Recommendations for Osteoarthritis in Dogs

What is Osteoarthritis?

Many dogs and cats suffer from osteoarthritis (OA) at some stage of their life.  Defined as inflammation of the joint, OA can affect both legs, the spine, even the jaw. 

It can be associated with an injury or trauma to a joint (ie cruciate ligament tear), with development problems (elbow dysplasia/hip dysplasia), and with age-related wear and tear.  Other forms of arthritis can affect joints and should be ruled out, namely Lyme or other infectious arthritis diseases, immune-mediated and septic arthritis. 

Even after the initial injury has resolved, arthritis can persist in joints for many years and often progresses as the pet ages.  Arthritis is worsened by over-activity and obesity, both of which force the joints to handle more stress than they are capable of.

Diagnosis of Osteoarthritis

While lameness in one or more legs is an obvious sign of OA, more subtle signs can prevail.  Frequently, pet owners will notice a reduction in activity, slowness on walks, or a reluctance to engage in certain activities like climbing stairs or getting up on furniture.  Often owners report a stiffness when the pet gets up from lying down or sitting, that improves with activity.  This stiffness may be more noticeable in the morning or after rest, particularly following increased activity. 

On examination, we may notice a decrease in the joint’s normal range of motion, increased swelling to the joint, or pain on movement.  With chronic arthritis, muscle atrophy will accompany the reduced use of the limb.  Arthritic dogs will shift body weight to other parts of the body and off the affected leg(s) resulting in the development of pain in overused muscles.  This myofascial pain can be often as severe as the underlying arthritic pain. 

Radiographs may be recommended to confirm OA and to assess the severity of the condition.  It can take up to 4 weeks for degenerative bony spurs to form on a radiograph, but increased joint fluid can be seen almost immediately.  It is important to note, however, that a joint can suffer quite severe changes and have only mild radiographic changes. 

Arthroscopy offers a direct evaluation of an affected joint.  While not always necessary, the arthroscope allows the surgeon to visualize joint surfaces and structures using a camera inserted in a very small hole.  In some cases, additional testing might be recommended such as joint fluid evaluation or advanced imaging techniques. 

Management of Osteoarthritis

Once a diagnosis of OA has been made, we will recommend a multi-pronged approach to manage the condition.

Weight loss: not only are overweight pets more likely to develop OA, but obesity will also contribute to damage to other joints as the pet shifts weight off the affected leg and onto the other legs.  In addition, pets with OA are less active and more likely to gain weight if their calories are not curbed.  Research shows at least a 14% improvement in mobility just by reducing a pet’s weight to their ideal body condition.   We will assess your pet’s current caloric intake and advise on strategies to reduce weight as effectively as possible.

Exercise Moderation:  While it seems obvious that too much vigorous activity will cause symptoms of osteoarthritis to flare-up, too little activity is also problematic.  Regular activity at a comfortable level helps maintain muscle tone and mass, which helps reduce stress on joints and keeps joints lubricated and active.   Exercise also helps with weight management. 

It may be difficult to tell what level of activity is acceptable for your pet as a dog will not show pain from osteoarthritis as easily when they are engaged in fun activities, such as playing with other dogs, or chasing squirrels.  However, once the excitement recedes and your pet lies down to rest, the arthritis joints will swell and become painful from overuse.  Arthritis typically shows up as stiffness after lying down, or hesitation to climb steps or stairs.  Restlessness or excessive panting, especially at nighttime, can also be a sign of unmanaged arthritis pain.  We recommend walks and gentle play to the level and duration that your pet seems comfortable and doesn’t exhibit a worsening of stiffness after rest.

Omega-3 fatty acids:  two of the omega-3 fatty acids, EPA and DHA, have anti-inflammatory properties at high doses.  We aim to provide EPA/DHA levels at higher than normal supplementary doses.  EPA is found in high levels in many fish oils but owners should only purchase quality products as fish can be contaminated with heavy metals.   The recommended dose for EPA is 40 to 50 mg/kg per day.  

* Hill’s J/D or Hill’s Metabolic and Mobility and Purina J/M are supplemented at these levels and do not require added supplementation. 

Fish oils should be added gradually as some dogs may develop GI upsets at the high doses.  In addition, high oil diets are contraindicated in pets suffering from or at risk of pancreatitis.

Cartrophen (pentosan polysulphate): this drug is classified as a Disease-Modifying Osteoarthritic Drug (DMOAD), a particularly important class of drugs due to their ability to repair damaged joints.  Given by injection under the skin, dogs receive it once weekly for 4 weeks, then once every 4 to 6 weeks as maintenance.  This is a very safe drug and has been shown to have several beneficial effects in the joint including 

• Improving the quality of the cartilage

• Improving the quantity and quality of the synovial fluid, the lubrication of the joint.

• Reducing levels of cartilage degrading enzymes

• Stimulating healing and growth of cartilage cells

• Increasing blood supply and nutrition to the joint and bone

• Reducing inflammation in the joint

• Scavenging of oxygen-free radicals, which are toxic by-products of inflammation.

Unnatured Collagen Type II (Flexadin Advanced): Collagen acts on the immune system to reduce the inflammation in arthritic joints.  A recent study demonstrated the effectiveness of Collagen Type II in reducing both the clinical signs of arthritis and the improved use of legs affected by arthritis in dogs.

Non-steroidal anti-inflammatory drugs (NSAIDs): this group of drugs includes strong pain medications such as meloxicam (Metacam, Rheumocam), carprofen (Rimadyl), robenacoxib (Onsior), and deracoxib (Deramax).  NSAIDs have some of the strongest effects in reducing the signs of arthritis and are often one of the initial drugs used to treat acute problems.  They also have the greatest potential risk of adverse events, including gastrointestinal bleeding and ulceration, and kidney or liver damage, so use requires careful monitoring and periodic blood work.  Fortunately, side effects are uncommon when used appropriately and under supervision.  Our goal is always to reduce the dose, frequency and reliance on these drugs if possible.

Galliprant (grapiprant):  Galliprant is a new type of NSAID that specifically targets a specific prostaglandin receptor called EP4.  Galliprant does not appear to cause many of the side effects associated with other non-steroidal anti-inflammatory drugs, so we use it commonly with pets at risk of stomach upsets, or kidney and liver concerns.

Other analgesics (pain killers):  Arthritic pain may require additional treatment with drugs such as gabapentin and amantadine.  These drugs have wide safety margins and may work better in combination with the other forms of therapy.  Both drugs can cause sedation at high doses but adjustments to dose can alleviate this if it occurs.

Librela (bedinvetmab):  this is one of the most significant advances in the management of arthritic pain.  Librela is given by injection under the skin once a month and is categorized as a monoclonal antibody class drug against a protein called Nerve Growth Factor (NGF) receptors.  While NGF is important in the growing fetus and young dog, it has little function in adult animals.  However, it is induced by arthritic joints as a pain signal at the level of the spinal cord.  Librela effectively blocks the pain and has been shown to be very effective at alleviating osteoarthritic discomfort.  In fact, Librela can be so effective in pain relief that dogs may overuse their arthritic joints and suffer from re-injury, so we always recommend introducing more activity slowly and cautiously.

Rehabilitation therapy: as a Rehabilitation Clinic, we offer a variety of additional therapies from physical exercises, laser therapy, electrical muscle stimulation and TENS, to having the pets walk in an underwater treadmill.   

• Low-Level Light Therapy (LLLT) or Laser Therapy:  has been demonstrated to offer a variety of beneficial effects for arthritic patients, including accelerating healing of damaged tissues and decreasing pain.  It is particularly useful for myofascial pain that often afflicts arthritic patients.  Treatments usually start twice weekly until the pain subsides.

•  Underwater and Land Treadmill:  The advantage of having a dog walk in an underwater treadmill is that the effects of gravity of sore joints can be minimized while increasing muscle effort and endurance.  Where outdoor conditions do not permit walking, land and underwater treadmill use can assist in maintaining activity and weight.  Special training in hydrotherapy permits the veterinary technician to focus on certain muscle groups to improve mobility.

Joint Injections:  In advanced or chronic arthritic conditions, injections into the joints may relieve pain that cannot be managed sufficiently by other methods.  Platelet-rich Plasma uses healing factors from the dog’s own blood that is prepared in a specialized centrifuge and injected into the joint(s) under sedation.  Hyaluronic acid and cortisone injections can be used to relieve pain where other treatments have failed, often lasting weeks to months.

Acupuncture and Chiropractic Management:  some of the doctors and technicians at Cedarview Animal Hospital have additional training in these techniques and can offer specialized pain management to improve strength and mobility.

Other Supplements:  Most people are familiar with glucosamine and chondroitin for osteoarthritis as they are commonly used by people for their own arthritis.  However, many clinical trials have yet to prove conclusively if these work to slow down the progression of OA or diminish OA symptoms.  While some studies appear promising, others show no benefit, and, to date, large meta-analyses of high-quality studies still remain inconclusive.  Other supplements may be added to these ingredients but also remain difficult to prove as effective.  It may be that some of these supplements may benefit some individuals in some circumstances.  Interestingly, a trial of Dasuquin Advanced, a veterinary supplement containing glusocamine, chondroitin, MSM and ASU, showed promising efficacy in dogs with osteoarthritis in a high quality trial at the University of Tennessee, so if a client is interested in trying these products, I recommend trying this one in particular.

Home care:  It’s important to think about the environment our pets have to negotiate with arthritic joints and weak muscles.  Just as we my eventually need to rely on assistive devices such as walkers and canes, dogs also can be helped.  Help ‘Em Up Harnesses provide extra handles and support that provides extra support to pets in getting up, traversing steps and stairs and in walking.  Toe Grips are small rubber bands that fit on the nails to add extra grip on slippery surfaces.  Placing mats around the house on hardwood or tile floors provides walkways for your pet to move more easily through the home.  Avoiding stairs or steps when possible can help avoid falls.  Many older pets also have diminished eyesight, so placing good lighting over stairwells and steps, for example, can make it easier to manage. 

Where do I start?     

With so many options available to manage arthritis, most pets should be able to live comfortably for many years.  Successful management of arthritis often combines different types of therapies to take advantage of various benefits, such as keeping weight under control, moderating exercise to maintain muscle mass, using rehabilitation therapy when needed to improve strength and endurance, and supplements to target joint health.  Pain control is essential to keep overall mood and mobility good, while reducing reliance on drugs with higher risk of side effects. 

At Cedarview Animal Hospital, we strive to improve every pet’s mobility and reduce pain from arthritis through appropriate management focusing on the unique needs of each individual dog.  We have staff certified in pain management, rehabilitation, veterinary acupuncture, hydrotherapy, massage, and veterinary chiropractic care to assist you in providing the best in care. Contact us to book an appointment today!