All Creatures Veterinary Hospital

All Creatures Veterinary Hospital
4549 HW 62 West
Mountain Home, AR 72653
(870) 425-5175


Managing Osteoarthritis

Osteoarthritis (OA), also known as degenerative joint disease (DJD) or "arthritis", is a chronic condition that results from a number of specific diseases or age-related degeneration of the joints. Because of the nature of OA, it is progressive and irreversible. The goal of long-term management is to slow the progression of OA so that joints function and quality of life is kept as high as possible. In some cases, osteoarthritis can be effectively cured with surgery. For others, best results may be obtained by combining surgical intervention with the medical management guidelines described below. These guidelines are also useful when surgical therapy is not an option.

The first concept to remember is that osteoarthritis is chronic and incurable. That doesn't mean that it can't be controlled but it may take some time and trial and error to find out what combination of therapeutic options works the best for your dog. Another important point to remember is the therapy that controls your pet's osteoarthritis now may also change with time as the disease progresses.

There are four primary areas that should be considered when medically treating osteoarthritis: diet, exercise, anti-inflammatory drugs, and chondroprotective agents.

Diet

Your dog's diet must be well balanced and must match his or her degree of activity. Obesity imposes a great burden on your dog's skeleton and joints. In general, treats and table scraps should be avoided. If your dog craves treats or table scraps, feed him green beans or carrots. They have little or no calories but can make your dog think he's getting a treat! Rarely, certain medical conditions such as hypothyroidism may make it difficult for your dog to lose or maintain a proper weight. If dieting, etc. is unrewarding, consult with your veterinarian about testing for these medical conditions.

If your dog is a large or giant breed and still growing, you should strongly consider changing his diet from a growth formula to an adult formula. Excessive calories and protein have been shown to play a role in the development of certain juvenile orthopedic conditions. Lowering the caloric and protein content of the diet will only show your dog's growth rate and have no effect on the ultimate body size for which your dog is genetically programmed.

Exercise

Just as too much exercise is bad for arthritic joints, too little exercise is also not good. Joints need some weight bearing and motion to maintain their health. This becomes even more important when osteoarthritis occurs. Low impact exercise such as walking or swimming are good for joints while running, jumping, and rough play will aggravate diseased joints. Swimming is especially good because it allows joint motion without weight bearing. When possible, walking should be done on soft surfaces such as grass. Harder surfaces such as concrete and asphalt should be avoided. Walking should also be done on level surfaces, avoiding steep hills. Exercise should be routine but not necessarily long. Begin by going on short walks. To some degree, let your dog decide how far enough but watch him or her closely for signs of fatigue or lameness. Stop the walk at the first signs that he or she has had enough. Some dogs are so intent on pleasing their master that they will not know when to stop; these dogs have to be more closely controlled to avoid overdoing it. If short walks are well tolerated, slowly increase the distance while watching for signs of pain such as slowing down, lameness, or an abnormal walk. Remember that cold and damp weather as well as changes in barometric pressure seem to affect dog joints just like they do the joints of people. That makes pain and lameness more common in winter and with changing weather patterns so don't be surprised if your dog seems more reluctant on exercise when these conditions occur. Exercise can also be encouraged by massage, range of motion exercises, heat packs, and anti-inflammatory drugs used before and/or after exercise.

Medication

Anti-inflammatory drug therapy will lessen the degree of inflammation and pain present in the joint and make your dog more likely to want to exercise. Medication does little or nothing to stop the osteoarthritis, it only treats the signs of arthritis. As a general rule, corticosteroids (steroids) of any sort should be avoided for the management of chronic arthritis.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin are typically used to treat the signs of arthritis. While there are many NSAIDs available for use in humans, most of these drugs are potentially dangerous to dogs. Drugs such as acetaminophen (Tylenol), ibuprofen (Advil), ketoprofen (Orudis KT), and naproxen (Aleve) should not be substituted for aspirin or one of the other "safe" NSAIDs unless approved by your veterinarian. Nonsteroidal anti-inflammatory drugs that are specifically designed for use in dogs include carprofen (Rimadyl), etodolac (Etogesic), and deracoxib (Deramaxx). The NSAIDs are generally very safe and effective for treating osteoarthritis in dogs. Sometimes even the "safe" NSAIDs can produce signs of stomach irritation such as loss of appetite, vomiting, diarrhea, and blood in the stool (usually seen as very black "tarry" stools) or in the vomit (either in the form of fresh "red" blood or old "coffee grounds" blood). Usually, these signs will stop if you stop giving the drug promptly. Stomach ulcers can be potentially dangerous so you should still check with your veterinarian, especially if the signs continue or worsen. It is a good idea to give the drug with food and, in the case of aspirin, to use products that combine an antacid with the aspirin such as Ascriptin. If your dog will not tolerate the prescribed NSAID but needs some sort of pain control, consult your veterinarian. Alternative choices that may help include combining NSAID therapy with protective drugs such as carafate, stomach acid reducers such as Zantac, Tagamet, and Prilosec, and synthetic prostaglandins such as misoprostol. Some of these drugs are available over the counter; DO NOT use them without first consulting your veterinarian.

Chondroprotective Agents

The final area that should be mentioned is the use of chondroprotective agents. These products, as their name implies, support the health and function of joint cartilage. A side benefit is the reduction of inflammation.

Adequan is an injectable solution of polysulfated glycosaminoglycan, also known as PSGAGs. These PSGAGs are a part of the composition of joint cartilage. Adequan is given as an injection in the muscle twice weekly for 4 weeks. Its effect is variable. For some dogs, it seems to work wonders, for others it seems to have little or no effect at all. Only a 4 to 6 week test period will determine its effectiveness for your dog. If it is effective, the frequency of injections can be slowly reduced to a level that still produces the desired effect.

Glucosamine and chondroitin sulfate are also components of joint cartilage. They are present in your dog's regular food but may not be present in sufficient quantities for dogs with osteoarthritis. Supplemental glucosamine and chondroitin sulfate may slow the breakdown of joint cartilage, reduce inflammation, and improve your dog's function. Many brands of generic glucosamine and chondroitin sulfate are available over the counter and probably work well. One specific product, Cosequin, is designed specifically for dogs and combines these two substances with manganese, a tract element necessary for cartilage metabolism. Whether or not using the brand name product (and incurring the associated increased cost) is more beneficial than using the generic product is debatable. In either case, these agents have a very safe record. The worst complication associated with their use is usually diarrhea that resolves when the medication is withdrawn. Like Adequan, some dogs appear to respond very well to these agents while others show no improvement. Only a 4 to 5 week course of therapy will determine their potential benefit. Both Adequan and Cosequin can be administered prior to surgery without risk of complications.

Other treatments for osteoarthritis include passive range of motion exercises, massage of the affected limb, cold and heat therapy, and therapeutic ultrasound therapy. Passive range of motion exercises, massage, and heat/cold therapy can and should be performed in conjunction with walking and swimming exercises to make your dog more comfortable and get the most from the exercises.

Treatments such as herbal remedies and acupuncture have little scientific information to support their use but may be effective in some dogs. Remember that herbal remedies and prescribed drugs such as NSAIDs may create problems. Consult with your veterinarian before giving your dog herbal remedies with other drugs or scheduling surgery.

Finally, remember osteoarthritis is a continually evolving process that requires patience and a combined approach of diet, exercise, NSAIDs, and chondroprotective agents to achieve maximum success. If you are not satisfied with your dog's progress, your dog still seems painful, or the pain returns after a period of control, consult your veterinarian for help in fine-tuning your osteoarthritis management program.