The purpose of this study was first to describe the clinical findings, case management and short-term outcome of horses with septic synovial structures over the last 25 years, and to identify risk factors and treatment modalities associated with specific short-term outcomes. Secondly, we wanted to evaluate a broad range real time polymerase chain reaction (RT PCR) assay for the diagnosis of septic synovitis from synovial fluid (SF) samples of horses, and compare its performance to currently available diagnostic methods. For the retrospective study, 367 cases met the inclusion criteria. Lavage of the synovial structure and endoscopic surgery were associated with an increased likelihood of discharge from hospital, however, none of the local antimicrobial delivery modalities were associated with a significant change in outcome. No significant improvement in hospital outcome of horses with septic synovitis was identified over the past 25 years. For the RT PCR study, 48 SF samples from horses with suspected septic synovitis were included, and RT PCR and microbial culture was performed on all samples. One additional RT PCR assay was performed on samples with discordant results or identification of dissimilar organisms. Thirty-eight percent of SF samples had positive culture results, and 42% of SF samples had positive RT PCR results. Sensitivity and specificity for the RT PCR assay relative to agreement of observers on the likelihood of infection were 87% and 72%, respectively, whereas for culture they were 56% and 86%, respectively (P=0.001). The combination of culture and RT PCR assay resulted in sensitivity and specificity of 85% and 81%, respectively. The broad range RT PCR assay was more sensitive than culture for identification of horses with septic synovitis. Further refinement of the RT PCR assay technique may facilitate use in a clinical setting. / Equine Guelph, University of Guelph

This research evaluated serum amyloid A (SAA) concentration in synovial fluid of healthy horses as a potential marker for use in the diagnosis and monitoring of horses with septic arthritis. The first study evaluated the effect of arthroscopic lavage of healthy joints on concentrations of systemic and synovial SAA; as well as total protein concentration, nucleated cell count and percentage of neutrophils in synovial fluid. The second study, evaluated the effect of repeated through-and-through joint lavage on SAA in systemic blood and SAA, total protein, nucleated cell count and percentage of neutrophils in synovial fluid from healthy joints. In the first study, middle carpal joints of 6 horses were randomly assigned to one of the following treatments 1) arthrocentesis (controls) or 2) arthroscopic lavage. A washout period of 30 days was allowed in between treatments. Synovial fluid and blood samples were collected at 0, 24, 48, 72, 96 and 120 h. Measurements included SAA in blood and synovial fluid, and total protein, nucleated cell count and percentages of neutrophils in synovial fluid. In the second study, one tarsocrural joint was randomly assigned to receive repeated through-and-through joint lavage at 0, 48 and 96 h in 6 horses. Synovial fluid and blood samples were collected at 0, 24, 48, 72, 96 and 120 h. Measurements included SAA in blood and synovial fluid, and total protein, nucleated cell count and percentages of neutrophils in synovial fluid. For this study, synovial fluid samples collected at time 0 were considered as control values. After arthroscopic lavage and repeated through-and-through joint lavage, systemic and synovial SAA did not increase from baseline values (except for systemic SAA at 24h after arthroscopic lavage and in controls). Total protein values were significantly increased at all time points after arthroscopic and through-and-through joint lavages (except at 96h on both lavage procedures) but not in controls. With both lavage procedures, nucleated cell count significantly increased from baseline values at all time points (except at 96h after through-and-through joint lavage). Percentage of neutrophils was significantly increased after arthroscopic lavage at all time points and only at 24h in controls; however, the percentages of neutrophils were not significantly increased after repeated through-and-through joint lavage. Synovial SAA was not affected by arthroscopic or repeated through-and-through joint lavage; however, synovial total protein and nucleated cell counts were significantly increased. Synovial SAA may be a valuable inflammatory marker that is not affected by procedures as arthroscopic or repeated through-and-through joint lavage in horses. Further validation of synovial SAA as a marker for evaluating the progression of septic joints while treatment is installed is warranted.