Your pet has been diagnosed with arthritis or has been treated for a condition that may result in arthritis in the long term. Therefore, it is extremely important to follow the guidelines below to allow your pet to have a longer, better and more active life. There are four important cornerstones of arthritis treatment:
1. WEIGHT MANAGEMENT
2. EXERCISE MODIFICATION/PHYSICAL THERAPY
3. JOINT SUPPLEMENTS
4. PAIN MEDICATIONS
Chronic arthritis can be a very debilitating and painful disease in dogs and cats. Reversing the disease process unfortunately is not possible. However, some interventions may slow the disease process. That is why the best treatment for arthritis is prevention. The single most important thing that you can do to prevent arthritis from worsening as well as increase your dog's life expectancy is maintaining a thin body condition!
Once arthritis is present, we can use various modalities to slow the disease progress and modify the associated pain. Most patients respond well to these treatments. However, in some cases, additional treatments are indicated. It is important to remember that regular follow up is necessary, not only to gauge the success of therapy but to reevaluate and add in other therapies as indicated by the specific needs of your pet. The following information is intended to give you an overview and guidelines for treatment and prevention of further deterioration of your pet's arthritis. This information was provided to us by Board Certified Veterinary Surgeon, Dr. Kelly Might, DACVS. https://tploaustin.com/6-steps/step-6-tplo-surgery-recovery/
1. Weight Loss/Management:
THIS IS THE MOST IMPORTANT PART! Keeping your pet thin is extremely important. There is strong evidence showing that a thin dog has less severe pain, less clinical signs, and less progression of arthritis on x-rays. Furthermore, the life expectancy is longer for skinny dogs! This has been shown in a life-long study where dogs were grouped into dogs that were fed as much as they wanted and restricted feeding (the ones that lived longer and had less arthritis). We need to be able to feel the ribs easily. There should be a change in size and shape between the chest and the abdomen. In other words, a "waist" should be present.
2. Exercise modification/Physical Rehabilitation:
In simple terms, rehabilitation means controlled physical activity. Regular physical activity is paramount in the treatment of osteoarthritis both in humans and animals. You want to avoid the ‘weekend-warrior’ type of exercise (i.e. taking your pet for a 10 mile hike only once a month). Ideally, multiple shorter walks are better than one long one. The same activity every day (or slightly increasing if tolerated) is ideal. Prior to high-impact activities (such as chasing ball, playing with other dogs) a ‘warm-up’ period of walking is ideal. Traditional rehabilitation in dogs has included activities such as passive stretching and range of motion exercises, controlled walking through or around obstacles such as tall grass and pools, swimming, and underwater treadmills. The efficacy of physical rehabilitation in dogs with osteoarthritis has been demonstrated repeatedly. In fact, a recent study involving dogs with osteoarthritis reported significant improvements in both comfort and strength following regular physical rehabilitation exercises. A second study, which specifically examined stretching and range of motion exercises in dogs with osteoarthritis, found significant improvements in overall range and comfort after 3 weeks.
3. Joint supplements:
Below are supplements that have been shown to be either anti-inflammatory or effective at inhibiting further progression of osteoarthritis. Supplements are not regulated by the FDA, which means there is a wide variety in the quality of products on the market. Some products, however, have been researched extensively and are tested by third parties to ensure quality is maintained. The Omega-3 Fatty Acid and Green Lipped Mussel products described below are given on a daily basis but require a veterinary prescription - feel free to call or email us if you'd like to try these products. Adequan (PSGAGs) can be administered by your veterinarian in the hospital.
- Omega-3 Fatty Acids: Omega-3 fatty acids have been shown to decrease the inflammation within an arthritic joint. In dogs the specific fatty acid EPA has been shown to have the most beneficial effect. This product has been shown in a double-blind, placebo-controlled study to significantly improve lameness scores, joint effusion (swelling), crepitus, and joint pain with range of motion, as well as significantly improved joint discomfort in dogs diagnosed with osteoarthritis. It can take up to 3 months for Omega-3's to reach their complete benefit, but positive results may be seen as soon as 2 weeks after initiating treatment.
- Green Lipped Mussel: When appropriately processed, a compound extracted from this mussel has been found to inhibit the activation of enzymes responsible for the destruction of articular cartilage and the bone lying under the cartilage (subchondral bone). We recommend use of Osteo TruBenefits by Veterinary Recommended Solutions. In a randomized, controlled, double blinded clinical trial Osteo TruBenefits significantly decreased the pain associated with chronic arthritis in dogs.
- Polysulfated Glycosaminoglycans (PSGAGs): This drug group was originally designed to treat acute joint cartilage injuries and it is approved for use in dogs for arthritis. Not only may PSGAGs help repair damaged cartilage, but they can interfere with destructive painful pathways in the joint. PSGAGs can also be effective in cats. The PSGAGs are naturally occurring in joints. A series of injections, twice weekly for 4 weeks to start, is implemented to determine if a patient is responding well. If a patient has a significant beneficial response, a plan is implemented to taper the injection to the longest effective interval.
- Flexadin Advanced: This joint supplement is a proprietary form of undenatured type-II collagen which works through oral tolerization to help maintain the normal metabolism of joints. This formulation helps support normal joint function by targeting the immune system. It comes as a once daily chewable treat.
Glucosamine / Chondroitin sulfate Containing Agents: At this time there is no evidence in the veterinary literature to support the use of products containing glucosamine or chondroitin sulfate.
4. Pain medications:
Pain medications are commonly used to treat arthritis. However, it is important to realize that none of these are without side effects that can be very serious. Therefore, it is important to use pain medications only if the above measurements are not sufficient and only at the recommended dose.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Nonsteroidal anti-inflammatory drugs are a cornerstone in the treatment of OA in dogs and cats. These medications are very effective and act by blocking inflammatory pathways that lead to the production of destructive molecules (prostaglandins) and subsequent pain. Many studies have documented the usefulness of these medications. Although these medications are very effective in dogs and cats, they also have side effects, which can preclude their use in some cases. It is very important that use of these medications be at the discretion of your veterinarian. Additionally, the use of these medications in conjunction with other types of medications (e.g. aspirin, ibuprofen, corticosteroids) can lead to serious illness and should be avoided completely. Side Effects of NSAIDs are uncommon, but can be serious if not treated/noticed right away. Please watch carefully for the following: vomiting, diarrhea, blood in the stool, not eating or drinking, lethargy, inactivity, mental dullness, or nausea. If you observe any of these please contact us and discontinue the NSAID.
- Gabapentin: The original use of this medication was for treating partial seizures in humans but not long after its introduction, it was found to be useful in treating neuropathic pain (the burning and tingling sensations that come from damaged nerves). It has recently been used in dogs and cats for arthritis treatment more frequently as well. The actual chemistry of how this drug works in the body is still unknown.
- Tramadol: Tramadol is a synthetic opioid that does not share the common side effects of most natural opioids. However, Tramadol is a “mu” agonist like other opioids. Tramadol can be used separately or in combination with non-steroidal anti-inflammatory drugs and can also be used in cats (whereas non-steroidal anti-inflammatory drugs have limited use). Side effects are considered rare but may include apparent sedation or bizarre behavior (if noted, the dose should be reduced).
This can be a great addition to aid in pain relief and to keep pets moving, building muscle mass to support any abnormal joints. It’s an alternative therapy that has no side effects and can be quite helpful. Please reach out to Dr. Moore with any questions on this if you’d like to learn more about this option.