Steroid Responsive Meningitis‐Arteritis: A Prospective Study of Potential Disease Markers, Prednisolone Treatment, and Long‐Term Outcome in 20 Dogs (2006–2008)

Abstract

Background: Previous multidrug studies have identified the value of prednisolone in treating steroid responsive meningitisarteritis (SRMA) and the potential value of acute phase proteins (APPs) and immunoglobulin A (IgA) in diagnosis and monitoring.Hypothesis: (1) Prednisolone monotherapy is a successful immunosuppressive modality in the treatment of SRMA; (2) protein markers are useful in identifying the potential for relapse.Animals: Twenty client-owned dogs with SRMA presented to the University of Glasgow Small Animal Hospital between May 2006 and May 2008.Methods: A prospective, observational study: CBC, biochemistry, and cerebrospinal fluid (CSF) analyses were performed. C-reactive protein (CRP), serum amyloid-A, a-1-acid glycoprotein, and haptoglobin (Hp) were assessed in the serum. IgA concentrations were determined in the serum and CSF.Results: Clinical resolution of SRMA was achieved in all 20 dogs. Serum CRP concentration remained increased at remission in 16/20 dogs whereas CSF cytology was within normal limits in 20/20 dogs. Serum APPs decreased significantly on treatment (P o .05) except Hp, which remained unaltered. Serum and CSF IgA concentrations remained increased for the duration of treatment.Conclusions and Clinical Importance: The prednisolone regimen presented was successful in treating SRMA without the need for additional drugs. Serum APPs are of use in the diagnosis and management of SRMA, particularly in relation to identifying relapse. Serum and CSF IgA concentrations remain increased throughout disease, aiding in diagnosis but not contributing to the management of SRMA.

Canine C-Reactive Protein Measurements in Cerebrospinal Fluid by a Time-Resolved Immunofluorimetric Assay

“…12 However, these methodologies do not seem to be sensitive enough to detect the small CRP concentrations present in this type of biological fluid in healthy animals and animals with different diseases such as IVDD, DLSS, and IE, since CRP values reported were in many cases below the detection limit of the assays. This could be why serum CRP concentration was found to be of clinical value in treatment monitoring and in the identification of putative relapse of SRMA, but CSF CRP turned out to be a less reliable marker in the management of the disease, 12,13 probably owing to the negligible concentrations observed after instauration of treatment.…”

Intracerebral haemorrhage in a dog with steroid‐responsive meningitis arteritis

“…Immunosuppressive doses of oral prednisolone (Prednidale, Dechra) at 2 mg/kg every 12 hours and 1 mg/kg of oral omeprazole (Losec mups, AstraZeneca) every 24 hours for seven days were initiated when the CSF analysis results were obtained. The dose of prednisolone was gradually decreased over a six-month period as previously described (Lowrie and others 2009). …”

“…It is a systemic disease with potential involvement of multiple organs (Harcourt 1978, Tipold and others 1995, Snyder and others 1995), but the clinical and pathological manifestation of SRMA is predominantly neurological (Tipold and others 1995, Lowrie and others 2009, Tipold and Jaggy 1994, Navarro-Cubas and others 2011). Intraparenchymal central nervous system lesions secondary to SRMA are uncommon (Snyder and others 1995, Wrzosek and others 2009, Hughes and others 2015); and to the authors’ knowledge, an intracerebral haemorrhage secondary to SRMA has not been previously reported.…”

Acute Phase Proteins as Biomarkers in Animal Health and Welfare

“…Dogs with mammary neoplasia have high CRP, SAA and Hp levels but the increased concentrations of APPs could be stimulated by different factors, such as metastasis, large size of the primary mass and ulceration or secondary inflammation of the neoplasm (Planellas et al, 2009;Tecles et al, 2009). Serum levels of these APPs are of use in the diagnosis and management of steroid responsive meningitis-arteritis (SRMA), particularly in relation to identifying relapse (Lowrie et al, 2009). Dog with gastric mucosa injury present elevated serum CRP, SAA and Hp levels and may be potentially useful together with gastroscopy in the diagnosis and monitoring of gastric injury (Bayramli & Ulutas, 2008).…”