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Osteoarthritis
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Information on the condition and its management options.

Osteoarthritis

Osteoarthritis (OA) is a progressive degenerative joint disease which results in chronic pain. It is commonly encountered in ageing dogs but may also present in young dogs as a result of developmental disease/poor joint conformation (such as hip dysplasia, patella luxation). It can also occur after a single traumatic event such as a Cranial Cruciate Ligament (CCL) rupture or a fracture. Addressing the primary cause is always indicated if possible as OA in dogs is usually secondary to this problem.

We should not just think of OA, and the pain related to it, as an inevitable part of the ageing process – there is much we can do to help reduce symptoms and alleviate pain.

It is important to remember that a synovial joint is an organ and injury to one component affects the others. In a healthy synovial joint, the ends of the bones which meet at the joint are covered by smooth cartilage (articular) and the capsule is filled with synovial fluid. Well hydrated articular cartilage allows low-friction, smooth movement of the joint and shock absorption and nutrition to the joint structures.

In the initial phases of OA, the fibrous tissue that forms the joint capsule and supporting structures become thickened, toughened and inflexible. The articular cartilage degenerates and becomes dehydrated and degenerates, resulting in increased friction between surfaces, loss of shock absorption, stiffness and discomfort. In severe cases, new boney growths (osteophytes) can occur around the joint in the body’s attempt to stabilise the area - these also cause further pain and reduced flexibility.

Once the joint becomes painful, the animal will use it less resulting in muscle wasting (atrophy) and soft tissue weakening. This in turn provides less support for the joint and a cycle of degeneration continues.

Currently, we can only control the disease, not cure it. Once the OA process starts, it is irreversible.

Treatment for an animal suffering with OA is focussed on:

  • Reduction of Pain/discomfort/stiffness
  • Improved Quality Of Life (QOL)

Main aims of treatment include early intervention to:

  • Increase muscle strength and joint function
  • Promote repair of damaged tissue (where possible)
  • Slow progression of disease
  • Control pain and discomfort
  • Maintain an acceptable QOL

It is important to approach the management of OA from many different angles to achieve optimum results (multi-modal approach). Conservative management aims to allow an affected pet to have an active happy life without the need for more invasive surgical procedures. Management in this way is a lifelong commitment and is hard work.

First, we need to understand when our pets are in pain. Chronic pain is harder to identify than acute pain and this can be the first hurdle to overcome. Acute pain can be considered as a direct result of an insult (such as surgery or trauma) and is short-lived. Chronic pain occurs over a period of time, is long-term and much more difficult to identify.

Our pets are often very stoic and good at hiding discomfort. Each pet will display symptoms differently - you will be best placed to pick up on subtle signs but these may include:

  • Changes in posture
  • Limping or favouring a limb
  • Licking or gnawing at site
  • Changes in demeanour – seems more vocal, clingy, seeks more attention
  • Lethargic/reduced activity
  • Hesitating before sitting/laying down/jumping up
  • Lagging behind on walks
  • Eating less than normal
  • Panting, even in cool weather
  • Restlessness, inability to stay still for long periods
  • Sleeping more
  • Wanting to play less
  • Reduced height of jump
  • Decreased grooming
  • Increased toileting outside of litter tray

How we can help our pets with early treatment and lifestyle modifications (in order of importance):

  1. Weight management
  2. Addressing the underlying condition if appropriate
  3. Exercise Moderation
  4. Lifestyle Changes
  5. Medication

1.Weight Management - Keep your pet at an optimum bodyweight

This is the single most important factor in controlling the symptoms of arthritis. Common sense suggests that the more weight a dog is carrying on diseased joints, the more painful those joints will be. However, there is also evidence, from human research, that suggests obesity may trigger an inflammatory response in joints which can exacerbate the symptoms. A study in dogs showed that preventing dogs becoming overweight delayed the development of OA and reduced the degree to which dogs were affected and the need for medication to treat the joint.

Your primary practice will be able to work with you to formulate a plan to allow your pet to reach its ideal weight and Body Condition Score (BCS).

In addition to the direct effect to the joints, maintaining a healthy weight has other benefits as obese dogs tend to be more sedentary which reduces interaction with yourselves and other pets– this in turn limits ability for play and environmental exploration (therefore QOL).

2.Addressing the underlying condition if appropriate

As OA is usually secondary to joint disease, some surgical techniques may be appropriate to alleviate the problem such as those to treat cruciate ligament rupture or luxating patella.

3.Exercise Modification

It is important that arthritic pets exercise. If they are restricted, there is a risk that their joints will lose mobility and become increasingly stiff. However, it is important to realise your pet may not be able to manage free unrestricted exercise, and a degree of moderation in the types of exercise it undertakes may be needed. It is important to tailor exercise regimes to your pet and this is based on the degree of joint pain, particular exercises they find difficult based on joints affected, demeanour, BCS etc.

Exercise helps to maintain an ideal bodyweight; increases muscle strength and tone- which prevents muscle atrophy and instability of the joint; improves ROM and neuromuscular training - all of which can help to improve clinical signs of OA.

Your practice will help you to develop an appropriate exercise regime for your pet that provides regular exercise to the highest possible level without producing prolonged exacerbation of pain symptoms.

A few general rules should be adhered to:

  • Start any exercise/play period with a gentle walk to warm up muscles. Stretching affected muscle groups and joints can help to reduce responses. Consider warming the area.
  • Reduce activities that aggravate degenerative joints, such as those which involve repetitive acceleration, braking and sudden changes of direction e.g. ball throwing.
  • Shorter more frequent exercise is better than longer walks i.e. 3x10min walks are better than 1x30 min.
  • Consistency with walks - avoid long exercise sessions at the weekend to make up for any lost during the week.
  • Walks should be brisk and purposeful minimising stopping but avoiding sudden bursts of energy that can cause acute ‘flare ups’ of arthritic joints.
  • Following exercise, a 5-10 minute cool down is recommended – this can be achieved with a slower paced walk at the end.
  • ROM and massage exercises can help to reduce pain, swelling and muscle spasm.
  • If joint pain is perceived to be greater after exercise, the length of activity can be reduced by half.
  • Cold therapy may be applied to painful areas for 15-20 mins to control inflammation.

OA tends to follow a course of exacerbation and remission – during a period of aggravation, do not force exercise. Low impact exercises are best then. Gradually re-introduce an exercise and note the response and how your pet copes.

Examples of low impact exercises include:

  • Controlled leash walking
  • Treadmill
  • Jogging
  • Swimming and walking in water (for dogs) - the buoyancy of water is significant and limits impact on joints whilst promoting muscle strength and joint motion.

4.Lifestyle Changes

Take some time to think specifically about what actions or behaviours are difficult for your pet and then see what can be done to make them less challenging.

This may include:

  • Placing grip on slippery floors, reducing stair access or providing a ramp for steps outside or to reach high places safely, access into the car etc.
  • Lead restriction based on terrain and presence of other dogs
  • Easy access to food and water bowls - lowering the height of food bowls and sleeping places to avoid high impact jumping
  • Providing warmth. Keeping your dog or cat warm and dry will help with stiffness and discomfort.
  • Change the litter tray to one with low sides to aid entry and prevent accidents in the house
  • Ensure the dog/cat flap is easily accessible both from inside and out

Physiotherapy can help to improve weight bearing, comfort and mobility in dogs. Hydrotherapy also works well with physiotherapy and helps with weight loss.

5. Medication

A combination of the treatment options above is recognised as the most effective way of controlling pain. However, some animals will require the addition of medication. Analgesics reduce pain but also help to maintain limb use and improve welfare.

Anti-inflammatory drugs known as Non-Steroidal Anti-inflammatory Drugs (NSAID’s) are the most commonly prescribed medication for joint pain. They act to reduce the inflammation that initiates pain and can be used as a pulse treatment to settle an acute flare up of symptoms, or as a lifelong medication, if necessary. There are many licensed NSAID’s that all act in a slightly different way. These are generally very well tolerated and come in different formulations for ease of administration. It is worth noting that clinical manifestations of OA will be worse in obese patients so will require a higher plain of analgesic management.

Occasionally other drugs may be indicated for use alongside NSAID’s – your primary vet will discuss the options.

Supplements: Very little evidence exists to state that these are effective. Diets supplemented with Omega-3 fatty acids have the best results in studies but the evidence is still relatively weak. Some benefits may exist with using these as part of a multi-modal approach to care. A supplement will need to be used for four to six weeks before any decision on its efficacy can be made.

Steroids injected directly into the joint (intraarticular) can give targeted anti-inflammatory effects that do not affect the whole body but they are short-lived.

Stem cell therapy has shown some success – see sheet.

Surgery

If the patient has an underlying primary condition such as a cruciate ligament rupture or luxating patella then these need to be addressed with appropriate surgery.

A last resort for controlling OA pain includes salvage procedures such as joint replacement or arthrodesis (fusing of a joint).

With all treatment options, it is important that you are able evaluate the response to treatment in the home environment in which your pet negotiates everyday tasks – and situations that are not present in the veterinary environment.

An excellent resource for OA can be found at: www.caninearthritis.co.uk