Osteoarthritis

Osteoarthritis is a common condition in our pets. A pet does not have to be older to require joint care, pain medication or physical therapy. Degenerative arthritis can result from an injury or can be the result of genetics/conformation. 

The most common clinical signs are stiffness, decreased ability to jump or willingness to use the stairs, slowing down in activity, and intermittent or occasional limping, especially when first getting up from lying down. When degenerative arthritis occurs, the cartilage between the joints becomes roughened, the joint capsule becomes inflamed and the joint no longer functions normally. In addition, the lubricating fluid between the joints wears down resulting in a painful joint. The goals of arthritis treatment are to alleviate pain and inflammation, provide the building blocks to allow the joint to heal and prevent further degradation. There are a variety of medications and supplements used for arthritis. 

*Arthritis management should be multimodal and many pets require a variety of different medications. 

Supplements

Cartilage and Muscle Support Supplements 

The body has a natural mechanism to rebuild damaged cartilage and improve muscle mass that requires certain building blocks. These building blocks can be provided with nutritional supplementation. These products are generally used for early stages of arthritis and require weeks to build up to a point to be effective. Also, supplements are not regulated by the FDA like drugs, therefore, it is important to follow veterinary advice to ensure you are purchasing a safe and effective product.

1. Glucosamine and Chondroitin Sulfate - These are referred to as “chondroprotective products.” Cartilage is made of chondroitin sulfate and glucosamine, therefore these products are a way to provide excess of these “building blocks” orally. These products may also have some anti-inflammatory properties. 
   • The most common products are Cosequin and Dasequin and Phycox. 
2. MSM -  MSM is “Methyl sulfonyl methane” which is another anti-inflammatory agent. It is present in normal plant and animal tissue but commercial products are made from DMSO. This product allows the dog's cartilage to soak up water and act as a cushion for articulating bones. 
   • Present in Dasequin + MSM and Phycox. 

Anti-Inflammatories 

1. Phycocyanin - This product is derived from algae and has  anti-oxidant and anti-inflammatory properties. 
   • Phycox (also present in a hypoallergenic form) 
2. Cannabinoids -  These products are derived from the hemp plant that serve as antioxidants and immunomodulators. They also decrease the perception of pain. These supplements are not well regulated, therefore, finding a reputable product is incredibly important. 
3. Omega 3 fatty acids: Fish oils have proven to have anti-inflammatory properties beneficial for itchy skin, heart disease, kidney disease and arthritis. These products require about 1 month to build up in the system enough to be helpful. Veterinary products are recommended to provide more accurate dosing than human products. 

Oral Medications

Anti-Inflammatories 

These are fast acting prescription non-steroidal anti-inflammatories. These medications work by suppressing the effects of prostaglandins which are important mediators of pain and inflammation in the joints. However, there are also “good” prostaglandins that are needed to maintain blood circulation to the liver and kidneys, therefore, these medications require closer monitoring to ensure we are not targeting the “good” prostaglandins. 

 The most common anti-inflammatories prescribed are carprofen (pill only- dogs), meloxicam (pill and liquid- dogs and off label use for cats) and robenacoxib (onsior- dogs and cats). These medications are similar to a human taking Advil or Aleve (which are toxic in our pets).  

These are used for acute injury or significant arthritis, when the patient is uncomfortable with neutraceutical supplements alone. The most common side effects are stomach upset (vomiting, diarrhea, decreased appetite) and this medication is best tolerated with food. Because these medications can decrease blood flow to the kidneys, blood work monitoring is recommended before starting these medications, one month after starting these medications and again every 6 months.  

 Multiple NSAID’s can not be given at the same time and these medications CANNOT be given with steroids. 

The Piprant Class of Drugs

 In 2017, a new type of anti-inflammatory Galliprant was created solely for the use of controlling the pain associated with canine osteoarthritis.  Because it is very specific in its target, it is less likely to produce side effects to the kidneys and GI tract. This medication was created to be safer for use in older pets or pets with underlying kidney dysfunction. This medication is more expensive than other anti-inflammatories. Blood work monitoring is still recommended although the reported risk of  side effects is reduced. 

Human NSAIDs 

Humans are much less sensitive to the problems caused by suppressing “good” prostaglandins. Human medications suppress all prostaglandins (good and bad) and therefore are not safe for our pets.
HUMAN MEDICATIONS ARE NOT RECOMMENDED AT ANY TIME FOR OUR PETS AND ADMINISTRATION COULD LEAD TO SIGNIFICANT HARM. 

Pain Medications 

These medications are not anti-inflammatories.  They do not alter the disease process or prevent progression of disease but they do help with pain. These medications are usually used as an adjunct to anti-inflammatories, for pets that don’t tolerate anti-inflammatories or for pets with mild signs. They can be combined with each other or supplements. The most common side effects of these medications are drowsiness, the goal is to find the dose that relieves pain but doesn't make the pet sleepy. Routine blood work monitoring is recommended for all senior pets but is not required with these medications. 

1. Gabapentin: This is a human medication most commonly prescribed for neurological/spinal pain. It also has anti-anxiety effects. It is being used more commonly in pets for arthritis (often in combination with other medications. 
2. Tramadol: This is another human medication that is a narcotic pain reliever. Its effectiveness in veterinary medicine is questionable. 
3. Amantadine: This is a human medication used to relieve “wind up” pain. “Wind up” pain is created when chronic pain has sensitized nerves to the point where things that shouldn’t produce pain leads to pain. This sensation occurs when pain has been present for long periods of time. 

Injections 

Adequan Injections

Adequan is an injectable “polysulfated glycosaminoglycan” which is used in healing and as an anti-inflammatory agent. Adequan inhibits harmful enzymes involved in joint cartilage destruction, stimulates cartilage repair and increases joint lubrication. Adequan is given as an injection under the skin, generally once to twice weekly for a month and then once monthly as maintenance . Adequan can be administered  in the clinic or pet parents can be taught how to administer injections at home. Adequan can be used with all other joint supplements and medications and reactions are rare.  It is a great product for those patients who will not eat their oral joint supplements or get stomach upset after taking oral joint supplements.

Diet 

There are many prescription and over the counter diets used to “promote” or “support” joint health. Many of these diets include omega 3’s, glucosamine and chondroitin as well as green-lipped mussel (a prostaglandin inhibitor). These diets are balanced to meet your pet’s needs, while supporting joint health.  

The most commonly recommended prescription diets are Hill’s J/D, Royal Canin Mobility Support (also comes as a weight loss option called metabolic + mobility) and Purina JM.  

Some over the counter options include Science Diet Healthy Mobility, Science Diet Senior Vitality (also promotes brain health and healthy coat) and Royal Canin Joint Care (only for large dogs). These diets can be purchased at any pet store without a prescription.