On a recent Thursday morning, I saw an older dog for her wellness exam and to refill her medications. She has long-standing arthritis in multiple joints and she takes pain and anti-inflammatory medication to stay comfortable. I talked to her mom about the many options – other medications, supplements, physical therapy, acupuncture, intra-articular injections, etc. I told her I would write some of them down for her, as it would be impossible to cover the entire subject of arthritis in a single office visit. The scenario of treating older patients for osteoarthritis is all too common, so I’ve written the promised list of options in this more public forum.
Osteoarthritis (OA) is a complex condition involving inflammation and degeneration of one or more joints. Osteo is Greek for “bone”, arthro means “joint,” and itis means “inflammation.” Osteoarthritis causes varying degrees of pain and inflammation and disruption of daily activities. The disease is diagnosed with a review of symptoms and medical history, physical examination findings, and, when needed, radiographs (x-rays) of the affected joints. Age is a risk factor for OA, but not a cause. There is no single cause, but many factors may contribute the development of the disease. Body conformation and body condition score are factors - being overweight is highly correlated with OA. Conditions such as hip dysplasia, elbow dysplasia, osteochondritis dissecans (OCD), and luxating patella all may lead to arthritic change. Past structural injuries and previous orthopedic surgeries are also clearly linked to later development of OA.
Osteoarthritis may show itself in different ways. Patients may have trouble going up and down stairs, getting in and out of the car, or on and off furniture. Lameness or walking stiffly are common. Reluctance to run and play or grumpiness to other dogs may occur. Owners may also notice stiff, sore, or swollen joints and a loss of stamina.
So, how can we all help?
Wherever possible, prevention is always ideal. For large breed puppies, we need to make sure that they don’t grow too fast by feeding puppy foods that are appropriate to their size. Throughout their life, we need to treat all injuries seriously with appropriate rest and therapy.
Weight control is the single biggest factor in prevention of OA. Weight control early in life and reduction in weight when symptoms occur are both important. To get the most benefit, patients need to be on the thin side of normal. Your veterinarian can help you determine your dog’s ideal weight.
At the earliest indication, we should consider dietary supplements to help your animal’s joints. Glucosamine, Chondroitin, MSM (Methylsulfonylmethane), Vitamin C and E, Selenium, and Omega-3 oils all have potential benefits for joint health.
Once the diagnosis of osteoarthritis has been made, we will manage the disease - there is no cure. The treatment options include:
- Nonsteroidal anti-inflammatory medication (NSAIDs). These include Carprofen (Rimadyl), Meloxicam (Metacam), and Deracoxib (Deramaxx). These medications are the mainstay of effective OA therapy and can be used safely long term. There is new similar medication called Galliprant, a prostaglandin receptor antagonist that is both effective and safe.
- Adequan injections. These injections are given under the skin and may increase the thickness of joint fluid in a manner similar to Glucosamine.
- Pain medication. These may include Gabapentin, Tramadol, opioid medications like Codeine, and wind up pain inhibitors such as Amantadine.
- Laser therapy. Regular treatments with a therapeutic cold laser may alleviate specific joint pain.
- Acupuncture. Eastern medicine and acupuncture can be very effective in pain management. Our own Dr. Jeanine Tweed is a certified veterinary acupuncturist who can provide acupuncture treatments for arthritic patients.
- Physical therapy. Water therapy, massage, and exercises may help manage osteoarthritis.
- Intra-articular injections. This form of therapy requires a specific diagnosis of which joints are affected. It can be both expensive and very effective. These options include platelet rich plasma (PRP), hyaluronic acid, and stem cell therapy, each of which involves injections directly into the affected joint(s) while under sedation.
Remember the simple things too! Don’t reach for your own medications in treating your dog, as human medications may be toxic to pets. Make sure they have soft bedding in many locations. Make sure they get regular exercise. Provide non-stick flooring options and ramps if needed.
While osteoarthritis is very common, we also have many options to help. If your dog is having any of these issues, don’t hesitate to consult with us and we can develop your dog’s best plan for comfort.
Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)
President Elect, American Board of Veterinary Practitioners