Can blood serum amyloid A concentrations in horses differentiate synovial sepsis from extrasynovial inflammation and determine response to treatment?
Abstract: Serum amyloid A (SAA) concentrations in blood and synovial fluid of horses with synovial sepsis have diagnostic value. Studies suggest serial blood SAA measurements could act as a prognostic indicator. This study evaluated the use of serial blood SAA concentrations for monitoring of horses with synovial sepsis. A prospective clinical trial was performed of horses referred to a single hospital with synovial sepsis that survived (n=17), synovial sepsis that were euthanised (n=5), non-septic intrasynovial pathologies (n=14) or extensive extrasynovial lacerations (n=5). SAA concentrations were determined on admission and every 24 hours thereafter. The area under the concentration-time curve from 0 to 144 hours of each group was compared by Kruskal-Wallis and post hoc Dunn's tests (P<0.05). Significant difference in mean blood concentration of SAA was found between synovial sepsis that survived and non-septic pathologies in the first 48 hours, as well as between non-septic intrasynovial pathologies and non-responsive sepsis requiring euthanasia. No difference was found between extensive extrasynovial lacerations and any septic group. While serial blood SAA is useful for monitoring clinical response of intrasynovial septic pathologies, interpretation should consider other clinical findings since blood SAA is not a specific marker for synovial sepsis.
© British Veterinary Association 2020. Re-use permitted under CC BY. Published by BMJ.
Publication Date: 2020-02-25 PubMed ID: 32098906PubMed Central: PMC7591800DOI: 10.1136/vr.105153Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Clinical Trial
- Veterinary
- Journal Article
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
The research evaluates the use of Serum amyloid A (SAA) concentrations in diagnosing, monitoring, and predicting treatment outcomes in horses with synovial sepsis.
Study Design and Groupings
- This was a prospective clinical trial involving horses referred to a single hospital for various issues related to synovial infections and inflammations.
- The horses were divided into four groups for analysis: those that survived synovial sepsis (17 horses); those euthanised due to synovial sepsis (5 horses); horses with non-septic intrasynovial pathologies (14 horses); and horses with extensive extrasynovial lacerations (5 horses).
Methodology
- SAA concentrations in the blood and synovial fluid of the horses were measured upon their admission and every 24 hours afterwards.
- The study investigated the concentration-time curve for SAA in the horses’ blood from 0 to 144 hours.
- The results were then analysed using the Kruskal-Wallis test and the post hoc Dunn’s test, with a significance level set at P<0.05. These tests are statistical methods used for comparing differences between medians in multiple groups.
Findings
- There was a significant difference in the mean blood SAA concentrations between horses that survived synovial sepsis and horses with non-septic intrasynovial pathologies in the first 48 hours. This suggests early SAA concentration might differentiate between septic and non-septic synovial conditions in horses.
- The study also revealed a significant difference in SAA concentration between horses with non-septic intrasynovial pathologies and those with septic conditions leading to eventual euthanasia; thus, potentially serving as an ominous prognostic indicator for those with poor response to sepsis treatment.
- However, no difference was found between the SAA concentrations in horses with extensive extrasynovial lacerations and any of the septic groups, indicating that SAA is not an exclusive marker for synovial sepsis. In this context, SAA might not discriminate between synovial sepsis and extrasynovial inflammation.
Implications
- This study suggests that while serial SAA measurements can be useful for monitoring clinical response in horses with intrasynovial septic conditions, its interpretation should be combined with other clinical findings due to its non-specificity for synovial sepsis.
Cite This Article
APA
Sinovich M, Villarino NF, Singer E, Robinson CS, Rubio-Martínez LM.
(2020).
Can blood serum amyloid A concentrations in horses differentiate synovial sepsis from extrasynovial inflammation and determine response to treatment?
Vet Rec, 187(6), 235.
https://doi.org/10.1136/vr.105153 Publication
Researcher Affiliations
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, Cheshire, UK.
- Program in Individualised Medicine, Washington State University, Washington, DC, USA.
- E Singer Equine Surgery and Orthopaedics, Parkgate, UK.
- Nantwich Veterinary Group, Nantwich, UK.
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, Cheshire, UK luis.rubiomartinez@hotmail.com.
- Sussex Equine Hospital, Ashington, Sussex, UK.
MeSH Terms
- Animals
- Biomarkers / blood
- Horse Diseases / blood
- Horses
- Prognosis
- Sepsis / blood
- Sepsis / veterinary
- Serum Amyloid A Protein / analysis
- Synovial Fluid
Conflict of Interest Statement
Competing interests: None declared.
References
This article includes 29 references
- Jacobsen S, Nielsen JV, Kjelgaard-Hansen M. Acute phase response to surgery of varying intensity in horses: a preliminary study. Vet Surg 2009;38:762–9.
- Haltmayer E, Schwendenwein I, Licka TF. Course of serum amyloid A (SAA) plasma concentrations in horses undergoing surgery for injuries penetrating synovial structures, an observational clinical study. BMC Vet Res 2017;13:137.
- Petersen HH, Nielsen JP, Heegaard PMH. Application of acute phase protein measurements in veterinary clinical chemistry. Vet Res 2004;35:163–87.
- Belgrave RL, Dickey MM, Arheart KL. Assessment of serum amyloid A testing of horses and its clinical application in a specialized equine practice. J Am Vet Med Assoc 2013;243:113–9.
- Cohen ND, Chaffin MK, Vandenplas ML. Study of serum amyloid A concentrations as a means of achieving early diagnosis of Rhodococcus equi pneumonia. Equine Vet J 2005;37:212–6.
- Coutinho da Silva MA, Canisso IF, MacPherson ML. Serum amyloid A concentration in healthy periparturient mares and mares with ascending placentitis. Equine Vet J 2013;45:619–24.
- Jacobsen S, Thomsen MH, Nanni S. Concentrations of serum amyloid A in serum and synovial fluid from healthy horses and horses with joint disease. Am J Vet Res 2006;67:1738–42.
- Jacobsen S, Andersen PH. The acute phase protein serum amyloid A (SAA) as a marker of inflammation in horses. Equine Vet Educ 2007;19:38–46.
- Jacobsen S. Review of equine acute-phase proteins. Equine Vet Educ 2007;53:230–5.
- Wright IM, Smith MRW, Humphrey DJ. Endoscopic surgery in the treatment of contaminated and infected synovial cavities. Equine Vet J 2003;35:613–9.
- Steel CM. Equine synovial fluid analysis. Vet Clin North Am Equine Pract 2008;24:437–54.
- Robinson CS, Singer ER, Piviani M. Are serum amyloid A or D-lactate useful to diagnose synovial contamination or sepsis in horses?. Vet Rec 2017:5–10.
- Sanchez-Teran AF, Bracamonte JL, Hendrick S. Effect of arthroscopic lavage on systemic and synovial fluid serum amyloid A in healthy horses. Vet Surg 2016;45:223–30.
- Sanchez-Teran AF, Bracamonte JL, Hendrick S. Effect of repeated through-and-through joint lavage on serum amyloid A in synovial fluid from healthy horses. Vet J 2016;210:30–3.
- Sanchez Teran AF, Rubio-Martinez LM, Villarino NF. Effects of repeated intra-articular administration of amikacin on serum amyloid A, total protein and nucleated cell count in synovial fluid from healthy horses. Equine Vet J 2012;44:12–16.
- Dykgraaf S, Dechant JE, Johns JL. Effect of intrathecal amikacin administration and repeated centesis on digital flexor tendon sheath synovial fluid in horses. Vet Surg 2007;36:57–63.
- Jacobsen S, Jensen JC, Frei S. Use of serum amyloid A and other acute phase reactants to monitor the inflammatory response after castration in horses: a field study. Equine Vet J 2005;37:552–6.
- Jacobsen S, Niewold TA, Halling-Thomsen M. Serum amyloid A isoforms in serum and synovial fluid in horses with lipopolysaccharide-induced arthritis. Vet Immunol Immunopathol 2006;110:325–30.
- Matthews JN, Altman DG, Campbell MJ. Analysis of serial measurements in medical research. BMJ 1990;300:230–5.
- Ludwig EK, Brandon Wiese R, Graham MR. Serum and synovial fluid serum amyloid a response in equine models of synovitis and septic arthritis. Vet Surg 2016;45:859–67.
- Hooijberg EH, van den Hoven R, Tichy A. Diagnostic and predictive capability of routine laboratory tests for the diagnosis and staging of equine inflammatory disease. J Vet Intern Med 2014;28:1587–93.
- Pollock PJ, Prendergast M, Schumacher J. Effects of surgery on the acute phase response in clinically normal and diseased horses. Vet Rec 2005;156:538–42.
- Gibson KT, McIlwraith CW, Turner AS. Open joint injuries in horses: 58 cases (1980–1986). J Am Vet Med Assoc 1989;194:398–404.
- Findley JA, Pinchbeck GL, Milner PI. Outcome of horses with synovial structure involvement following solar foot penetrations in four UK veterinary hospitals: 95 cases. Equine Vet J 2014;46:352–7.
- de Seny D, Cobraiville G, Charlier E. Acute-phase serum amyloid A in osteoarthritis: regulatory mechanism and proinflammatory properties. PLoS One 2013;8:e66769.
- Kum C, Voyvoda H, Sekkin S. Effects of carprofen & meloxicam on CRP, ceruloplasmin, & fibrinogen concentrations in dogs undergoing OVH. Am J Vet Res 2013;74:1267–73.
- Ebersole JL, Machen RL, Steffen MJ. Systemic acute-phase reactants, C-reactive protein and haptoglobin, in adult periodontitis. Clin Exp Immunol 1997;107:347–52.
- Karademir U, Akin I, Erdogan H. Effect of ketoprofen on acute phase protein concentrations in goats undergoing castration. BMC Vet Res 2016;12:123.
- Menkes CJ. Effects of disease-modifying anti-rheumatic drugs, steroids and non-steroidal anti-inflammatory drugs on acute-phase proteins in rheumatoid arthritis. Br J Rheumatol 1993;32:14–18.
Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists
