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By Lisa Blanchard BA, LVT, CMT, CCRP, FP-MT

Canine Osteoarthritis:  Proper Identification and Effective Treatments

My first dog when I got married was a yellow Labrador retriever named, Sergei.  He was your typical high energy, fun loving Labrador.  When he was about 13 ½ years old we had to make the difficult decision to let him go.  The cause of death: osteoarthritis (OA). Sergei’s hips were so bad that he could no longer stand to defecate. He also had OA in his shoulders that made walking as well as going up and down stairs extremely difficult.  My husband and I had Sergei before I was a veterinary technician and long before I knew rehabilitation even existed.   Looking back I now know that Sergei’s poor structure contributed to his OA.  I also see that he was probably painful for many years and could have benefited from the medications that the veterinarians suggested, but I was too scared to try them because I was told by friends they would cause liver and kidney damage.   In retrospect, I now know that Sergei’s quality of life would have been improved and he may have even lived longer had I provided him with proper pain control. When we think of chronic pain we most often think of osteoarthritis (OA). Experts say if we live long enough we will all develop some form of OA in our lifetime. According to the Arthritis Foundation osteoarthritis is but one of 100 types of arthritis diseases and is also the most common. (1)  In the canine world, osteoarthritis (OA) is highly prevalent with 1 out of 5 adult dogs experiencing symptoms of the disease. (2)  It is the number one cause of chronic pain in dogs. (3)  The scary thing is that because dogs age so much faster than humans, OA often develops much more quickly as well.  By the time a pet owner notices that their dog has symptoms, osteoarthritis has progressed to a point where it can be difficult to manage. Therefore, early diagnosis is imperative to the treatment and management of OA cases. As pet owners you play an integral role in managing your dog’s osteoarthritis and therefore your dog’s quality of life.

Signs of Osteoarthritis Pain

The first step in managing and treating OA is recognizing it.  So what are some signs that your animal may be painful with OA? Clinical signs of chronic osteoarthritis pain include (but are not limited to):

• joint pain and/or swelling
• lameness
• muscle atrophy
• decreased joint range of motion and muscle flexibility
• stiffness upon rising from a down and or a sit
• reluctance to do stairs, get on/off the furniture or in/out of the car
• reluctance to go on walks or play
• lethargy
• change in appetite or temperament (i.e. grumpy)
• licking or biting an affected joint
• restlessness
• seeking warmth and/or more comfortable bedding
• difficulty posturing to urinate and/or defecate

A Multimodal Approach to Managing Osteoarthritis

The goals in OA management are to relieve pain, reduce inflammation, improve joint health, increase limb and core muscle strength, increase joint range of motion, improve quality of life and prevent future joint degeneration (4)(5). Treating OA is best done by blending traditional and alternative therapies thereby creating a multimodal approach.  When developing a plan for your pet the veterinarian selects therapies that work together to break the cycle of pain, joint stress, weight gain, reduced activity, and muscle atrophy to help restore your pet’s function and quality of life. For example, if you were to compare OA management to a rowing team you would see that when all of the modalities (rowers) work together, the dog has less pain, better function, and improved quality of life (the boat moves smoothly and in a straight line). If one or more of the modalities (rowers) is skipped (like when a rower stops paddling or starts paddling backwards), the dog starts to feel worse (and the boat starts to spin).

Components of a Multimodal Approach to Managing Osteoarthritis

The main components of a multimodal OA management program are:

• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
• Adjuncts (i.e. Tramadol, Gabapentin, etc.)
• Glucosamine/chondroitin
• Adequan ®
• EPA Rich Diet
• Weight Control
• Rehabilitation
• Environmental Modification

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat osteoarthritis and are usually the cornerstone of a multimodal OA management program (6). Without proper pain management attempting to treat the OA patient with veterinary rehabilitation and home exercise can be very difficult. Adjunctive therapies such as Tramadol and Gabapentin can give added pain relief when NSAIDs are ineffective or when NSAIDs cannot be prescribed due to medical issues such as hepatic or renal compromise.  The key is to work with your veterinarian to ensure which pain medication(s) are best suited for your pet based on its personal health issues. Controlling pain and decreasing inflammation is one of the first steps in veterinary physical rehabilitation.  Modalities used to help in these areas include laser therapy, acoustic compression therapy, acupuncture, cryotherapy, thermotherapy, myofascial trigger point therapy, and massage therapy.  Therefore, even if your dog is too painful to exercise, rehab can still help with alternative modalities to help comfort your pet until the time when exercise can be introduced. Unfortunately, many osteoarthritis patients are also in need of weight management.  Weight reduction alone can result in a significant improvement in clinical lameness.  A 14-year study conducted by Nestle Purina on Labrador Retrievers showed that dogs on a restricted diet lived 15% longer (1.8 years) than their counter parts. The median life span of the dogs in the study who consumed 25% fewer calories was 13 years while the median life span for control group was 11.2 years.   The dogs that were fed fewer calories maintained a significantly leaner body condition.  They weighed less and had better muscle tone as they aged compared to the control group.  (7) As in human medicine, awareness can be the start of a healthier lifestyle for your pet.  We will have more information in our January 2016 blog on weight management.  Stay tuned!!!

Physical Rehabilitation Exercise

Once pain and weight management issues are under control, patients can be re-assessed and cleared for some low-impact, controlled exercised.  Like people, dogs with OA should engage in some sort of physical activity on a regular basis.  Physical activity should be geared toward slow leash walks and active therapeutic rehabilitation exercises.  Active exercises are designed to improve range of motion, proprioception (where are their feet in space) and muscle mass all while being low-impact to the joints.  Some dogs may need to be assisted by supportive devices (i.e. sling, cart, exercise ball) when performing the exercises (8). Aquatic exercise (i.e. underwater treadmill) can be beneficial especially when starting an exercise program with a geriatric dog. Human studies show that aquatic therapy contributes to decreasing pain, increasing range of motion and improving overall functionality in arthritic patients (9). The benefits of aquatic therapy to the geriatric / overweight patient are (10):

• minimal weight bearing on joints
• increased circulation and decreased pain
• reduced swelling and stiffness
• improved range of motion
• enriched proprioception,
• cardiovascular conditioning
• enhanced muscle mass

Environmental Modification

Environmental modification goes hand-in-hand with rehabilitation. This is an area that owners must be involved in and fully committed to keeping their pets safe and healthy.  There are several things that owners can do to protect their pet and increase their comfort in the home.

• Keep nails trimmed short and fur trimmed between pads
• Cover hardwood, tile and linoleum floors with yoga mats or latex backed throw rugs
• Provide quality bedding – but thicker is not always better

The Commitment to Managing Osteoarthritis

Osteoarthritis patients never officially “graduate” from rehabilitation as OA is a disease that must be managed.  The goal is to get the patient stronger and manage their pain so that they are more functional and have a better quality of life.  A carefully crafted home exercise plan allows owners to be part of the solution in their dog’s recovery process. Once the dog’s pain is under control and there is a plan established for those with weight management issues a committed owner is vital to their pet’s improved quality of life.  Managing OA is a lifelong commitment. A strong team is needed to help the dog including the owner, referring veterinarian, and veterinary rehabilitation professionals.  A multimodal approach to canine osteoarthritis management is the best way to ensure that your pet has the best quality of life. In our next installment we will discuss glucosamine/chondroitin supplements, Adequan ®, and EPA rich diets.

References:

(1) What is Arthritis? (2015). Retrieved from the Arthritis Foundation  May 2, 2015 http://www.arthritis.org/about-arthritis/understanding-arthritis/what-is-arthritis.php

(2) Pfizer Animal Health. Retrieved from PR Newswire May 3, 2015 http://www.prnewswire.com/news-releases/national-survey-reveals-that-owners-regard-senior-dogs-as-children-but-many-are-unknowingly-overlooking-pet-health-concerns-75726222.html

(3) 1999 Rimadyl A&U Study –  USA: 039 DRIM 097. Pfizer Animal Health USA

(4)MacPhail C (2000). Treatment of Canine Osteoarthritis. WALTHAM Focus, Vol 10, No2, pp 25-30. Retrieved from Bearscamp Newfoundlands May 4, 2015. http://www.bearscampnewfs.com/health/Waltham%20Center/Treatment%20of%20Canine%20Osteoarthritis.pdf,

(5) Edge-Hughes L. Treatment of Osteoarthritis in the Literature. Retrieved from Four Leg Rehab, Inc. August 30, 2012. http://www.fourleg.com/

(6) Fox S, Millis, D  (2010), Multimodal Management of Canine Osteoarthritis, pp. 32. Manson Publishing.

(7) http://www.purina.com.au/dog-food/feeding/nutrition/extending-healthy-years

(8) Lascelles BD, Marcellin-Little DJ, Surgery Section, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (2007). Practical Approach to Pain Management and Rehabilitation in Canine Osteoarthritis. Retrieved from: http://www.dcavm.org/07%20feb%20notes%20pdf4.pdf

(9) Templeton MS, Booth DL, O’Kelly WD, Effects of Aquatic Therapy on Joint Flexibility and Functional Ability on Subjects with Rheumatic Disease, Journal of Orthopaedic & Sports Physical Therapy ®, 1996, 23, 376-381

(10) Levine D, Millis D, Flocker J, MacGuire L, (2014). Aquatic Therapy.  In Levine D & Millis D (Eds.), Canine Rehabilitation and Physical Therapy,  (pp. 525-527),  Saunders an imprint of Elsevier, Inc.