The Pains of Arthritis

Our Labrador, Jack, was an arthritic old man at the end of his life.  He ran hard until arthritis and age finally slowed him.  Like most Labradors he only had an on and off switch.  It is how it is supposed to be for them.  Arthritis and joint pain are exceedingly common in older patients, especially bigger dogs.  Having perfect joints as an old Labrador is like us dying with money in the bank.  Like most owners, we searched for ways to help Jack in his later years and ended up using multiple medications and treatments to keep him as comfortable as possible.

The signs of arthritis often start with stiffness and soreness after activity and then may progress to lameness and constant pain.  Symptoms may initially be intermittent and advance to persisting constantly.  Chronic arthritis may be due to a single acute injury in the past or to repeated wear and tear on the joints.  Please contact us if you observe pain or soreness in your pet.  Diagnosis will involve a physical examination and possibly x-rays.  The more we know about where a problem is and why it is there, the better we understand our options for treatment.

There are many strategies and approaches to help patients with arthritis.  I like to think of it as a continuum along a patient’s lifespan.  We will have different ways to address issues as the disease progresses.  Early on, at the very first signs of any soreness, we may consider nutritional options to slow arthritis.  Supplements like glucosamine, chondroitin, MSM, vitamin C and fatty acids have natural anti-inflammatory and antioxidant properties and improve cartilage health and joint fluid viscosity.  Supplements have the greatest impact as preventatives and as treatments early on.  A high quality combination product of the above supplements should be started early.  These should be used long term, even if it is difficult to gauge response, in an effort to prevent future problems.
Obesity complicates arthritis.  Extra weight is extra work for the joints.  Thinner dogs move better longer.  We need to strive to keep our dogs at their ideal weight.  

There are several good weight loss diets for older dogs with arthritis that also include added fatty acids and glucosamine to help the joints.  Hill’s Metabolic Plus and Royal Canin Satiety are both excellent diet choices for overweight pets with arthritis.  Please contact the clinic if you are unsure of your pet’s ideal weight or would like help selecting a diet.  As patients progress over time beyond occasional soreness and begin to show lameness, non steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to alleviate pain and inflammation.  Carprofen (Rimadyl), meloxicam, firocoxib (Previcox) and deracoxib (Deramaxx) are the most common NSAID drugs used in dogs.  Human NSAIDs, including Naproxen, Celebrex, and ibuprofen, should not be used in dogs.  Aspirin is often thought of as an alternative arthritis medication, especially at lower doses.  However, aspirin is not a good choice.  Much of the work that has been done to develop other NSAIDs has been done to avoid the side effects of aspirin.  Aspirin will almost always cause some degree of stomach ulceration if used long enough.  Other NSAIDs are safer and more effective.  NSAID usage for arthritis therapy often starts with periodic use.  Pain and ongoing soreness may eventually require daily medication.  These medications are very safe, rarely producing serious side effects.  Routine bloodwork and examinations should be performed to ensure their safety.  Other pain medications such as Tramadol and Gabapentin may be prescribed along with NSAIDs if additional pain control is needed.Other approaches may be helpful for some dogs.   Adequan is a very safe injectable medication that increases the thickness of the joint fluid throughout the body.  It is given by injection weekly at first and then monthly long term.  

Laser therapy also can be helpful in decreasing pain and inflammation in arthritic joints. Typically pets receive laser therapy three times a week for several weeks initially and then monthly thereafter.  We also often refer patients to WellSprings-K9 for swimming therapy and to Dr. Lena McCullough for acupuncture.Newer, novel therapies are available for patients with individual joints that are arthritic.  Stem cell therapy can be used to target the repair of damaged joint surfaces. This therapy uses surgically collected stem cells from the patient being treated.  For more information on stem cell therapy, see a previous blog, “Mojo’s Story”.  Platelet rich plasma (PRP) is a therapy relatively new to small animals but it has been used extensively in people and in horses.  Plasma high in platelets is collected from a patient’s own blood and then injected into an affected joint.  The PRP  utilizes the healing properties of the patient’s own platelets to decrease inflammation.  For more information, see Dr. Nick Paulson’s blog on the subject.Arthritis therapy is a challenging and important part of effective geriatric care.  There are many options and approaches.  Please let us know if you have any questions or concerns about arthritis or pain control in your pet.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)
Outreach Chairman, American Board of VeterinaryPractitioners