Lowrie, Mark L.
Steroid responsive meningitis-arteritis : a prospective study of potential disease markers, prednisolone treatment, and long-term outcome in 20 dogs (2006 – 2008).
MVM(R) thesis, University of Glasgow.
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Steroid responsive meningitis-arteritis (SRMA) is a common disease of the dog with no specific ante-mortem diagnostic test and management is complicated by the requirement for prolonged treatment and the potential for relapse. The value of immunosuppressive prednisolone has been established but an optimal regime is not described. The lack of diagnostic and prognostic markers makes management frustrating. This study prospectively evaluates a protocol for the use of a prednisolone monotherapy in the management of SRMA. The utility of conventional and novel protein markers was evaluated by examining their expression at various milestones in the management of SRMA and by comparing this to their expression in other canine inflammatory and non-inflammatory central nervous system (CNS) diseases.
This prospective study recruited twenty dogs with a clinical diagnosis of SRMA presenting to the University of Glasgow Small Animal Hospital between May 2006 and May 2008. These patients were enrolled on a strict prednisolone regimen with serum and cerebrospinal fluid samples taken at key points in the management of this disease.
The protocol was successful at achieving resolution of clinical signs with no relapse in the follow up period in all 20 dogs. Clinical remission was achieved in all cases within 2 weeks of starting the protocol. When relapse occurred during the treatment schedule (4/20), restarting the treatment schedule led to resolution of the disease. The fact that dogs did not relapse post-treatment in this study is supportive of the value of this protocol in managing SRMA.
Overall, the findings detailed in this thesis support the use of an immunosuppressive prednisolone monotherapy in the treatment of canine SRMA. Acute phase proteins are significantly elevated at initial presentation with the remission of clinical signs, induced by immunosuppressive therapy, reducing but not eliminating this increase in serum concentrations. APPs are of particular value in the identification of putative relapse. In contrast, serum and cerebrospinal fluid IgA provides valuable information at diagnosis but a persistent increase throughout the disease limits their value in the monitoring of therapy. This immunoglobulin was found to be also be elevated in the serum and cerebrospinal fluid of other inflammatory and non-inflammatory canine CNS diseases. A robust prognostic marker for SRMA remains elusive
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