Immune-Mediated Poly-Arthritis Average Cost

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Average Cost

$2,500

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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.

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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

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)

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.

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.

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.

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

Gibson
Catahoula Bulldog
7 Years
Serious condition
0 found helpful
Serious condition

Has Symptoms

see above

Medication Used

mychophenolate
Benazepril
denamarin
prednisone

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.

Dr. Michele King, DVM
Dr. Michele King, DVM
1406 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.

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.

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Jake
German Shepherd
7
Moderate condition
0 found helpful
Moderate condition

Has Symptoms

Hip pain

Medication Used

Carprofen

My 7 year old German shepherd Was treated with prednisone. He had been off of it now for a little over two weeks. This is the first time it has occurred and was diagnosed with immune arthritis . He has one hip that is slightly off and and wanted to put him on galliprant. He has never really been sick this is a first. All bloodwork has continued to come normal. Is gallipant a good route to go? Should I be giving him something else also. There so far has been no reoccurrence. He was a dog that ate raw up until this occurred with no issues. He is currently eating earthborn as he was losing weight after illness occurred. So far so good I am now looking for info on keeping him comfortable with his hip other than that he is doing great. I am giving him carprophen as needed and have heard galliprant could be more beneficial and less damaging to kidneys and liver.

Dr. Callum Turner, DVM
Dr. Callum Turner, DVM
2992 Recommendations

Galliprant (grapiprant) is a newer type of antiinflammatory which has been shown to have less side effects than the other antiinflammatories being overall better for liver and kidney function over the long term and even at absurdly high doses; Galliprant is also in a new different category of medication as it works differently to other products like carprofen and meloxicam. I cannot give any recommendations as I haven’t examined Jake and the Galliprant wouldn’t affect the underlying cause (you would still need prednisone if there was another flare up) but may be suitable for pain management; you would need to speak with your Veterinarian about Jake’s specific case. Regards Dr Callum Turner DVM

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Bailee
German Shepherd
6 Years
Serious condition
0 found helpful
Serious condition

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.

Dr. Callum Turner, DVM
Dr. Callum Turner, DVM
2992 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

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Millie
Spoodle
9 Months
Serious condition
0 found helpful
Serious condition

Has Symptoms

Pain
Loss of Appetite
Lethary

Hi, Our 9 month old Spoodle has been diagnosed with Poly Arthritis and Pancreatitis. When first taken they stated that she had a respiratory infection. We have now seen three vets at the same clinic and we are extremely confused and concerned. Should we treat one first over the other? They vet here has stated that the steroids if we treat Poly Artritis may affect Pancreas and we are unsure what to do. Any advice would be greatly appreciated as our little lady is in pain. Thank you

Dr. Michele King, DVM
Dr. Michele King, DVM
1406 Recommendations
Thank you for your email. Unfortunately, without examining Millie and knowing more details about her lab work and signs, I can't comment on how to treat her. What would be a good idea is to talk frankly with one of the veterinarians taking care of her case and find out what exactly they have found, and how they want to treat it. Both immune mediated arthritis and pancreatitis need to be treated, and they need to have a plan as to how to treat those disease, and they need to communicate it to you. If you are not satisfied with the answers, it is more than acceptable to seek a second opinion, but they should be able to clear things up if you let them know that you don't understand. We tend to get hurried, and forget that not everyone speaks medical language. I hope that Millie recovers well.

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douglas
Labrador Retriever
3 Years
Serious condition
0 found helpful
Serious condition

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.

Dr. Michele King, DVM
Dr. Michele King, DVM
1406 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.

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Bones
Labrador Retriever
10 Weeks
Serious condition
0 found helpful
Serious condition

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!!!

Dr. Callum Turner, DVM
Dr. Callum Turner, DVM
2992 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

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