Septic Arthritis or Mediated Polyarthritis?

[Mac and Cats]

Hi,

Our cat Molly, who is about 14 years old, has been getting monthly Solensia injections for about a year. She has very bad arthritis. She also gets Gabapentin twice a day and hyperthryoid meds. Recently, I noticed her ankle joints were crazy swollen. I took her to the vet where they had planned to do an x-ray. When we arrived, the vet told me their machine was broken and we'd have to do the x-rays another time. Anyway, they had me leave her there for a couple hours so the doctor could take a look at her. When it was time to pick her up she told me she suspected it is Septic Arthritis or Mediated Polyarthritis. They told me the Septic Arthritis is usually from an injury from another cat, but she hasn't had any injuries and hasn't been in contact with other cats except our own who are all indoor cats. Molly will sometimes go out in the backyard with us during the summer, but that's it. She just likes to roll on the pavement and lay in the sun. It's winter so she hasn't gone outside. (She used to belong to my parents and they let her outside, which is why we allow her to go in the backyard with us.) The vet said she wanted to start her on antibiotics and if that helps, we would probably do another round of antibiotics and also add steriods. However, she said that we wouldn't know if they were working until day 14. She started the antibiotics on Sunday evening (it's now Tuesday). She said if we started with steriods and it isn't IS septic arthritis, it could make it worse, which was her reasoning for not starting them yet.

I'm wondering if it is Mediated Polyarthritis, which is an autoimmune response, if it could be that her body is reacting to the Solensia injections? I did ask the vet this, but she said she couldn't find anything about that and I couldn't either. Does anyone have any experience with either of these? The doctor also recommends we stop the Solensia injections, which I agree with.

In addition to her hind hocks (ankle joints), her front elbows are also swollen. I also noticed her standing super weirdly a day before we took her to the vet with her sort of walking/standing on her front ankle occasionally. I will show pictures below. She isn't really acting any different. She's still getting up to use the bathroom, eating/drinking normally, peeing/pooping normally and not vomiting. She does sleep a lot, but before the solensia injections, she was basically not moving at all aside from going to the litterbox. Now she at least moves locations throughout the day. Here are the photos.

NORMAL

NOT NORMAL

For the record, she's not fully walking on her front ankle like that, but every once in a while it will go to this position, mostly when she's just sitting and only for a few seconds and occasionally when she is walking. Over the past year or so, I have noticed sometimes when she sits her ankle sort of quivers for a few seconds, but I've never been able to get a video of it. Any input or other ideas or if you think I should have the vet do something further besides just going back for x-rays would be very much appreciated. We don't have unlimited funds and we already have another cat going through a lot of our funds right now, but I also don't want to do Molly any injustice by not taking this as seriously as her brother's health issues. Thank you in advance.

Edit: I forgot to mention that the vet said that neither of these options have anything to do with her actual arthritis.

 

[FeebysOwner]

Hi. From what I know, both of those conditions can arise from an auto-immune issue (like an underlying viral condition). Neither has to be from an injury. It does seem that the first line of treatment is long-term antibiotics, and sometimes anti-fungal drugs. Those are often followed by/accompanied with anti-inflammatories. You might ask the vet if there would be any help in testing Molly for some of viruses that could potentially lead to this.

Joint taps can be done to determine what kind of bacteria/fungus that might be involved, but as far as I know that requires a cat to be anesthetized. X-rays can be helpful in looking at the structure of the joints, so probably should get those done when you can. Pain management is crucial.

These conditions are typically the result of an infection elsewhere in the body that is attacking the lining of the joints, Probably why your vet said it really doesn't have anything to do with Molly's arthritis. Given Molly's long term use of Solensia, it stands to reason that discontinuing it would make sense. There are only so many follow-up studies out there about it. I don't know whether introducing another arthritis joint aid would be advisable at this juncture, but you could ask the vet about Adequan which is a joint pain and supplement for arthritis.

Has the vet considered consulting with specialty vets and/or a vet university to see if they could help?

Please keep us posted. Our thoughts and hopes are with Molly and you.

 

[Mac and Cats]

Hi. From what I know, both of those conditions can arise from an auto-immune issue (like an underlying viral condition). Neither has to be from an injury. It does seem that the first line of treatment is long-term antibiotics, and sometimes anti-fungal drugs. Those are often followed by/accompanied with anti-inflammatories. You might ask the vet if there would be any help in testing Molly for some of viruses that could potentially lead to this.

Joint taps can be done to determine what kind of bacteria/fungus that might be involved, but as far as I know that requires a cat to be anesthetized. X-rays can be helpful in looking at the structure of the joints, so probably should get those done when you can. Pain management is crucial.

These conditions are typically the result of an infection elsewhere in the body that is attacking the lining of the joints, Probably why your vet said it really doesn't have anything to do with Molly's arthritis. Given Molly's long term use of Solensia, it stands to reason that discontinuing it would make sense. There are only so many follow-up studies out there about it. I don't know whether introducing another arthritis joint aid would be advisable at this juncture, but you could ask the vet about Adequan which is a joint pain and supplement for arthritis.

Has the vet considered consulting with specialty vets and/or a vet university to see if they could help?

Please keep us posted. Our thoughts and hopes are with Molly and you.

Thank you so much for your response, I really appreciate it. I'll be honest about this vet. The only reason I am still taking her there is because my mom still pays for her wellness plan and the X-rays are included in her plan AND we don't have a office visit with her Solensia because of the plan. I have not found them to be very helpful in the last few years with several of our (now late) cats. I have previously taken all of our cats to this same vet since I was younger, but am just now starting to discontinue using them as our other boy's plan runs out in May and he is way beyond their capabilities. I actually just made an appointment for her X-rays and that's on Sunday. I also just made an appointment with the vet that we are transitioning to for Thursday just as a second opinion. I will ask both vets about Adequan and consulting another specality vet. The vet we did take her to did say she consulted another doctor about what she thought it might be and that doctor agreed. She does take Consequin, but I know that is a supplement and not an actual medication.

I will update later once I have seen the vet we are transitioning to and the X-ray appointment. Thanks again for your input!

 

[Mac and Cats]

I don't have much of an update on Molly, but I did take her to our preferred vet today and they are also stumped. I am pretty convinced it is a result of the Solensia at this point. I am NOT one to call out drugs or vaccines, so please do not take it as that. My reasoning is because that is the only thing at this point that we can point to. I said to the vet today something like "I'm wondering if the Solensia has caused this because I was reading that it was not approved for humans because..." and I was about to say that it has accelerated arthritis in humans. But she cut me off and said something like "Well, humans and cats are different and it has caused septic arthritis in humans who were taking NSAIDs at the same time..." which is not anything that I knew about. I have not researched this yet, but plan to tomorrow. Molly is not on any NSAIDs, but being that they do such a small study on cats, I would not be surprised at all if it can cause this in cats that are not taking NSAIDs. Plus, it would be so the universe to throw this at me! (Not that I believe in that anyway.) At this point, I have zero proof and I probably never will. But I am very aware that they do a very small sample of studies for drugs like this.

I had my late soul cat do Darbepoetin and I read the studies on that before and during the process and the study was VERY small, yet I was still willing to try and it did buy us a few months more with him.

It has given Molly months of feeling better, but if this is what caused the current situation, I'm not sure I would say it is worth it. Maybe I'm just looking for a reason. I'm not trying to disuade anyone from trying Solensia with their cat, but at this point, it's the only thing I can point to. She has started walking on her ankles almost always today.

Our plan is to do the x-rays on Sunday and see what we see. If it warrants it, we can do a...I forgret what it's called, but they will basically sedate her and remove fluid from her joints and test it. I am feeling so brain dead right now as we are also dealing with a cat that has potential IBD/SCL and has just started Chlorambucil (He is doing GREAT, btw). I do not have human children but oh boy, I'm glad I don't because I can just barely handle what we are going through now.

Sorry this isn't really a positive post. To be clear, Molly is acting totally normal. She is bitchy in general, but with Solensia she was very, very slightly less bitchy. She's still sleeping on me at night, meowing for treats and has even been baking bread recently which she hasn't done in months. But I just cannot even believe we are dealing with all of this! Ugh.

Cheers to almost Friday.

 

[fionasmom]

Really big long shot here, which may be entirely incorrect. I have never used Solensia but I believe it is a monoclonal antibody. These are immune system stimulants and if there is an autoimmune disease at play, the immune system is already working overtime. You may be onto something with the Solensia in the case of your cat, which does not make it a bad drug overall.

 

[Mac and Cats]

Really big long shot here, which may be entirely incorrect. I have never used Solensia but I believe it is a monoclonal antibody. These are immune system stimulants and if there is an autoimmune disease at play, the immune system is already working overtime. You may be onto something with the Solensia in the case of your cat, which does not make it a bad drug overall.

Yes, I agree with you! She was due for her next injection on the 24th 20th of this month. So, it is still currently in her system. I'm hoping we will see some improvement after it wears off. Seems like a long wait!

 

[Mac and Cats]

Update on Molly: We had Molly's X-ray appointment today and the doctor said that based on what they saw in the X-rays, she is pretty certain that Molly is experiencing immune mediated polyarthritis and not septic arthritis. They will be sending her X-rays to a radiologist and I should hear back by Wednesday. Since we have not seen any improvement with the antibiotics (which was prescribed in case of septic arthritis), she recommended we start her on 10mg of Prednisolone once a day and to bring her back for a follow up appointment next Sunday.

They gave me 20mg Pred pills and told me to give her half of one per day. I will NOT be giving her half of these pills, they are HUGE. I instead will be giving her two 5mg Pred that are prescribed to our other cat since I know she will eat those on her own. Photo for reference. Seems ridiculous that they would expect anyone's cat to eat that. Molly is AMAZING with pills. So, I can't even imagine giving half of one of these to a cat that is not amazing with taking pills. If I gave her half of one of these and she accidentally bit into it, the entire cooperation with pills deal we have going on would be over and war would be declared. I tried to cut them into quarters, but they crumbled. Also, I paid an astronomical price or them and I know Pred is cheap. Moving forward, if she continues these, I will ask them to prescribe the 5mg pills instead.

My suspicion is that, maybe the Solensia itself is not to blame, but possibly the act of monthly injections has triggered this response? Injections can apparently be be one of the triggers of immune mediated polyarthritis. Although, I would not be surprised if the Solensia itself also played a role. We will be starting her on Prednisolone this evening. I hope with the addition of Prednisolone and the subtraction of Solensia, that we will start to see some improvement. I also attached Molly's X-rays. The doctor showed me one on her phone when I spoke with her in person and she said her front elbows looked especially bad. I'm not an expert, so I really don't know what I'm looking at. Although, I do think the x-rays are super creepy looking and I'm a big time horror/thriller fan. Will update further when I have anything more to update (good or bad).

 

[Margot Lane]

Might be worth reading other TCS threads on Solensia. I think you and your vet are making a good move here.

 

[Mac and Cats]

Might be worth reading other TCS threads on Solensia. I think you and your vet are making a good move here.

I'll have to look more in depth, but I've seen many on here and not seen anything concerning. I did do a google search and reddit search, but didn't see anything even close to what Molly is experiencing. I would be curious to see if anyone has anything negative to say.

 

[FeebysOwner]

I would be curious to see if anyone has anything negative to say.

3 months in to using Solensia for Feeby she developed a crazy itchiness. Not being sure if the two were related, we kept her on Solensia for another 3 months.

At that point - 6 months (10/2022 - 4/2023) - between the itchiness and the fact that no studies were done on Stage 2+ CKD cats, we decided to stop. I also could not find follow up studies on use beyond 6 months. Plus, I wasn't seeing much improvement.

Less than 3 months later, her itchiness subsided. I seem to recall at least one or two other cases of itchiness, and a few additional cases with other side effects, but nothing like what Molly is going through.

 

[Mac and Cats]

3 months in to using Solensia for Feeby she developed a crazy itchiness. Not being sure if the two were related, we kept her on Solensia for another 3 months.

At that point - 6 months (10/2022 - 4/2023) - between the itchiness and the fact that no studies were done on Stage 2+ CKD cats, we decided to stop. I also could not find follow up studies on use beyond 6 months. Plus, I wasn't seeing much improvement.

Less than 3 months later, her itchiness subsided. I seem to recall at least one or two other cases of itchiness, and a few additional cases with other side effects, but nothing like what Molly is going through.

Thank you for sharing your experience. I'm sure you already know, but just in case you don't, the itching is a listed side effect for Solensia. I've seen a lot of people on message boards leave comments that their cat experienced this too. I have not seen anything even remotely close to what Molly is experiencing.

 

[Mac and Cats]

Another update on Molly: Normally, Molly is the first to greet me for morning pills and she happily eats them when I set them in front of her because she knows it means she gets her treat afterwards. She was actually still first to greet me for the pills, but when I put them down for her to eat, she went and ran under the bed and then proceeded to squeeze her self in other tight places. The vet said she may be sore from the poses they did for her x-rays. I finally was able to to hunt her down and give her the pills, but I had to force her. Shockingly, she didn't try to fight me. We did skip her gabapentin last night because of the pain meds and sedative they gave her at the vet. So, I am hoping it is just because the pain meds wore off. Poor girl.

 

[fionasmom]

Does your vet have the smaller pills? If so, I would request them and ask that it be comped.

 

[Mac and Cats]

Does your vet have the smaller pills? If so, I would request them and ask that it be comped.

Good idea, thanks! I assume they probably do since we have gotten them for other cats before. I will bring them with me and ask them on Sunday when we go in for her re-check. I have enough for her to share with our other cat right now.

 

[Mac and Cats]

Hello and happy Valentine's Day.

Day 4 of Prednisolone with Molly (this evening will be the 4th dose). Three pill times in a row now that she refused to eat them on her own (she normally does) and I had to shove them down her throat. She also did not fight me a single time.

Does this look like the swelling has gone down a bit or am I wishfully imagining it?

BEFORE (1-28-24)

TODAY (2-14-24)

She wouldn't allow me to get a great picture of her left leg and threatened me with my life when I attempted to move it. If I can get a better photo later today, I'll post it.

 

[Mac and Cats]

I got a slightly better picture of her left leg. Left photo is from the 28th. Right is from today. Slight improvement or wishful thinking?

 

[DeesCats]

Her left leg looks better to me, less swollen.

 

[Mac and Cats]

Her left leg looks better to me, less swollen.

Thank you for responding! I appreciate it. That was the worst one to my eyes. So, I'm glad you also think there is a slight improvement! Hoping it will improve even more in the next few days.

 

[DeesCats]

I wanted to add that the right leg also looked better but it's hard to tell unless the legs are exactly in the same position when comparing them.

I also hope you continue to see improvements on both legs in the coming days. How is she acting otherwise?

 

[Mac and Cats]

I wanted to add that the right leg also looked better but it's hard to tell unless the legs are exactly in the same position when comparing them.

I also hope you continue to see improvements on both legs in the coming days. How is she acting otherwise?

Thank you! I agree, it's hard to tell. I will try to get better photos in the same poses moving forward. She isn't super big on people touching her so it's hard to get her to pose right! (Sorry, my baby cat just climbed up on my desk and posted my comment for me too soon!)

She's acting ok mostly. She's not super active in general in the first place. I think maybe the antibiotics are what are turning her off to taking her pills on her own like she usually does, but I can't be certain if that's what it is or if it's the pred. She will finish the antibiotics on Sunday, so hopefully she will go back to eating her pills on her own. At least she isn't fighting me when I pill her. She mostly is grumpy and lethargic for the first half of the day and then she seems a bit better for the rest of the day. She's not super cuddly, but does enjoy sitting on my lap or next to me. She likes head scratches and pets and will purr. She actually came out and sat next to me on the couch for a long while today. She's still eating/drinking/litter box-ing normally. I'm sure the swelling is super uncomfortable though. I'm keeping a daily journal on my phone/computer so that I can keep track of what's going on and relay to the vet if need be. Thanks for your response. I really do appreciate it.