Follow-up appointments will be very important and absolutely necessary with a diagnosis of steroid-responsive meningitis-arteritis. Your veterinarian will determine the schedule of the return visits which will depend on how well your furry family member responds to the treatment. The follow-up will mean repeat blood tests and analysis of the CSF until the veterinarian can see that the markers have returned to normal. This could mean appointments every 4 to 6 weeks for several months. It is imperative that you keep the appointments and do not discontinue the medication even though you may think your dog is feeling better. It should be noted that many pets will need a prescription for gastroprotectants; if you see any side effects from the long-term therapy such as blood in the stool or vomiting, or if you are concerned in any way with your pet’s health, contact the clinic without delay. With SRMA there is a potential for relapse, meaning that continued contact with your veterinarian will be recommended.
Conclusions The clinical, laboratory, and radiologic findings associated with SREAT are more varied than previously reported. Misdiagnosis at presentation is common. This treatable syndrome should be considered even if the serum sensitive thyroid-stimulating hormone level and erythrocyte sedimentation rate are normal, the cerebrospinal fluid profile does not suggest an inflammatory process, and neuroimaging results are normal. Until the pathophysiologic mechanism of this and other autoimmune encephalopathies is better characterized, we believe that descriptive terms that reflect an association rather than causation are most appropriate for this syndrome.
The exact etiopathogenesis of SRMA is unknown ( Tipold 2000 ). Activated T cells have been demonstrated in dogs with SRMA, indicating potential contact with an antigenic stimulus; however, no bacterial or viral agents have been identified to date ( Tipold and others 1996 ). A Th2-mediated immune response is most likely, based on the presence of high CD4:CD8a ratios and a high proportion of B cells in peripheral blood and CSF. A Th2-mediated immune response is further supported by the expression of low levels of Th1-response-related cytokines (IL-2, IFN-γ) and upregulation of Th2 cytokines (IL-4) in blood and CSF in dogs with the acute form of SRMA ( Schwartz and others in press ). This Th2-mediated immune response leads to an upregulation of the humoral immune response and excessive IgA production ( Schwartz and others 2008b ).