Click here for Part I.
Since arthritis ultimately both results from and causes long-term changes to the joints themselves, we can't really expect to cure it. Fortunately, there are many options to improve comfort and interrupt the inflammatory process. A multimodal approach - one using multiple strategies in combination - is by far the most effective and safest; your veterinarian can tailor a plan to your pet's individual problems, monitor improvement, and adjust therapy when and if their arthritis worsens. The ultimate goal is always to keep pets happy and comfortable while slowing progression.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
These are drugs that work in the same manner as aspirin or ibuprofen. They are the medical treatment with the most proven benefits - the right NSAID will make pets more comfortable - but they also have the most risk of side effects. Major concerns include stomach ulceration, as well as kidney and liver damage. Dogs, and particularly cats, are much more sensitive to side effects from these drugs than people, and for this reason they should only be used under the supervision of your veterinarian. That said, when used properly they are incredibly valuable in treating arthritis because they both reduce pain and directly interrupt the inflammatory process, potentially slowing progression.
A practical note - while aspirin can relieve pain in dogs, please don't take it upon yourself to give it to your dog without talking to your veterinarian. It has a high incidence of gastric side effects, and due to the subtle differences in the way it works from other NSAIDs we have to stop aspirin and wait several days before starting more appropriate pain medications. Not doing so can have life-threatening consequences.
Exercise, Weight Loss, and Physical Therapy
While heavy exercise can exacerbate arthritis, moderate exercise is a pillar of dealing with it. Walking is ideal for keeping joints flexible and improving blood flow; swimming is even better when possible, since there's no impact involved. Weight loss is another pillar - it doesn't take a medical degree to realize painful joints hurt more when loaded with unnecessary weight. Fat also produces proteins that encourage inflammation, so it might even directly worsen arthritis. Check out this article for weight loss tips.
Just like with people, physical therapy can be immensely valuable for dealing with arthritis. Often this includes low-impact exercise such as underwater treadmills and specialized stretching. In many urban areas there are veterinarians with special training and facilities for physical therapy; ask your regular vet for recommendations.
Nutraceuticals
There's a laundry list of nutritional products with claims to reduce arthritis. I habitually start arthritic pets on omega-3 fatty acid supplementation, as much research supports their effectiveness at reducing inflammation. Glucosamine and chondroitin sulfate also have some support. I try to keep an open mind - if there's a reasonable body of evidence a supplement is safe for pets, it's worth trying if owners are interested. One thing to keep in mind about nutraceuticals - they are virtually unregulated, so there's no real guarantee of the amount or quality of the product on the label like there would be for an actual drug. For this reason, it's probably best to avoid the bargain product off the shelf at Wal-Mart. Your veterinarian likely carries some supplements who's quality they trust, or they can recommend specific products.
PSGAGs (polysulfated glycosaminoglycans) also have reasonable scientific support for improving comfort and function. They are given as an injection, and having personally seen some dramatic improvement from them recently, I strongly recommend talking to your veterinarian about them early on when trying to address arthritis.
Novel Therapies
Arthritis is very prevalent in older animals; not surprisingly, new treatments are constantly being proposed. Some of these hold promise - stem cell therapy, for example, is already being used in pets, has shown promising results, and has growing research support. Therapeutic lasers have also become very popular. Just like with people, many swear by things like acupuncture, herbs and the like. Myself, I'm skeptical of anything without verifiable research to support it. Believe it or not, the placebo effect has a prominent effect in animals too. On the other hand, when proven therapies become insufficient, it's hard to argue against trying other modalities so long as there is reasonable evidence they are safe.
When treating any disease, our ultimate goal is to improve pet's quality of life. Considering that, treating arthritis is one of the most rewarding parts of being a veterinarian, because we so often see dramatic improvement in activity, energy, and enjoyment. It all starts with you recognizing that there is a problem, though. So if Muffy doesn't seem to have the spring in her step she used to, ask your veterinarian if there's a way to get it back!
I love your blog, David! Just curious; the PSGAGs you mentioned, is this referring to pensosan polysulphate? I ask because pentosan is routinely used where I practice (Aus) but I wasn't aware of them being available State-side. We have great success with them although I know there's not much in the way of evidence-based research to back it up...yet.
ReplyDeleteNo, regular old polysulfated glycosaminoglycans, sold under the trade name Adequan, labled for dogs and horses here in the states. Never used PPS myself, but interesting to hear you've seen some success - orally, I presume? I'd say about 80% of the pets I've put on Adequan have improved, 10-20% dramatically. One dog went from twice daily carprofen to maybe once a week, with increased mobility to boot; still, some don't seem to benefit at all. I really think in a couple of decades when we've a better grip on how arthritis works we're going to see we're dealing with several "different" diseases, and hopefully we'll have a better grip on what nutraceuticals will benefit which dogs.
DeleteAlso, from the sound of it you're a veterinarian yourself - there's a systematic review of nutraceuticals in arthritis that just came out in JVIM (May/June 12), worth a read.