Med management addresses dog’s severe immune mediated joint disease

When Sunshine, a seven-year-old German Shepherd presented to The Ohio State University Veterinary Medical Center (VMC) in May 2025, she had a reduced appetite, a severe fever and intense pain in her leg joints. A sitter who was watching her while the family was on vacation noticed Sunshine was unwell and sought veterinary care.

Members of the VMC’s Companion Animal Internal Medicine team — led by Valerie Parker, DVM, DACVIM (SAIM, Nutrition), professor-clinical, in addition to third-year resident John Rowe, DVM, MS, and second-year resident Annika He, DVM — performed a number of diagnostic tests, including sampling of Sunshine's joints. “We ultimately determined she had a severe case of immune mediated joint disease,” says Dr. Rowe.

The disease, which Dr. Rowe says is similar to rheumatoid arthritis in humans, can be a perplexing condition of unknown cause in which the immune system mounts an attack against an animal’s own cells. In this autoimmune disease, normal inflammation becomes out of control and off-target, leading to harm of the body itself. In this instance, this meant harm to Sunshine's joints.

Dr. Rowe says it’s not uncommon to see the immune mediated disease in dogs, which generally respond to treatment very well. “Our Internal Medicine Service commonly manages a variety of immune mediated diseases, including ones that occur in joints, like Sunshine’s, but also ones in the blood, blood vessels or internal organs,” he says.

However, he says, “Sunshine’s was a very severe case that did not respond as we would typically expect.” For example, he says, “she was running a fever for at least a week, which is very uncommon in these patients.” He adds that immune mediated diseases are not like a light switch. “We can't turn them off and on — they require management and maintenance over time.”

Because Sunshine required a lot of supportive care and different immunomodulatory medications, she remained at the VMC for 10 days. During that time, the team provided Sunshine with aggressive immunomodulatory medication to suppress any inappropriate immune response and tried to keep her comfortable.

The team also gave her with nutritional support using a nasogastric feeding tube and regular IV fluid therapy adjustments. She received medications for nausea and for stimulating her appetite to get her gut moving. Steroid medications helped treat her immune system, Dr. Rowe adds.

There were other serious considerations the team had in managing Sunshine’s care, Dr. Rowe says. “For example, her platelet count became incredibly low, to where she could be at risk for spontaneous bleeding, which isn't something we usually see in dogs with this disease process. There was definitely a point when we didn't know if she would get to that moment of getting to leave the hospital.”

While Sunshine had some other complications or adjustments throughout her course of treatment, she eventually improved and was well enough to return home 10 days after her initial admission.

Dr. Parker notes that Sunshine’s case is the most severe form of this disease that she's seen in her career. She credits Sunshine’s family for their diligence during her treatment.

“In addition to the wonderful medical care provided to Sunshine by the doctors, technicians and students at Ohio State, her case truly is a testament to her owners’ ability to manage what was an especially emotional period, and to give the medications time to do their job,” she says.

On a follow-up visit in August, Sunshine was like her old self, her owners say. Her weight had increased and she was comfortable on her current medications. “She is really doing about as well as we could hope,” Dr. Rowe says.

He recommends that referring veterinarians who have a question are welcome to contact the team. “We're happy to talk about these cases,” he says. For patients who are not close to Ohio State and require long-term follow up, primary care veterinarians can consult with Ohio State on the patient’s medication adjustment, monitoring and overall care, he says.

For owner Elizabeth Cooksey, PhD, a senior research scientist at Ohio State, the Internal Medicine team’s work was as bright a star as Sunshine herself.

“I know there were many people who cared for and grew to love Sunshine during the 10 days she spent in the hospital,” she says. “And we are so grateful to each and every one.”