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ARTHRITIS – WHAT YOU CAN  DO ABOUT IT

Arthritis is a degenerative joint disease that affects nearly 50% of pets over 7 years of age.  It is one of the most common sources of pain treated by veterinarians.  This painful, degenerative disease can be a result of the normal aging process – during normal wear and tear of the animal’s body -- or can also be due to accident or injury. 

What are the signs of arthritis?

Signs of arthritis can range from mild to severe, with decreased mobility to chronic pain and stiffness.

In the early mild stage your pet may exhibit slight stiffness and lameness when walking, mild pain if affected area is touched, licking of the affected joint, and 10-20% loss in normal range of motion.

For pets with a moderate amount of arthritis you may notice increased stiffness and lameness, shorter strides when walking, obvious pain if affected joint is touched, occasional whining and/or whimpering, 20-50% loss in range of motion, sitting preferred over standing, reluctance to climb steps or jump up, and slow to rise from a resting position.

In the severe advanced stage your pet may exhibit reluctance to rise or walk more than five steps, will not allow the affected joint to be touched, frequent whining or whimpering, frequent licking of affected joint, more than 50% loss in range of motion, noticeable behavioral changes, and increased difficulty in rising from a resting position.

What is cartilage?  What are the joint components that are involved?

Articular cartilage provides shock absorption to the joint and is composed of chondrocytes surrounded by a matrix of collagen, proteoglycans and water.  Chondrocytes produce the proteoglycans which make up collagen.  Proteoglucans are made up of glycosaminoglycans (GAGS) which are synthesized in part from glucosamine.  Viscous synovial fluid provides lubrication to the joint and nutrition to articular cartilage.  All of these components are essential for a nice, healthy, well-lubricated joint.

How does osteoarthritis progress? 

Degenerative joint disease can be defined as a loss of articular cartilage combined with chondrocyte death.  In response to joint insult, chondrocytes release elevated levels of enzymes such as collagenase which are able to degrade collagen and proteoglycans.  Once cartilage is damaged an inflammatory response occurs.  As white blood cells enter the area they release free radicals into the environment.  These free radicals, destructive enzymes, and prostaglandins break down major molecules of cartilage and synovial fluid.  Cartilage strength and resiliency is impaired.  Synovial fluid is produced at a high rate, but it is of low viscosity and provides little nutrition to chondrocytes.  Overworked and undernourished chondrocytes cluster and begin to die.  This leads to further loss of articular cartilage and further degeneration of the joint occurs.

Why is it so important to manage pain?

Pain is a significant stressor, leading to the most common consequences of stress, such as immunosuppression, slowing of the healing process, and acceleration of disease processes.

What can I do to help make my pet more comfortable?

Based upon the severity of your pet’s arthritis, medical history, and other health problems, your veterinarian will discuss and make recommendations for treatment of this progressive disease.  Many times further diagnostics such as blood tests and x-rays will be recommended.  Please keep in mind that the sooner your pet is properly diagnosed and treated for arthritis, the better.

Exercise, when in moderation, will help to strengthen your pet’s muscles and joints.  We recommend starting the pet on a very light regimen of exercise with gradual increases in distance and time.  However, you do not want to overdo the exercise and place too much strain on the joints.  Swimming is an excellent exercise activity because there is no gravity to add extra strain to the joints.

There are many different medications available to help your pet’s osteoarthritis—chondroprotectives (oral and injectable), analgesics (pain relievers), NSAIDS (non-steroidal antiinflammatories), and Steroids.  These are recommended for use in conjunction with steady daily exercise.

ACUPUNCTURE

Acupuncture is an alternative medical therapy that helps to relieve arthritis pain. It can be used in conjunction with other forms of treatment, including anti-inflammatory medication. Several weekly treatments are usually needed before clinical improvement is seen. Treatment intervals are then based upon maintenance for your pet’s comfort. Please refer to our Acupuncture handout for further information.

CHONDROPROTECTIVE DRUGS

These drugs contain glucosamine (glycosaminoglycan) and chondroiten sulfate.  These products are necessary for the construction of connective tissue as a precursor and stimulant of proteoglycan synthesis.  They also inhibit the degradation of proteoglycans and possess anti-inflammatory properties.  As a supplement, these nutraceuticals help the body maintain and replenish healthy cartilage and return viscosity to the joint’s synovial fluid.  This viscosity allows the synovial fluid to increase its ability to carry vital nourishment that rebuilds cartilage.  It can stimulate the production of new connective tissues within the joint, as well as repair the damage caused to the joint over time and/or by exercise. 

The components in these supplements improve joint lubrication, reduce inflammation and joint pain, as well as improve the range of motion of the affected joints. 

GLYCOFLEX—This is a chewable natural supplement extracted from sea mussel.  Most dogs (and some cats) will take this as a chewable treat.  It contains glucosamine and chondroiten sulfate and is given on a daily basis.  Side effects are rare.

PROMOTION—This is a chewable flavored tablet that contains Glucosamine, hydrolyzed collagen, bioflavanol, N-acetyl cysteine, vitamin C, manganese and zinc.  The antioxidants help to decrease free radical formation.  Side effects are rare.

ADEQUAN—This is an injectable polysulfated glycosaminoglycan.  It is given intramuscularly twice weekly for 4-8 weeks, then as needed.  It blocks the formation of damaging enzymes, relieves inflammation and pain, improves joint lubrication, and inhibits cartilage damage.  Side effects are rare (pain at injection site, vomiting, diarrhea, depression, and abnormal bleeding).  These are usually mild, transient, and self-limiting.  This product is not approved for use in cats, although some cats have been treated with good response. 

NSAIDS (NONSTEROIDAL ANTIINFLAMMATORY DRUGS)

These drugs help relieve inflammation and pain.

RIMADYL (CARPROFEN)—This is a safe and effective non-narcotic analgesic, relieving pain and inflammation associated with osteoarthritis.   Rimadyl also has antipyretic activity (helping to reduce fever).  It has been proven safe for both short-term and long-term use and has been used in over 4 million dogs as of December 2000.  Research suggests that this drug also has chondroprotective properties.  It is a considerably more potent pain reliever than aspirin.  It is 10 to 25 times less likely to cause GI ulceration and bleeding than aspirin.  The most common adverse reaction to this drug involves gastrointestinal disturbances—anorexia, vomiting, and diarrhea.  Adverse reactions seen with this drug are consistent with expected reactions seen with the use of other NSAID medications.  Twelve in 10,000 dogs had GI signs.  Five in 10,000 dogs had reversible liver disease.  One in 10,000 dogs had hepatic insufficiency or liver failure.  Two in 10,000 dogs had neurological disease or behavioral changes.  Three in 10,000 had kidney problems.  This medication is not approved for use in cats.

ASPIRIN—This is an over the counter non-narcotic analgesic, antipyretic drug that also relieves pain and inflammation.  Adverse reactions involve the gastrointestinal system—nausea, vomiting, and diarrhea.  There are many different types of aspirin/antiinflammatory drugs out there, some of these more ulcerogenic than others.  Pet owners need to be sure that they discuss the correct dosage and drug with their veterinarian before giving any aspirin to their pet.  Tylenol is fatal to cats.       

CORTICOSTEROID DRUGS

PREDNISONE/PREDNISOLONE—This is a steroid anti-inflammatory, antipyretic, analgesic medication that relieves pain primarily by relieving inflammation.  It is widely used for many medical problems—shock, liver disease, inflammatory bowel disease, adrenal disease, immune-mediated disease, allergies, respiratory disorders (asthma) and inflammation of bones, muscle, etc.  The most common side effects associated with this medication involve increased thirst, increased urination, increased appetite and increased weight gain.  Prolonged usage can potentially suppress the immune system, affect the liver, cause diabetes, and cause hyperadrenocorticism.  Used properly, these side effects are minimal.  This drug is approved for use in cats and is the primary medication used for arthritis pain relief.

Note: This article is provided by Claws & Paws Veterinary Hospital® for informational purposes only.