Abstract
<strong>PICO question</strong><br /><p>In dogs suspected of having steroid responsive meningitis-arteritis (SRMA), how long should immunosuppressive monotherapy with steroids be undertaken in order to achieve clinical resolution without relapse of clinical signs?</p><strong>Clinical bottom line</strong><br /><p>Based on the currently available literature, steroid treatment using the protocol outlined in Lowrie et al. (2009) at a gradually tapering dose over a course of 6 months, appeared to lead to clinical remission in all cases, with a disease free post treatment interval of at least 6 months. However, further research is needed as there are currently three published papers with a low number of cases, so a definitive time course cannot be suggested until stronger evidence is available.</p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" />
Highlights
Population: Dogs with clinically confirmed SRMA referred to the Institute of Animal Neurology, University of Berne, Brem-gartenstrasse, Switzerland during an unspecified time frame
Some dogs had additional testing including electromyography (EMG), electroencephalography (EEG), myelography, Computed Tomography (CT) and cisternography Dogs received prednisolone at 4 mg/kg/day. This was reduced to 2 mg/kg/day after 2 days and maintained for 2 weeks, followed by 1 mg/kg/day for a further 2 weeks At this point dogs returned for examination to include Cerebral Spinal Fluid (CSF)
Review date: Mar 28 2021 analysis, blood profile and EEG. These were repeated every month since the beginning of the treatment for at least 6 months - As soon as neurological exam and CSF analysis were normal, the prednisolone dose was reduced from 1 mg/kg/day until 0.5 mg/kg every other day was achieved for 6 months
Summary
Based on the currently available literature, steroid treatment using the protocol outlined in Lowrie et al (2009) at a gradually tapering dose over a course of 6 months, appeared to lead to clinical remission in all cases, with a disease free post treatment interval of at least 6 months. Further research is needed as there are currently three published papers with a low number of cases, so a definitive time course cannot be suggested until stronger evidence is available. Clinical Scenario You are presented with an 18-month-old female neutered Beagle with a history of anorexia and lethargy. On examination the dog shows cervical hyperesthesia and has a rectal temperature of 39.8°C. Cerebral spinal fluid (CSF) analysis reveals a marked neutrophilic pleocytosis with elevated protein. A presumptive diagnosis of steroid responsive meningitis-arteritis (SRMA) is made, and you wish to start the dog on immunosuppressive monotherapy with steroids, you are unsure as to how long the dog will require treatment to achieve clinical resolution and without relapse of clinical signs
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