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What are Immune-Mediated Poly-Arthritis?

This type of arthritis is similar to rheumatoid arthritis that impacts humans as well. There is often times no cause or reason behind the arthritis and the symptoms can come and go without explanation. There is no cure for arthritis, however, there are ways to help your dog live his best and most comfortable life.

This disorder is the most common type of arthritis for dogs and can cause pain, difficulty walking, muscle atrophy, and more in your dog. This condition can cause symptoms that mimic other disorders as well and there is no guarantee that your dog will exhibit textbook symptoms. Immune-mediated poly-arthritis can impact both small and large breed dogs equally.

Immune-mediated poly-arthritis (IMPA) is a noninfectious disorder of your dog’s immune system that impacts his joints. It is possible to cause inflammation in all joints which can cause your dog to be in discomfort and pain.

Immune-Mediated Poly-Arthritis Average Cost

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Average Cost

$2,500

Symptoms of Immune-Mediated Poly-Arthritis in Dogs

The symptoms of IMPA can vary and look like other disorders, as the signs are often generic to multiple disorders. The symptoms listed may not all be present and may come and go over time.  

  • Lameness
  • Multiple joint pain
  • Joint swelling
  • Fever
  • Malaise
  • Anorexia
  • Lethargy
  • Difficult walking/standing
  • Stiffness
  • Vomiting
  • Diarrhea
  • Lymph nodes enlarged

Types

There are 2 larger subtypes – erosive and nonerosive IMPA and within that there are 4 subtypes of IMPA – Type I, Type II, Type III and Type IV. Erosive IMPA indicates there has been some damage to bone and/or cartilage. Nonerosive indicates there has not been any damage to bone or cartilage in your dog. 

Type I – Non identifiable disease

  • Most common of all IMPA
  • Accounts for more than 50% of all cases of IMPA in dogs
  • Diagnosis of exclusion

Type II – Infectious or inflammatory disease related

  • Superficial pyoderma
  • Urinary tract infection
  • Pneumonia
  • Endocarditis
  • Mastitis
  • Dirofilariasis
  • Fungal infection
  • Pleuritis
  • Severe periodontal disease
  • Diskospondylitis
  • Chronic salmonellosis
  • Bacterial prostatitis
  • Bacterial tonsillitis
  • Pharyngitis
  • Dermatitis
  • Pancreatitis

Type III – Seen with chronic stomach disease

  • Inflammatory bowel disease
  • Intestinal malabsorption
  • Bacterial overgrowth
  • Ulcerative colitis
  • Chronic and bacterial diarrhea
  • Eosinophilic gastric
  • Lymphocytic-plasmacytic hepatitis

Type IV – Associated with abnormal cells

  • Squamous cell carcinoma
  • Mammary adenocarcinoma
  • Leiomyoma
  • Heart base tumor
  • Seminoma

Other types

  • Breed associated
  • Drug associated
  • Vaccine associated
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Causes of Immune-Mediated Poly-Arthritis in Dogs

In the subtypes I-IV, 3 of them have known causes and those cases make up about 50% of dogs diagnosed with IMPA. However, Type I does not have any specific known causes and accounts for 50% of cases. 

Type I

 

  • Typically, no known cause
  • Common in all ages and breeds

Type II

  • Reactive to an infection
  • Bacterial infection
  • Fungal infection
  • Viral infection

Type III

  • Stomach/intestinal related
  • Liver related
  • Rare in dogs

Type IV

  • Overgrowth of cells outside of your dog’s joints
  • Rarest form of IMPA 

Other Causes

 

  • Breed associated (Akita, Chinese Shar-Pei, Boxer, Weimaraner, Bernese Mountain,German Shorthaired Pointer, Spaniel and Beagle breeds)
  • Drug associated (given within 30 days of onset of symptoms, but typically occurs within 5-20 days after drug administered - sulfonamides, lincomycin, erythromycin, cephalosporins, phenobarbital, penicillins)

  • Vaccine associated (administered within 30 days of onset of symptoms, somewhat weak link between the 2)
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Diagnosis of Immune-Mediated Poly-Arthritis in Dogs

If you begin to notice that your dog is suffering from pain, discomfort, difficulty walking and other odd symptoms with no readily available explanation, your veterinarian may be able to help you. Your veterinarian will most likely want to do a full physical exam on your dog to see if he is having pain, swelling in his joints, unexplained fever and other common symptoms to begin diagnosing.

Once your veterinarian performs a physical exam she will most likely want to hear about your dog’s history of other health concerns including any medication changes or recent vaccinations, injuries, exposure to anything that could have resulted in his symptoms. While a physical exam and history alone can diagnosis IMPA, your veterinarian may want to run some tests as well.

These tests could include drawing fluid from your dog’s joints (arthrocentesis), and x-rays of joints he is feeling pain in to see any deterioration of those areas. Your doctor may want to rule out lyme disease, other tick borne disease, and any other possible underlying causes via blood tests. Tests may be done on your dog’s stomach to determine if the cause is Type III as well – including ultrasounds, x-rays or scans. 

When prepping for your visit with your veterinarian it is important to gather as much information as possible to share with her about your dog. It would be beneficial to have a timeline of how long your dog has been suffering from symptoms and what his exact symptoms are. It would also help your veterinarian to make the best diagnosis for your dog if you can give any specifics as to when it gets worse or better, or if you have noticed the symptoms come and go over time, as arthritis symptoms tend to do this.

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Treatment of Immune-Mediated Poly-Arthritis in Dogs

In terms of treatment options for your dog, your veterinarian will most likely suggest medication management for your dog’s symptoms as the disease is not curable. Learning to manage your dog’s symptoms will lead to a happier, healthier and pain-free life for him. 

Medication management for your dog’s symptoms is the go to option for many veterinarians. These medications fall under two categories which are immunosuppressive  and chemotherapeutic medications. Immunosuppression medications will be anti-inflammatory typically, such as corticosteroids (prednisone) alongside other medications (chemotherapeutic) such as Azathioprine, Leflunomide, and Cyclophosphamide. Long term corticosteroid use can have side effects also such as diabetes, urinary tract infections and hyperadrenocorticism. 

It is recommended that liver enzymes be checked out if your dog is on Azathioprine, and side effects can include bone marrow becoming suppressed and cystitis. Azathioprine can be used for a longer period of time than Cyclophosphamide which is not recommended past four months of use. 

Immunomodulation drugs which are used to regulate your dog’s immune system have been found to be beneficial if your dog’s IMPA does not go in remission or they have a relapse of symptoms. There are some side effects however, such as lethargy, vomiting, diarrhea, agitation, and anemia. 

Medication management is done over the course of 2-4 months and if your dog is responding, your veterinarian will begin to taper him down off of the medications. The taper can take another 2-4 months after that. 

There is a high rate of relapse with IMPA due to the fact that it can act up anytime and without warning. The prognosis is good for Type I with ongoing medication management. Types II-IV have a good prognosis assuming the underlying cause of their IMPA is treated adequately in order to take care of the IMPA symptoms. Up to 56% of dogs have gotten off of medication management therapy.

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Recovery of Immune-Mediated Poly-Arthritis in Dogs

It will be important as your dog continues to age and grow to have him checked out regularly for any changes in his IMPA symptoms and any necessary medication changes. Your dog may relapse as discussed above, so follow up appointments will be beneficial to keep him comfortable. 

If it has been found that your dog’s IMPA was the cause of Type II-IV you may have to continue working with his veterinarian to ensure those underlying issues are continuing to be taken care of as well. Keeping up with your dog’s medication and making sure he is taking them as directed will also help him to remain pain-free.

Lastly, as there is no cure for IMPA you can expect to deal with possible flare ups throughout your dog’s life. However, once the underlying issues are handles in Types II-IV it should be easier to control the IMPA and your dog should be able to continue his normal routine.

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Immune-Mediated Poly-Arthritis Average Cost

From 593 quotes ranging from $800 - $4,000

Average Cost

$2,500

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Immune-Mediated Poly-Arthritis Questions and Advice from Veterinary Professionals

Need pet health advice? Ask a vet

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Ask a Vet

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Elton

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Hound

dog-age-icon

4 Years

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Moderate severity

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Moderate severity

Has Symptoms

Limb Swelling
Limping

My dog Elton was diagnosed with IMPA and prescribed presnidone 15 mg x 2 per day. He initially responded well and in 3 days was back to his normal self but a few days after he started to regress and became lethargic and unable to walk/stand on his own. We took him back to the hosptial where they re-examined him and didn’t feel the need to run additional tests, felt this came on from overuse and prescribed strict crate rest a long with the same presnidone dosages. Elton had to be a carried for a few days to his walks but today was finally able to walk (short just to pee) on his own. However, he did have throat swelling in the beginning (which caused them to do an endoscopy before diagnosing the IMPA through a joint tap) and we came to decide with the vet that the swelling was a result of the inflammation and pain (it has gone down significantly since) but Elton has still lost his bark. The engiscopy showed no foreign objects or abnormalities of the throat. Could this still be a side effect of the inflammation? We have only had him on presnidone for a week thus far.

Aug. 12, 2018

Elton's Owner

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3320 Recommendations

Some inflammation may occur after endoscopy, but shouldn’t be too severe and the corticosteroids should also help with that; keep an eye on Elton for the time being and ensure that he he is kept well rested. If there is no improvement over the next few days return to your Veterinarian. Regards Dr Callum Turner DVM

Aug. 12, 2018

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Gibson

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Catahoula Bulldog

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7 Years

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Serious severity

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Serious severity

Has Symptoms

See Above

Hello, My 7yr old, 55lb bully mix was diagnosed with IMPA last November. He has been treated with prednisone, but is experience very extreme side affects that are now potentially life threatening. Mychophenolate was added before tampering the pred. He relapsed on 3 occasions even at previously therapeutic levels. Cyclosprine was added to the mix and after 3-4 days, a very fast tamper of pred (reduction every 3-4 days) resulted in another relapse. We are now experiencing significant protein in the urine (5.7!), in addition to the pancreatitis, increased liver enzymes (controlled with Denamarin), and extreme muscle wasting caused by the prednisone. We are evaluating Leflunimide currently, but have started Benazapril in the short term. Any advise is appreciated as my vet is struggling with next steps. He is currently on all medications listed above except Cyclosporine, which was deemed ineffective.

April 18, 2018

Gibson's Owner


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Dr. Michele K. DVM

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1611 Recommendations

I'm sorry that this is happening to Gibson. Given your description, it might be best to have a referral to a specialist by your veterinarian. It seems that they have done a great job managing his disease, but his condition is complicated, and a specialist is often helpful to provide ongoing support and care.

April 18, 2018

Our lab was DX with IMPA 2 months ago. Takes high dose Prednisone and Cyclosporin. She is very weak, no energy at all. Taking Codeine for pain. She just turned 2 years. We tried Holistic meds, prescribed by her general vet, not the internist, Phytoprofen, Yi Yi Ren Tang, and she vomited. We stopped and started same meds, she vomited so off the Holistic meds. Were trying BPC-157 injections. Hope this helps, but nothing much helping at month 2. We are treating joints with cold laser TX.

June 24, 2018

Patty H.

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Bailee

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German Shepherd

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6 Years

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Serious severity

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Serious severity

Has Symptoms

Lameness, Inflammation On Joints

Do you have any recommendations in changing a dog’s diet that can also help manage IMPA in addition to anti inflammatory medications. Bailee was diagnosed with IMPA for a year now. The initial symptoms were lameness, bloody lesions in her legs, mass on the left side of her face, loss of appetite and weight. She was on prednisone for a year but was taken off for a few months now. She is also prescribed Atopica. She had TPLO surgery on both knees last October 2017. Recently, she had exhibited infalammtion in her elbows, neck, and eyes.

March 3, 2018

Bailee's Owner

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3320 Recommendations

There is no specific diet for managing immune-mediated polyarthritis, the only recommendation I can give is to keep Bailee on the lean side of her reference range for weight to reduce stress on the joints. Regards Dr Callum Turner DVM

March 3, 2018

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douglas

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Labrador Retriever

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3 Years

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Serious severity

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Serious severity

Has Symptoms

Swollen Joints

Our currently 3 year old lab was diagnosed with Immune-Mediated Poly-Arthritis at 1 1/2 years old. He was initially treated with steroids and tapered off, relapsed and treated with Cyclosporine. The initial treatment with steroids was harsh on him, but the Cyclosporine didn't affect him adversely. He was tapered off about 6 months ago and has been fine since. Our vet suggested he does not get any further vacines including rabies. This poses a problem as we RV travel and periodically kennel him during the day if we are unable to have a reliable Air Conditioning source. Also, groomers and our local doggy-day-care requires rabies shots for all animals. I would like to gather more info on the possible adverse effects of the rabies vaccination and also like to hear some other opinions on this.

Feb. 8, 2018

douglas' Owner

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Dr. Michele K. DVM

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1611 Recommendations

Thank you for your email. Medications, and vaccinations, are recognized as a cause of IMPA in dogs. What most people do when their dogs have a condition that makes vaccines a dangerous possibility is to have regular Rabies titers run to prove protective levels of Rabies antibodies in that dog, and have documentation for that as well as a signed document from your veterinarian stating that Douglas is not advised to have vaccines. I am attaching an article written by Jean Dodds, a noted veterinary authority on vaccinations: https://drjeandoddspethealthresource.tumblr.com/post/156217554971/immune-mediated-polyarthritis-dog#.WnzM7CXwbIU. I hope that helps, and that Douglas continues to do well.

Feb. 8, 2018

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Bones

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Labrador Retriever

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10 Weeks

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Serious severity

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Serious severity

Has Symptoms

Extreme Lethargy Jaw & Joint Pain

Last night My sons 10 week old lab puppy presented with jaw pain, joint pain in all four legs and the inability to open his mouth (even after sedated). The vet “diagnosed” IMPA, but to costs we were unable to do the joint tap to be certain of its origin. The vet gave him an injectable steroid and pain meds and said if it was auto immune, as opposed to infectious, we would see a marked improvement by morning (we were at the ER clinic until 1 am). This morning by 7 am, he is licking things, starting to tenderly chew things (in true puppy fashion) and seems to be getting around not nearly the amount of lethargy he’s had for the last 2 days, being EXTREME last night. Anyhow, what now? I know there will be a long term steroid treatment, at least that’s what it sounds like,but what can we expect from here on out? The dog was bred to be a hunting dog and an outdoor partner. Will IMPA affect whether he can do his job? Will this limit his ability to go on prolonged outdoor adventures? We definitely do not want to put the little guy ina position where we cause a flair up. Your thoughts would be appreciated!!!

Jan. 27, 2018

Bones' Owner

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3320 Recommendations

Immune-mediated polyarthritis is due to an immune system dysfunction which leads to joint inflammation during flare ups; it is possible that this will be the only flare up or it may be that the condition will recur throughout his life. It is important to monitor how he will respond to treatment and then in discussion with your Veterinarian discuss his life as a hunting dog. I cannot give you any assurances this early on in the diagnosis and I haven’t examined him either. Regards Dr Callum Turner DVM http://veterinarymedicine.dvm360.com/recognizing-and-treating-immune-mediated-polyarthritis-dogs

Jan. 27, 2018

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Nara

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Mini Australian ShepherD

dog-age-icon

1 Year

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Serious severity

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pill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filled

Serious severity

Has Symptoms

Limping
Lameness

My 1 year old was diagnosed recently with IMPA after 2 weeks of going through symptoms such as lameness in one back leg to another, and vets diagnosing it initially as a cruciate tear and suggesting surgery. After she developed a fever, lack of energy and decrease in appetite, we went back to our vet and did blood work and joint taps to get an IMPA diagnosis. Our dog was on raw food for most of her puppyhood until the diagnosis and the vet recommended against it while she's on prednisone because of a lowered immune system and possibilities of a food borne illness. I've heard some mixed opinions from other people who've fed raw with dogs that have IMPA and am confused about whether we really need to change my dog's diet completely or not. For the past 2 weeks, we've been cooking food for her but I know it's not the most balanced diet at the moment in comparison to what we were doing with raw. Any advice would be appreciated!

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Ducky

dog-breed-icon

Golden Retriever

dog-age-icon

2 Years

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Serious severity

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pill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filled

Serious severity

Has Symptoms

Fever
Joint Pain In Limbs
Joint Pain In Jaw

Our golden was diagnosed in July at 1 1/2 years old, and we're still working with a specialist to get him into remission. He's on prednisolone and cyclosporine. We tried to taper the prednisolone in October but he relapsed. We had hoped to taper after his recent checkup since his symptoms were well controlled, but his white cell count was still elevated so we opted to maintain the current dose. Then, on Dec. 1, we gave him his NexGard dose (hadn't in a few months since he'd been on so many meds during this ordeal) and his HeartGuard, and his symptoms returned, this time with joint pain in his jaw -- a symptom he hadn't had before. We are so discouraged.

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Shiloh

dog-breed-icon

Golden Retriever

dog-age-icon

5 Months

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Serious severity

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pill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filled

Serious severity

Has Symptoms

Fever
Lethargy
Joint Pain
Trouble Sitting/Standing Up

My golden retriever puppy was sleeping all day long, and I noticed a limp when he was walking. I took him to the vet and they believed it was just being worn out from environmental change. His symptoms got worse and worse and he seemed depressed so I decided to take him on a walk. The next day it was so bad he couldn't stand up. So I took him into the vet again and she ran x-rays, blood tests, stool tests, and everything came back normal. Took him to a specialists and did a tick panel. Also came back negative. But he was put on Doxycycline and his condition improved greatly. He is now getting joint taps done and will probably need to be put on steroids for a while. I am hoping that this is not a recurring situation and steroids will solve the condition. He is too young for all these problems!

Immune-Mediated Poly-Arthritis Average Cost

From 593 quotes ranging from $800 - $4,000

Average Cost

$2,500