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Immune Mediated Polyarthritis In A Dog

by mandercrosby - October 22, 2014 View Case Report

Hi all,

I've got a 5 year old IMPA lab who's doing well on cyclosporine alone at this point. Unfortunately he absolutely couldn't tolerate prednisone and developed skin sloughing, severe liver enzyme elevations, and horrible lethargy, but seems better since rapidly tapering it. So far joint swelling seems under control.

His initial presentation was vomiting followed by severe joint swelling 24 hours later and he's still belching fairly frequently. He prefers cool surfaces, but has otherwise normalized since discontinuing prednisone.

He has somewhat somewhat deep, but full pulses bilaterally, a pink, wide tongue, and heat over BL 20. He developed numerous hot spots with skin sloughing on the prednisone. He also had severe and rapid muscle wasting while on the pred.

I'd like to start him on herbs and thought that San Miao San might be a good place to start. I've also heard of Angelica and Mastic being used, but was hoping to find some guidance here.

I'm sorry for leaving this case question here - unfortunately the website seems to have a malfunction that won't allow me to access the case question tab. Every time I click that tab it opens up a new "Ask a General Question" box.

Thanks so much!

Mandy

by naturevet

October 27, 2014

Hi Mandy,

First off, you're in the right spot for your question. For patient questions, we just like people to start a case for them first, so you can update it later and have it be part of the case database

To your question, the severe reaction to steroids suggests a severe Damp Heat pathology, so SMS makes sense. In fact, it's first use was for severe rheumatoid arthritis causing secondary withering of the extremities.

The pulse, however, indicates we need something dispersing as well. I like your idea of Xian Fang Huo Ming Yin, which can be used simultaneously.

Lastly, another option is Yi Yi Ren Tang. It's quite tonifying, but can be made more anti-inflammatory by adding Yin Chen Hao (Capillaris). It seems a bit too supportive for this dog, but it was invented (as was Si Miao San) to address joint effusion and immune polyarthropathy.

Hope that helps you out,

Steve

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