| WURTSBORO VETERINARY CLINIC |
| wvc@warwick.net |
| 163 SULLIVAN STREET |
| WURTSBORO, NY 12790 |
| United States |
| Phone: 845-888-4884 |
Dr. Linda Tintle , DVM
Dr. Linda Tintle is a 1981 graduate of the NYS College of Veterinary Medicine at Cornell. Dr. Linda founded the Wurtsboro Veterinary Clinic in 1984 watching it grow from a small part-time outpatient clinic to the busy full service hospital it is today. In 1981 she was given the pick of a litter of Chinese Shar-Pei puppies, irrevocably changing the course of her life. She had enjoyed showing her Great Danes as a teenager and quickly became active in breeding and showing Shar-Pei in rare breed shows. In 1981, Shar-Pei were still rare and little was known about the health problems of the dogs recently imported to the United States from Hong Kong. After observing unique problems in her own dogs and those of her friends & clients, Dr. Linda began research with scientists at Cornell’s Veterinary College and co-authored several published papers with them. She enjoys being a “Shar-Pei Friendly” Vet and is a longtime member of the Chinese Shar-Pei Club of America, Inc. & serves on its Health Through Education Committee and is the Research Liaison & advisor to the CSP Charitable Trust. She was awarded the William W. Morison Service Award by the CSPCA in 1995. She traveled to Mainland China in 2002 where she was able to observe the traditional Shar-Pei in their land of origin. She has been invited to speak about CSP health issues in the U.S., Canada, and Great Britain. Dr. Linda has a special interest in internal medicine and has collaborated on research in cancer and inflammatory bowel disease. Dr. Linda is President of the Orange County Animal Emergency Service in Middletown, NY and has served on its Board of Directors since its inception. She is the Regional Director for the Hudson Valley Veterinary Medical Society serving on the Executive Board of the NYS Veterinary Medical Society and is a co-chair and mentor in their Leaders 2005 program and is a Past-President of the HVVMS. She is honored to serve on the Dean's Advisory Council of the NYS College of Veterinary Medicine at Cornell.
|  Vie |
This Is an article from Dr.Tintle's own website.I personally used Dr.Tintle's medical protocol regarding FSF. Colchicine was at the heart of our regiment.
SHAR-PEI FEVER
Hematology & Oncology - Nephrology & Urology
Shar-pei fever is a disorder that resembles familial Mediterranean fever of humans. It is also referred to as familial shar-pei fever or swollen hock syndrome and is characterized by recurrent fever episodes that last 24 to 36 hours. Typically, the first episode occurs in young adult dogs. The fevers are believed to be associated with an elevation of the cytokine Interleukin-6 (IL-6), which is caused by dysregulation of the immune system. IL-6 production leads to production of inflammatory proteins, which in turn leads to the production of amyloid. Amyloid accumulates in the body and gets deposited in multiple organs. The organs most commonly affected include the kidneys and liver. This in turn may result in renal and/or hepatic failure. Many dogs with a history of recurrent fevers develop renal failure between the ages of 3 and 5 years. Clinical liver disease is less common.
DIAGNOSIS OF SHAR PEI
ETIOLOGY AND RISK FACTORS
-
- Age - Signs often begin in dogs younger than 18 months, but may be seen in older dogs as well.
- Breed/genetics - This is a disease of shar-peis and shar-pei mixes.
- Sex - No known risk
- Geographic/environmental - No known risk
- Other medical disorders - No known risk
- Age - Signs often begin in dogs younger than 18 months, but may be seen in older dogs as well.
- Causes - Shar-pei fever is believed to be caused by dysregulation of the immune system and elevated levels of Interleukin-6.
- Risk factors
- Prevention - Because this is an inherited disorder, affected dogs should never be used for breeding.
HISTORY AND CLINICAL SIGNS
- Species affected - Dogs
- Presenting signs and historical problems - Most of the dogs afflicted with shar-pei fever have recurrent fevers, which results in lethargy and possible reduced appetite. In addition, roughly half of the dogs suffer swelling in and around joints, most commonly the hock. Even if joint swelling is not seen, dogs may be stiff or lame, and may be reluctant to move. Less commonly, they may have swelling and pain associated with the muzzle, or abdominal pain, vomiting and diarrhea.
Dogs that develop renal failure may experience weight loss, vomiting, diarrhea, anorexia, polyuria and polydipsia.
PHYSICAL EXAMINATION FINDINGS
-
- Attitude - Mental status varies from mild lethargy to profound depression
- Body condition - Most dogs have normal body condition, but dogs that have developed renal failure may be in poor condition
- Vital signs - Fevers are characteristic
- Mucous membranes - Usually normal
- Hydration status - Usually normal but if renal failure has developed, dogs are usually dehydrated.
- Attitude - Mental status varies from mild lethargy to profound depression
- General
- Head and neck - Some dogs have swelling and pain of the muzzle.
- Eyes - Unremarkable
- Oral cavity - If renal failure has developed, uremic ulcers may be present.
- Thorax (cardio-pulmonary) - Unremarkable
- Abdomen (gastrointestinal/urinary) - Some dogs may have abdominal pain. Hepatomegaly is possible if the dog has significant amyloid deposits in the liver. Palpation may reveal small, nodular kidneys if the dog has progressed to renal failure.
- Reproductive system - Unremarkable
- Lymph nodes - Unremarkable
- Integumentary system - Unremarkable
- Neurologic examination - Some dogs may be depressed. The swollen joints are often painful, which may cause lethargy.
- Musculoskeletal examination - Many affected dogs have swelling in and around joints, most commonly the hock. Even if joint swelling is not seen, dogs may be lame and may be reluctant to move.
DIAGNOSTIC STUDIES
-
- CBC - An elevated white blood cell count is typical during an episode.
- Serum biochemical tests - Affected dogs may have elevated globulins early in the disease. As the disease progresses, the following abnormalities may occur:
↑ BUN
↑ Creatinine
↑ Phosphorus
↑ ALP, AST, ALT - Urinalysis - Urinalysis may reveal isosthenuria, proteinuria and possible casts. Urine protein/creatinine ratio can be used to quantify the amount of protein in the urine, and can help indicate renal amyloid deposition.
- Radiographs (other body areas) - Radiographs of the affected joint usually reveals soft tissue swelling with no bony changes.
- Biopsy/histopathology - Renal or hepatic biopsy confirms the presence of amyloid deposits.
- CBC - An elevated white blood cell count is typical during an episode.
- Special examination techniques - Joint taps can be performed and the joint fluid can be cytologically examined and cultured. This test should not be used as a specific indicator of shar-pei fever since joint inflammation due to various causes may have similar cell types in the joint fluid. Some affected dogs have normal fluid analyses.
- Clinical laboratory tests
- Serology/immunologic tests - Serology for tick-borne diseases should be performed to rule out these diseases. Antinuclear antibody test (ANA) and rheumatoid factor should be performed if systemic lupus erythematosus or rheumatoid arthritis is suspected.
- Microbiology - Blood culture is infrequently performed when the dog has a fever. Blood culture is usually negative in dogs with shar-pei fever. Urine culture may also be performed and is usually negative.
- Diagnostic imaging
- Pathology
DIAGNOSIS AND PROGNOSIS
-
- Systemic lupus erythematosus (SLE)
- Immune-mediated polyarthritis
- Septic arthritis
- Lyme disease
- Ehrlichia
- Rocky Mountain spotted fever
- Rheumatoid arthritis
- Neoplasia
- Systemic lupus erythematosus (SLE)
- Differential diagnosis - Other diseases that may cause clinical signs similar to those seen with shar-pei fever include:
- Recommended tests - CBC, biochemical profile, urinalysis, urine protein/creatinine ratio, renal or hepatic biopsy
- Summary of diagnostic criteria - Results of the diagnostics tests vary depending on the stage of disease. Early in the disease, the tests may only reveal an elevated white blood cell count. As amyloid deposits occur and the disease progresses, azotemia or liver dysfunction may develop. Biopsy confirms the presence of amyloid.
- Prognosis - The long-term prognosis for affected dogs is poor. Many dogs are in renal failure by 3 to 5 years of age and may expire by 7 years of age.
TREATMENT OF SHAR PEI
TREATMENT PRINCIPLES
The main goal of therapy in dogs with shar-pei fever is to reduce the risk of secondary renal or hepatic disease in patients suffering from the signs of recurring fever and lameness.
INITIAL/HOSPITAL THERAPY
In most cases the fever episodes are short-lived and do not cause prolonged illness. Sometimes, however, the fevers can be quite high and may require hospitalization. In dogs with temperatures greater than 106 degrees F, there is a risk of cell damage secondary to the excess body heat. These patients need to be hospitalized and treated with intravenous fluids. If there is any indication of concurrent bacterial infection, antibiotic therapy is also warranted. In most cases there are no infections, and antibiotics do not help. Supportive therapy should be provided for dogs already showing signs of renal failure. This may include fluid therapy, gastric protectants and anti-emetics.
LONG-TERM/HOME THERAPY
Non-steroidal anti-inflammatory drugs may be used to relieve pain and lameness associated with the episodes of fever and joint swelling. They may also reduce the fever but should be used with caution in dogs with renal dysfunction. Colchicine has been used in the treatment of people with familial Mediterranean fever and has been used experimentally to treat dogs. When used early in the course of the disease, colchicine helps reduce the frequency of fever episodes, as well as reducing the likelihood of amyloid deposition and secondary renal or hepatic failure. The use of colchicine in patients with established renal failure may or may not be helpful, and may increase the risk of drug toxicity. A low protein diet may be helpful in delaying the development of renal disease in dogs with recurrent fever episodes.
FOLLOW-UP CARE
Frequent monitoring of complete blood counts is important for patients treated with colchicine. Initial evaluation should be carried out every 2 weeks. Patients in renal failure also require careful and frequent monitoring of weight, CBC, biochemical profile and blood pressure.
-------------------------------------
Colchicine:
Colchicine is a drug that has been in use in people with FMF to
prevent amyloidosis. It is currently being recommended in Shar-Pei
with FSF for the same purpose. No studies have been completed to
determine if it is useful for this purpose in the Shar-Pei or not.
The clinical impression is that it does help. Those dogs on colchicine
seem to have fewer FSF episodes and less severe signs while on the drug.
Side-effects appear to be minimal at this time and are primarily
gastrointestinal, such as vomiting, diarrhea, anorexia
(decreased appetite), etc.
