) de recevoir un diagnostic d'infection des voies urinaires. Nos résultats suggèrent que le dosage linéaire standard de glucocorticoïdes peut exposer les chiens de poids corporel plus élevé à un risque accru de développer des événements indésirables. Une diminution accélérée des glucocorticoïdes et/ou des schémas posologiques alternatifs chez les chiens ayant un poids corporel plus élevé peuvent être avisés dans les efforts visant à améliorer la tolérance et l'observance du client.(Traduit par Dr Serge Messier).

Outcome of Tibial Closing Wedge Osteotomy in 55 Cranial Cruciate Ligament-Deficient Stifles of Small Dogs (<15 kg).

OBJECTIVE: To describe the outcome of cranial closing wedge osteotomy (CWO) of the tibia for treatment of cranial cruciate ligament (CrCL)-deficient stifles in dogs with a body weight of <15 kg. STUDY DESIGN: Retrospective case series. ANIMALS: Forty-five client-owned dogs (n=55 stifles). METHODS: Medical records (2005-2014), radiographs, and owner questionnaire were used to identify the surgical procedure performed, associated complications and outcome in 45 dogs undergoing CWO in 55 stifles. RESULTS: Data for 55 stifles from 45 dogs were included. Bichon Frise was the most frequent dog breed (n=11). Mean pre- and postoperative tibial plateau angle (TPA) were 36.3° (95% CI 35.1-37.5) and 7.5° (95% CI 6.7-8.2), respectively. Pin and tension bands were placed in 38/55 stifles (69%). The most frequent complication at short-term follow-up (2 weeks) was incisional complications in 8 stifles; all resolved with systemic antibiotic administration alone. Data were available for all stifles at 8 week follow-up with an overall complication occurrence in 16/55 stifles (28%); 1 dog required revision surgery. Tibial osteotomy healing was evident on radiographs at 8 weeks postoperative in 53 stifles (96%), considered complete in 27 stifles, and good in 26 stifles. Follow-up owner questionnaire was available for 36 dogs at a mean of 24 months and 34/36 owners (94%) were satisfied with the procedure and considered their dog had a good quality of life with minimal long-term complications. CONCLUSION: Dogs with a body weight <15 kg undergoing CWO for treatment of a CrCL-deficient stifle had a good outcome based on clinical status, radiographic evaluation, and owner questionnaire.

Evaluation of ilial screw loosening after triple pelvic osteotomy in dogs: 227 cases (1991-1999).

OBJECTIVE: To investigate factors influencing screw loosening after triple pelvic osteotomy (TPO) and ischial wire stabilization of the acetabular segment. DESIGN: Retrospective case series. Animals-227 dogs with congenital hip dysplasia or subluxated hip joints. PROCEDURES: Medical records and radiographs of 227 dogs that underwent 332 TPO procedures were evaluated, and data pertaining to screw type, plate position, sacral screw engagement, use of ischial interfragmentary wires, and pelvic alignment were assessed for associations with screw loosening. RESULTS: Complications developed in 96 of the 332 (29%) procedures. Cancellous screws without sacral engagement were associated with the lowest frequency (6%) of loosening, compared with cancellous and cortical screws engaging the sacrum and cortical screws that did not engage the sacrum. Frequency of screw loosening increased when cortical or cancellous screws engaged the sacrum and when cortical screws were used. In dogs that had surgery bilaterally, the first limb on which TPO was performed had a higher frequency of screw loosening than the second limb. Pelvic alignment loss was greatest (5.4 degrees ) when the 3 most cranial screws were loosened. Loss of pelvic alignment was significantly different between dogs that underwent surgery and had complications and those that underwent surgery and did not have complications in association with loosening of 1, 2, and 3 screws. CONCLUSIONS AND CLINICAL RELEVANCE: TPO screw loosening was multifactorial and related to stability of the affected ilium, screw type, and screw position. Placing cancellous screws that do not engage the sacrum in pelvic osteotomy plate positions 1 through 3 may decrease the number of screws that loosen.