Written by Dr Javiera Correa, August 2020, Associate veterinarian at Tequesta Vet Clinic
Arthritis (Osteoarthritis or Degenerative Joint Disease)
What is degenerative joint disease (more commonly known as osteoarthritis)?
Osteoarthritis (OA) is a complex disease process involving inflammation and degeneration of one or more joints. Dogs with OA experience pain that can interfere with daily life.
How is osteoarthritis diagnosed?
OA is diagnosed by a veterinarian via a thorough physical examination and diagnostic imaging such as x-rays. The veterinarian will palpate joints to try and localize pain. Once the pain is localized then imaging of that area is then recommended.
What are causes of OA?
Osteoarthritis has many factors involved in its development and most dogs experience a combination of these factors as OA develops and progresses. It is not just a simple process of aging. Factors include but are not limited to:
- Body conformation
- Genetic predisposal
- Body condition/weight
- Abnormal joint development
- Activity history
- Previous trauma/injury
- Previous orthopedic surgery
- Nutritional history
What are clinical signs (symptoms) of OA?
There are many signs that are indicative for OA in a dog. A dog can demonstrate some and not necessarily all at the same time. The most common signs include but are not limited to:
- Limping (lameness) in one or more limbs
- Difficulty or reluctance to get up or get down (rising, laying down)
- Walking stiffly
- Difficulty or reluctance going up and down stair
- Difficulty or reluctance to jump (on/off furniture or in/out of the car)
- Stiff/swollen/sore joint(s)
- Reluctance to be touched on a particular part of the body
- Loss of stamina
- Unexpected aggression
How is arthritis medically managed?
There is no one magical go to treatment for OA. Once OA has been diagnosed, we are more managing the disease that treating for OA cannot be cured. Since OA is a complex disease, managing it is also a complex process involving combining multiple modalities. Common multimodal management of arthritis includes but is not limited to:
- Weight management
- Non-steroidal anti-inflammatory drugs (NSAIDS)
- INSTEAD of an NSAID sometimes a corticosteroid is prescribed as an anti-inflammatory although this is case dependent.
- Adjunctive medications (medications that can have a synergistic effect for pain control)
- Nutraceuticals (joint supplements)
- Laser therapy
- Physical therapy
- Referral to a surgeon for surgical options
- Stem Cell Therapy
- CBD products Note: this is a controversial subject within the veterinary medical field and veterinarians cannot legally prescribe nor recommend CBD beyond “use per package instructions”. However, Dr Joi has had her senior arthritic cat on CBD since 2017 and feels it has significantly improved her quality of life. CBD decreases pain signaling. We carry Hemp RX brand of CBD chews and oil as we’ve found it to be the best product on the market and not bitter tasting as many OTC CBD products can be. The more refined the CBD oil, the less bitter aftertaste. Clearly, we don’t want our patients to refuse a treat or oil due to the taste.
Non-steroidal anti-inflammatory drugs (NSAIDS)
Common NSAIDs prescribed include Galliprant, Carprofen, Meloxicam, and for cats, Onsior. Onsior is also FDA approved for dogs. Other less common NSAIDS are Deramaxx and Previcox. NSAIDs are generally used as the first choice of treatment for pain of OA. Nonetheless, we typically couple an NSAID with other options for “multi-modal” analgesia so that we can lessen the dose of NSAID needed. This is also often helpful to your pocketbook as NSAIDS can be expensieve. Of the NSAIDs for dogs, Galliprant is our favorite as it is theoretically the safest NSAID on the market. Please note though that not all patients are candidates for NSAIDs and this should only be determined and prescribed by a licensed veterinarian.
Human over the counter pain relievers (ibuprofen, Tylenol, Aleve, etc…) should NEVER be used in animals for most are toxic to dogs and cats. Rarely, a corticosteroid such as prednisone is used as the anti-inflammatory treatment. We NEVER use a corticosteroid and an NSAID together at the same time in animals. If your pet is prescribed an NSAID for long term pain management of OA, bloodwork is recommended every 6 to 12 months to monitor for any effects on kidney and liver function. The most common side effect of NSAIDs is GI upset (vomiting and/or diarrhea). These side effects should always be alerted to the veterinarian if they develop and the medication should be stopped in the interim. Most often these side effects are mild and temporary and can be managed symptomatically.
Onsior is a non-steroidal anti-inflammatory that is prescribed in cats for acute pain. It is not prescribed for long term management of chronic pain. Cats don’t have the same liver enzymes as humans and dogs and don’t tolerate long-term anti-inflammatories. We try other options such as turmeric, laser therapy, omega 3 fatty acids, gabapentin, joint supplements for cats. Using an NSAID long-term in a cat is often our last resort.
Adjunctive therapies are treatments that addresses chronic pain differently from NSAIDs or corticosteroids and complements those medications. These are also helpful in patients that cannot be given NSAIDs or corticosteroids. Common adjunctive therapies include but are not limited to:
- Gabapentin has been shown to be very useful in treating chronic pain especially neuropathic pain in small animals. Gabapentin has come into favor by most veterinarian due to the wonderful effects seen in pain management but also due to the minimal side effects. Most often the only side effect seen is mild drowsiness. Gabapentin is very cost effective and can be sprinkled onto the pet’s food as it has virtually no taste. Some clients don’t like that gabapentin can make some pets drowsy. If your pet is one of the pets that acts drowsy on gabapentin we can lower the dose. Additionally, we can have you give it at night only. Pets who sleep better at night feel better! Gabapentin is best use two or 3 times per day, but if your pet gets drowsy on gabapentin, a night-time dose can be very helpful for the overall analgesia and quality of sleep and quality of life.
- Amantadine is an NMDA antagonist which has been shown to be useful in treating chronic pain and neuropathic pain as an adjunctive therapy. Amantadine can be used long-term. Or, if your pet has been on pain meds long term and doesn’t seem to be responding as well, we can use amantadine intermittently to help reset pain signals that have gone awry.
- Tramadol is an opioid and has recently fallen out of favor for use in treating acute or chronic pain. Studies have shown that dogs lack receptors for tramadol and therefore it has no or minimal effect on pain. Though some cases have shown improvement with tramadol, therefore this again should be determined and prescribed by a licensed veterinarian on a case by case basis.
- Muscle relaxers
- Common muscle relaxers that are prescribed as an adjunctive therapy to manage pain include diazepam (valium) or methocarbomol. When a dog or cat is in pain they can become very tense and stiff to prevent them from moving an affected joint and thus causing pain. The constant tension in itself then becomes painful further adding to the overall pain sensation of the patient. Relaxing the muscles can help alleviate pain from muscle tension. This is most commonly prescribed in patients suffering from conditions of the neck or back.
Nutraceuticals are nutritional supplements that have medicinal effects. Nutraceuticals that are specifically targeted for joint health are more commonly referred to as joint supplements. The most common known components of joint supplements are Glucosamine and Chondroitin. Other components that have recently become popular include turmeric, marine lipids, and egg shell membrane. Several of the nutraceuticals now contain a combination of these components all in one product.
There are many of these products available but not all are of the same quality. As with most supplements, they do not have to undergo FDA approval therefore they may not contain an adequate amount of the medicinal product to actually have an effect. We therefore recommend that the veterinarian suggest which nutraceuticals to add in to the treatment protocol. The most common nutraceuticals recommended among veterinarians include but are not limited to:
- Dasuquin and Dasuquin advanced
- Omega – 3 fatty acids (Antinol and Wellactin are our favorite brands)
Dr Joi’s cat is on feline Dasuquin, canine Movoflex, RX Vitamin turmeric, and Antinol in addition to Adequan and laser therapy and gabapentin.
Adequan is a chondroprotectant that reduces inflammation and restores synovial i.e. joint fluid. It is given as a series of injections over a period of time. This is often prescribed as an additional treatment to help restore function of the joints. It is FDA approved for dogs, but we can use it off-label for cats.
Adequan is an expensive injectible. We give it twice weekly for the first month as the induction period. Giving Adequan at cost is one of Dr Joi’s gifts to our clients. We sell you the box (2 bottles) of Adequan for $150 and you can bring your pet in for us to give the injections at no charge. Adequan induction (the first month) pairs nicely with laser therapy induction!
Cold laser therapy sounds like VooDoo. And yet, it works. It concentrates light energy to promote healing, decrease pain signals, decrease inflammation and edema. Dr Joi brings her cat to work with her not only for Twinkle’s good company, but so Twinkle can have therapy laser 3 times per week. Dr Joi is developing a smidge of lumbar arthritis and has started using the therapy laser on her own back!
Our class 4 therapy laser is a 28 thousand dollar machine. This is the same laser that many chiropractors use! We charge minimally for the laser therapy because we want all of our patients to benefit from this amazing technology. Laser sessions start at $15 in our hospital.
Acupuncture has been around for centuries and is a popular practice in eastern medicine, but recently has become common place here in the western part of the world. Veterinarians can now become certified acupuncturists for animals. This allows another method to help manage chronic conditions such as OA. Here at TVC we do not offer acupuncture, but please be aware we are actively looking for a certified veterinary acupuncturist to add to our crew.
Physical Therapy is another field of veterinary medicine that is growing and applies techniques from human medicine to animal patients. These techniques include but are not limited to:
- Therapeutic LASER (which we offer in clinic!) see above
- Therapeutic exercise
- Joint mobilization
- Hydrotherapy (using an underwater treadmill)
Jupiter Pet Emergency Specialty Center is our local referral hospital with board certified specialists that offer physical therapy.
Other things that an owner can provide to a dog with OA that can help with comfort and mobility are:
- Soft, padded bedding
- Raised food and water dishes (elbow height)
- Non-skid floor surfaces
- Adhering to prescribed treatment recommendations by your veterinarian.
If you have any further questions please do not hesitate to contact us here at Tequesta Vet Clinic.
Dr. Javi on behalf of all the TVC doctor team