Steroid-responsive Meningitis-Arteriitis

SRMA and what you need to know about it

What is SRMA?
SRMA stands for steroid responsive meningitis-arteritis. This means that an inflammation of the meninges and surrounding blood vessels (arteritis) that is which responds to steroids.
SRMA is one of the most common forms of meningitis in dogs.
The inflammation is caused by an exaggerated reaction of the immune system against its own meninges. The many activated inflammatory cells also damage vessels are also damaged. The exact cause of this attack of the immune system attack on its own body is not known. The disease usually occurs acutely. It However, it is possible for an acute form of the disease to develop into a chronic form. This chronic form, especially in cases where the disease is not treated or the dog does not respond
or the dog does not respond well to treatment.

Which animals are affected by SRMA?
Basically, dogs of all ages and breeds can get SRMA. There There is, however, a predisposition to certain breeds of dog, such as Boxers, Beagles, Nova Scotia Duck Tolling Retrievers, Bernese Mountain Dogs, Weimaraners, Jack Russel Terriers, Border Collies and Whippets.
To date, no study has been published on the correlation of breed and sex in dogs with SRMA in relation to the total population of a country in Europe. Published studies such as those by ROSE etal. (2014) and LOWRIE etal. (2009) only use in-clinic databases as a reference for the analysis of breed-specific incidence of SRMA. With this limitation, the study by ROSE etal. (2014) concludes that Boxers, Beagles, Border Collies, Jack Russell Terriers, Weimaraners and Whippets are predisposed to SRMA. In contrast, the present study is the first to use a nationwide database on the occurrence of dog breeds as a comparative variable. It can be shown that Boxers and Beagles have a significantly higher incidence of SRMA compared to other dog breeds. It should be emphasised that Boxers and Beagles were not only diagnosed with SRMA more frequently than other dog breeds, but that these two breeds actually have a higher risk of contracting the disease than other breeds in relation to their frequency in Germany. This supports the statement of previous studies regarding the predisposition of Boxers and Beagles. (Source: Dissertation by Elisabeth Hilpert, Clinic for Small Animals, Faculty of Veterinary Medicine, University of Leipzig, 2021, Steroid-responsive meningitis-arrteriitis: epidemiologist's prognosis).

The disease usually occurs in young dogs between 6 and 18 months of age.
What are the symptoms of SRMA in my dog?
The most common manifestation of the acute form of the disease is pain in the neck. in the neck area. The dog does not want to bend its neck any more and also shows strong pain and shows severe pain even when touched in this area. In addition, affected dogs usually have usually have a fever and are reduced in general condition.
However, the clinical signs of SRMA are not the same in all dogs. It It is common for the symptoms to occur intermittently and then subside.
In the less common chronic form, gait disturbances can be observed. can be observed.

How is SRMA diagnosed in my dog?
Your vet will first ask you a few questions to get a complete history of your dog. complete history (medical history) of your dog.
This will be followed by a clinical examination to assess the dog's general condition and which organs are affected. and which organ system is affected. Should your animal the nervous system, a comprehensive neurological examination will be carried out. a comprehensive neurological examination will be carried out, which will indicate the localisation of the problem within the nervous system.
Since other diseases can lead to similar symptoms, further examinations are necessary to further examinations are necessary to rule them in or out. These may include X-rays and blood and/or urine tests. Which which of these examinations are necessary for your dog must be decided
be decided on an individual basis. In order to be able to diagnose SRMA, an analysis of cerebrospinal fluid is important. of cerebrospinal fluid (CSF) is important.
This can be obtained by puncturing the cerebrospinal fluid space of the spinal cord. then examined.
A general anaesthetic is absolutely necessary for this. The examination of the cerebrospinal fluid makes it possible to detect inflammatory processes in the area of the meninges.
If there are indications of an inflammation, this can be further differentiated and thus
differentiated and thus provide clues to the possible cause. If there is infectious cause, the cerebrospinal fluid can also be tested for the presence of specific pathogens. can also be tested for the presence of specific pathogens.
Due to the fact that the symptoms often occur in episodes, it is essential to test the cerebrospinal fluid. the CSF examination at the time of clear symptoms (e.g. fever, pain). (e.g. fever, pain). Otherwise there is an increased risk that the CSF analysis will not show clear results.

What are the risks for my dog?
Due to the necessary anaesthesia and cerebrospinal fluid puncture, there is a certain risk the extent of which depends on the animal's state of health. About the vet will inform you in detail about the exact risks of anaesthesia and cerebrospinal vet will inform you in detail about the exact risks of the anaesthesia and the CSF puncture.

How will my dog with SRMA be treated?
After the diagnosis of SRMA, it is important to prevent the immune system from attacking and from further attacking and damaging its own tissue. This can be done with a variety of drugs can be used to reduce the immune system's response.
These drugs are called immunosuppressants. The therapy is usually started with glucocorticoid, such as prednisolone. Depending on your dog's response to the therapy, it may be necessary to add other immunosuppressants. immunosuppressants may need to be added. SRMA requires a relatively long course of therapy.
During this time, clinical signs and certain laboratory parameters in the dog's blood and cerebrospinal fluid are monitored. and cerebrospinal fluid (CSF) will be monitored regularly. Depending on the The therapy is adapted individually for each dog. In the process the dosage of the required medication is slowly reduced and possibly eliminated altogether. the dosage of the medication required and possibly to phase it out completely. Until this is possible this is possible, it will take several months.

What must be observed during therapy?
It is very important that before any dosage adjustment is made, your dog should be fully
examination of your dog is carried out. Based on the results of the
changes can be monitored closely and the risk of relapses reduced. reduce the risk of relapses. The dosage of medication administered The dosage of medication administered should never be adjusted independently. This can cause many complications complications, such as the recurrence of clinical symptoms or the symptoms or the triggering of a so-called Addisonian crisis, which is characterised which can manifest itself, among other things, as severe weakness and vomiting. Since the desired effect is a suppression of the body's own immune defence, care should be taken not to infect the dog with secondary pathogens.
infected. Excessive swimming or boarding should be avoided to be on the safe side. should be avoided. With regard to a possible vaccination, the vet should be informed about the vet should be informed about the MUO disease.

What side effects can the therapy have?
Prednisolone, a glucocorticoid, can have many side effects. Some of the most common of these are:
- Increased drinking and urination
- Tiredness
- Vomiting and diarrhoea
- Frequent panting
- Hair loss
- Increased appetite and
- weight gain
The side effects often become more severe with long-term therapy, which is why it is important to reduce the dose of the medicine as much as possible if there is a good response to the therapy. to reduce the dose as much as possible. The veterinarian balances the reduction of side effects against side effects and a sufficient dosage to control the clinical symptoms. clinical signs. If your dog shows severe side effects, the prednisolone can also be combined with another immunosuppressant to reduce the to reduce the dosage. Many of these alternative immunosuppressive drugs have
side effects than prednisolone, but are also more expensive.
more expensive. It is important that you inform your vet if you experience any side effects. inform your vet if any side effects occur. Together we can then decide how the therapy should be continued.

What does the treatment of SRMA cost?
The costs are mainly made up of the initial intensive, usually inpatient therapy, the complex diagnostics and the subsequent long-term drug therapy. long-term drug therapy. With the examination of blood and cerebrospinal as well as any further tests, approximately CHF 700.- to 1000.- / € 700,- to 1000,- for the entire diagnostic procedure.
The exact amount for the therapy may vary depending on the size of your dog, its response to the medication and the duration of the therapy. The costs for the initial intensive therapy are much higher than for the later long-term long-term therapy. However, due to the long therapy, fixed costs over several months must be over a period of several months. It is important to discuss a cost estimate with the veterinary with the vet right from the start, in order to avoid surprises later on. to avoid surprises later on.

What is the prognosis for SRMA?
The general prognosis for suspected SRMA is cautious to good. It is important important that the correct therapy is started as soon as possible and is consistently implemented. Approximately one third of all dogs will have one or more relapses within two years. relapse within two years, which may necessitate renewed therapy. therapy may become necessary. After the long therapy phase, most patients achieve a normal normal quality of life without medication.
Source: SRMA (unibe.ch)