Steroid-responsive meningitis-arteritis: managing relapses
14-month-old Beagle diagnosed with steroid-responsive meningitis-arteritis 3 months ago. It responded within 48 hours to immunosuppressive prednisolone, but as the dose is reduced it again shows fever, neck pain and stiffness. Serum C-reactive protein is elevated again.
What is the most appropriate step?
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A. Withdraw the corticosteroids and switch to an NSAID, because the relapse shows it is not responding
Relapses during tapering are common and do not mean lack of response. An NSAID alone does not control the immune-mediated disease and must not be combined with corticosteroids.
B. Return to the immunosuppressive prednisolone dose, consider adding a second immunosuppressant (e.g. azathioprine) and then taper more slowly, guided by clinical signs and CRP
Correct. Tapering should last at least about 6 months. Adding a second drug allows corticosteroids to be reduced sooner in dogs that relapse or have significant adverse effects.
C. Start broad-spectrum antibiotics, because the relapse suggests bacterial meningitis
Bacterial meningitis is rare in dogs. The picture (young dog, rapid response to corticosteroids, relapse during tapering) is typical of meningitis-arteritis.
D. Keep the current dose, because relapses resolve on their own within a few days
A clinical relapse with raised CRP requires stepping treatment back up. Leaving it untreated favours chronicity and the protracted form with more damage.
lightbulb Key takeaway
Meningitis-arteritis affects dogs aged 6–18 months (Beagle, Boxer, Bernese Mountain Dog, Nova Scotia Duck Tolling Retriever, Weimaraner). The prognosis is good with early and sufficiently long treatment. Measure CRP before each dose reduction: if it remains high, do not taper.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.