Immune-mediated polyarthritis in dogs: Are corticosteroids the best bet?

PICO question In dogs with type I immune-mediated polyarthritis (IMPA), is sole treatment with other immunosuppressive agents as effective as treatment with corticosteroids at reducing clinical signs?   Clinical bottom line Category of research question Treatment. Number and type of study designs reviews One pragmatic open-label randomised controlled clinical trial. Strength of evidence Weak. Outcomes reported In the single randomised controlled clinical trial reviewed, 7/10 (70%) of dogs in both treatment groups (prednisone or cyclosporine), were reported to have shown resolution of owner-reported symptoms, clinical symptoms and improved locomotor scores and cytologic signs of disease at the end of the 90 day trial period. Of the remaining dogs, 2/3 cyclosporine treated dogs required change to prednisone, and 2/3 prednisone treated dogs required combination therapy to achieve clinical response. Conclusion There is insufficient evidence to support the use of alternative immunosuppressive agents in place of corticosteroids for the treatment of IMPA type I. Further controlled clinical trials are needed before a change to clinical practice can be considered.   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.