Auto-immune Disease

Anecdotal Evidence and Hindsight

By Jo Tucker

Cases of autoimmune disease are still relatively uncommon within the general dog population but its incidence appears to be increasing and is of genuine concern to owners, breeders and the veterinary profession. Owners of dogs in over 100 different breeds (including a some cross and mixed breeds) have contacted me at CIMDA, and information has been received from many owners whose dogs have suffered from an auto-immune disease of one kind or another. 

 When information is received in this way, it is inevitable that ‘common factors’ will be highlighted.  Sadly, there are many ‘coincidences’ that are not instantly recognised as possible indicators to AI diseases. This article has been composed from the accounts of owners who have been unfortunate enough to have a dog diagnosed with an autoimmune disease.

Breed, age, and family history are important factors when considering a diagnosis of autoimmune disease.   Dogs affected have a genetic predisposition which may be triggered by environmental influences such as: a virus,  drugs or chemicals, vaccination,  hormonal changes and stress.

Many of these anecdotal references cannot be regarded as having been confirmed by scientific evidence, but they do illustrate some of the common recurring signs that seem to be associated with a dog suffering from an AI disease.  So does hindsight and anecdotal evidence have any value or should we wait for the evidence to be proven by science before reacting to certain ‘coincidences?

Dogs suffering from autoimmune disease have shown one or more of the following ‘symptoms’.

General Observations Regularly Reported Prior to a Diagnosis

Diarrhoea – with or without traces of blood eg. colitis.

Depression & lethargy, and the look of premature ageing.

Skin irritation, skin sores, nail bed problems, mouth ulcers, nose or anal lesions.

High temperature.

Weakness in the legs.

A tendency to lameness – limping or shifting lameness

Stiffness in limbs

Muscle wastage

Enlarged lymphnodes

Anaemia

Collapse

Pungent body odour

Loss of appetite

Loss of weight

Weight gain (hypothyroidism)

Change in bark

Intermittent symptoms that can disappear & reappear.

Young to middle aged dogs were the most commonly affected.

On going symptoms such as high temperature, limping or lethargy, that even after treatment remain unresolved.

Autoimmune Haemolytic Anaemia (AIHA or IMHA)

 Signs of AIHA that have been reported are:  orange coloured faeces, orange coloured urine, craving to eat earth or gnaw concrete, weight loss, pale gums, high temperature, lethargy, fainting and little or no appetite (but some dogs do not go off their food until they are desperately ill).

 To confirm AIHA, a Coombs blood test is usually carried out, to look for red cell-bound antibodies. A negative result does not necessarily mean that the anaemic dog does not have AIHA, as the red cell destruction could be occurring in the bone marrow.  This type of anaemia is know as non-regenerative autoimmune haemolytic anaemia and a misdiagnosis of Leukaemia is not uncommon. To confirm diagnosis  of non-regenerative AIHA,  a bone marrow biopsy is necessary. Examination of a blood smear, by your vet,  may also prove useful.   

 Thrombocytopenia (IMTP)

 Many owners, whose dogs were eventually diagnosed with IMTP, have said that some of the common symptoms were:

 Bleeding from the nose or gums, blood shot eyes, bruising on the body, blackened or dark coloured faeces (traces of dark coloured blood), sickness showing ‘coffee ground’ type vomit,  high temperature.

 That the dogs suffered from anaemia, haemorrhaging, lethargy & little or no appetite (some dogs will not go off their food until they are desperately ill).

 Another indicator was:

 That the vet initially suspected poisoning & not an AI disease, as the symptoms were similar to ‘Warfarin’ poisoning.  Vitamin K was frequently prescribed.

 Signs for AIHA & IMTP can come on quickly, or show gradually over a period of a few weeks, and then the dog can deteriorate rapidly.

Several owners have said that their vet didn’t appear to attach too much importance to their dog’s nosebleed, in fact, in one case, a vet operated on the dog’s nose.  IMTP is a bleeding disorder, whereby the dog’s blood loses ability to clot.  In this case the dog haemorrhaged and was quickly referred to a specialist.  Fortunately, after a blood transfusion, intensive treatment and care, she is now well and fully recovered.

With so many AI diseases, the owners have said that for sometime before their dog became acutely ill they had noticed the dog had an intermittent limp.  Very often the limp was thoroughly investigated, without a diagnosis being achieved. The limp disappeared after treatment of the AI disease.

 Immune Mediated Polyarthritis

IMPA is an immune mediated disease that tends to remain undiagnosed for some period of months.  Owners have reported:

Shifting lameness

Intermittent high temperature

Lethargy

Depression

Difficulty in rising to feet from sitting or lying position

Eventual weight and muscle loss

Anorexia

Evidence of pain

Hot joints

Appearance of premature ageing

The Pemphigus Group and Lupus Group Skin Diseases

These AI diseases can show in varying forms of skin problems.

Owners have reported:

These diseases have been particularly difficult to diagnose and the poor dogs have suffered from very painful and uncomfortable skin lesions and/or ulcers, sometimes to the face only, and sometimes to the face or body or nails, or a combination of all three.

The process of trying to reach a conclusive diagnosis of some AI diseases, especially skin conditions, can prove to be costly and often without any significant progress being obvious. It can be extremely difficult to confirm a diagnosis as blood tests and biopsy results can be returned as ‘inconclusive’.

 Systemic Lupus Erythematosus (SLE) is a multi-systemic disease affecting several body systems including the skin.  SLE is a serious AI disease which is difficult to diagnose. SLE should be considered when symptoms which include high temperature, stiffness of limbs, anorexia and total lethargy remain unresolved for several weeks after anti-inflammatory and antibiotic veterinary treatment.

 Anecdotal reports appear to have shown that an AI disease, in an acute stage, has often caused the dog to have a high temperature.  Understandably, the vets have suspected an infection & usually prescribed antibiotics or if the dog is lethargic it may be given intravenous fluid therapy, which has shown some temporary improvement in the dog’s condition. A high temperature does not necessarily mean your dog has an infection, it may be due to an inflammatory autoimmune disease or some other underlying condition.

 If the improvement is only temporary, and the vet cannot establish what is wrong with the dog, you may choose to ask for a referral to a vet college, or even seek a second opinion from another vet.  This might seem obvious, but when you are trying to cope with a desperate situation, the obvious is not always the first consideration, especially when your hopes and trust are placed with a vet who may appear to have the situation under control but is really struggling for a solution.

Some owners have said that their vets continued to treat their dog in the same way, without successfully finding out the underlying cause of the illness.  The treatment, in many cases, continued for some considerable time, without any real improvement.

There have been some reports that certain vets have failed to make an accurate diagnosis, even when the symptoms presented were ‘classic’ to a particular AI disease.  On the other hand, most owners praised their vets very highly and attributed the ‘saving’ of their dog to the prompt diagnosis, skill and attention they received. 

When the illness is prolonged, it is not uncommon for a dog to go into a ‘crisis’.  This is often the case with Addison’s disease, vasculitis or one of the AI blood disorders.  The situation turns into ‘a fight against time’ and so often a diagnosis is reached at ‘the eleventh hour’. This can be too late, and the poor dog may not have any time left to respond to treatment.  A correct, early diagnosis can make the difference between life and death for your dog.  A full biochemical blood test or a complete blood count can provide vital information which may lead to a diagnosis.

 This article attempts to share ‘anecdotal evidence’ and observations that many unfortunate owners of dogs with AI disease have noted.  There are reports where the owner (because they were aware of the health status of their breed) had made a suggestion to the vet, which subsequently led to a correct diagnosis and saved the dog’s life. 

These anecdotal accounts indicate that more dogs seem to survive AI disease than die. Many dogs that have survived their initial ‘crisis’ have continued to lead a normal life and have been ‘weaned off’ of medication.

With Addison’s disease and hypothyroidism, once a diagnosis has been reached, the appropriate hormone therapy started, and the dog stabilised, the prognosis is excellent.

Autoimmune disease can affect any part of the body and the diseases mentioned above are only a few of the diseases that are more commonly reported. 

Care must be taken not to assume that your dog has an AI disease simply because one or more of the ‘signs’ are apparent.  If you are at all concerned, always contact your vet.

It is hoped that reporting these facts may help to provoke a (quicker) diagnosis, thereby minimising suffering and possibly save the life of a dog in the future.

 Jo Tucker

 If you would like further information please contact:  CIMDA, 73, Osidge Lane, Southgate, London N14 5JL   Tel:  020 8368 9148   email:  jo@cimda.fsnet.co.uk