My
pet has osteoarthritis?
All the medical advances in veterinary care and
improvements in nutrition have resulted in our pets living longer lives. We get to enjoy their company and
unconditional love longer, but unfortunately with a longer life our beloved
pets get to experience some of the consequences of older age. One of the most common orthopedic problems seen
in geriatric animals is arthritis. Arthritis (from
Greek arthro-, joint + -itis, inflammation) is inflammation on a joint
or multiple joints. So now you can tell your friends that you speak Greek!!! A
joint is where two bones meet allowing motion (shoulder, elbow, carpus, among
others). There are many different types of arthritides, which can be classified
as inflammatory or non-inflammatory. The
most commonly seen in older pets is osteoarthritis (OA) or degenerative joint
disease classified as a non-inflammatory arthritis. OA is commonly the result
of loss of articular cartilage and damage to subchondral bone. If you just learned that your pet has
arthritis, please know that your pet is not alone. OA is the most common type
of arthritis in people in the United States and is also the leading cause of
disability. Clinical signs associated
with osteoarthritis include joint swelling, pain, stiffness when walking and
lameness. With time, decreased joint motion due to pain and discomfort leads to
a reduction on muscle mass (muscle atrophy) because of disuse. Use it or lose
it! As your pet ages the water content of the cartilage decreases with
reduction of proteoglycan content, with the loss of the structural framework the
cartilage becomes more susceptible to damage.
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Fig. 1 End stage osteoarthritis in a canine
elbow.
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Fig. 2 Normal elbow
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Fig. 3 Hip dysplasia and osteoarthritis present on
both hips.
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Fig. 4 Normal pelvis
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How
do I know that my pet has OA?
Watch your pet for any evidence of acute or chronic
lameness (limping) such as difficulty standing, climbing stairs, reluctance to
jump and stiffness when walking. Approximately 20% of dogs over 1 year old are
estimated to be affected with OA. Cats also can have clinical signs as a result
of arthritis, but they are masters at hiding pain so the condition is
underdiagnosed in cats.
How
does my veterinarian diagnose OA?
Diagnosis is based on history, physical exam
findings and radiographs of the affected joint(s). On physical examination the
affected joint may be swollen, unstable, painful and may have decreased range
of motion. Radiographic evaluation of the affected joint(s) is the most common
screening tool used by veterinarians. Collecting joint fluid of the suspected
joint and analyzing it under the microscope can also give you invaluable
information that can help you localize the problem joint as well as rule out
other problems that may be affecting the joint. Other advanced imaging that can
be used to evaluate the joint are CT scan and MRI, but are not used as often
due to added expense. Minimally invasive procedures such as arthroscopy can be
used to explore the joint and rule out underlying disease leading to OA.
How
can I help my pet with OA?
Once your veterinarian definitively diagnoses OA on
your pet, medical management should be implemented to improve your pet’s
quality of life.
The five mainstays of medical management are:
Weight loss or weight management- Your pet may be
obese because of inactivity, sometimes associated to the OA pain. Reduced
weight decreases that stress and forces placed on the joints. A variety of
commercial weight management diets are available to control the daily caloric
intake of your pet while giving them the sense of satiety. Visit your
veterinarian for diet recommendations. Weight management will require regular
visits to your veterinarian (Doggy Weight Watchers, if you will) to monitor
weight and diet.
Nutritional supplements- Nutraceuticals are not
marketed to diagnose, treat, or prevent disease, but are presumed to protect
the cartilage and inhibit degradation of cartilage with positive effects in
experimental and clinical trials. The most common nutraceuticals used are
Glucosamine, Chondroitin, Methylsulfonylmethane (MSM), and Omega-3 Fatty Acids.
Chondroprotectants include Adequan (Polysulfated glycosaminoglycan), sodium
hyaluronate, and pentosan polysulfate.
Controlled regular exercise- Your pet should be
rested during the initial onset of clinical signs. During the recovery period low
impact regular exercise improves and maintains joint range of motion and muscle
mass. Swimming is a great exercise since it helps joint motion without the
added stress to the joints.
Pain management- A multimodality approach to pain
control should be followed when it comes to pain control on these patients.
Pain management may include some or all of the following modalities depending
on the severity of pain:
Veterinary non-steroidal anti-inflammatories such as
Carprofen (Rimadyl®), Deracoxib (Deramaxx®), Etodolac
(EtoGesic®), Meloxicam (Metacam®), Tepoxalin (Zubrin®),
Firacoxib (Previcox®), are frequently used for pain control of
orthopedic conditions. Potential side effects include vomiting, diarrhea,
inappetence, anemia, and dark tarry stool. NSAID use can result in stomach ulcers,
colitis, and can be toxic to the liver and kidneys. If any side effects are
noted it is imperative that the medication is discontinued and to contact your
veterinarian for further recommendations.
Tramadol is a centrally acting synthetic analgesic used
to treat mild to moderate pain. Tramadol has been used as an alternative to
pure opioid medications and also given in combination with a NSAID.
Acupuncture may result in increase function and
muscle strength by ameliorating pain in pets diagnosed with arthritis.
Amantadine is an antiviral medication used in people
that may reduce the tolerance to other analgesic medications in animals.
Typically it is used in combination with other pain medications because it is
unknown if amantadine has any analgesic properties when given alone.
Just like in people, arthritis in animals is a
condition that does not have a cure, but can be managed with a combination of
exercise restriction, weight management, pain medications and neutraceuticals.
Once your pet’s condition is not responsive to medical management other options
may include stem cell therapy and total joint replacement. Stem cell therapy in
animals holds promise, but further research is needed to confirm efficacy and
results of treatment.
Submitted by Dr Leonardo Baez
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