ARTHRITIS IN DOGS AND CATS 
 December 2009

The SPAW
Aldergrove Animal Hospital
26841 Fraser Highway, Aldergrove, BC
www.thespaw.ca
 
Degenerative joint disease (arthritis) is the number one cause of chronic pain in the dog and cat. Arthritis is common in people as nearly 50% of the people over 65 years of age are affected.  Our pets, especially older dogs, are also commonly affected with arthritis as they are living longer than ever before. The condition itself is the result of long term stresses and instability of a joint either as a result of old injury or of natural development of the joint in that individual. Arthritis can occur in any joints but the most common places are the hips, knees, shoulders, elbows and back. While surgery may be able to help in some situations, most of the time the degeneration of the joint cannot be reversed and treatment focuses on preventing progression of damage.

Many people with older dogs believe they are getting around slower just because of normal old age aches and pains, while many of these dogs, probably at least half, are actually suffering from arthritis and are not being treated.  Symptoms of arthritis at first are slight stiffness in the morning, reluctance to walk, and difficulty rising.  These symptoms should tell you that your dog is having a problem and a veterinary visit is recommended. 

The first part of the veterinary visit is a complete physical examination. This is to not only locate the areas of pain, but to check all other organ systems such as heart lungs and teeth. Then if areas of pain are located x-rays should be taken to find the cause of the pain. There are many causes of pain in older animals. Once the diagnosis of arthritis is made then a complete blood screening should be done to assess health of kidneys and liver. Some medications used for pain control should not be used if an animal has kidney or liver problems.

Once I have a diagnosis of arthritis and blood work to show me if there are any other problems I develop a treatment plan starting with the least invasive treatment and working up to pain killers or even surgery if nothing else works.

Arthritis Treatment
The treatment options are laid out in order of recommendation.

Weight Loss
The first consideration is weight. At least 50% of the arthritic dogs that I see in my practice might not need any arthritis pain medication if they would just lose the extra weight.  This should be done with a veterinary prescription diet as the over the counter foods are often not low enough in calories for weight loss to occur and the diet will often not be effective. In the perfect world, arthritic pets would be a little on the thin side. We have a computerized weight loss program called "Slim Fit" which creates a customized diet program for your cat or dog.

Arthritis Diets
There are special prescription diets that have been developed to manage arthritis. They contain high levels of vitamin c&e and essential fatty acids along with nutraceuticals at therapeutic levels that have been proven to be beneficial. Pet store diets with glucosamine have very small amounts. This can be fed if your dog is a fussy eater or if you do not want to have to give other supplements. Our two favorite "joint diets" are Royal Canin/Medi-cal Mobility Support Diet that contains green-lipped muscle powder which contains natural omega 3 fatty acids, glycosaminoglycans, amino acids, antioxidants, and many minerals that are important to cartilage health and Hills JD that contains very high levels of Omega Fatty Acids to manage inflammation and slow the progression of arthritis.

Nutritional Supplements
Glucosamine and MSM
Glucosamines are cartilage components and by taking these orally, the patient is able to have plenty of the necessary building blocks needed to repair damaged cartilage. It is also felt that these products may have some anti-inflammatory properties separate from their structural uses. MSM stands for methyl sulfonyl methane and represents another nutraceuticals anti-inflammatory agent. These supplements have no side effects but because they are classified as a food there is no quality control of the different products. Be wary of low priced supplements, they may have very little active ingredient in them. We have several brands that we recommend.

Omega 3 Fatty Acids
Certain fats have been found to have anti-inflammatory properties. While this finding has primarily been utilized in the treatment of itchy skin, many arthritic dogs and cats have also benefited from supplementation. While there are no toxic issues to be concerned with, these products require at least one month to build up to adequate amounts. EPA is the most important Omega 3 fatty acid and most often comes from fish oil. Much higher doses are needed for arthritis (180mg EPA/5 kg or 10 lbs) then is often on the bottle. Because it is a fat the calories have to be taken in to consideration in the overall diet!

*Ask your rehab therapist which supplements they recommend for your dog!

Cartrophen Injections
Cartrophen VetR (pentosan polysulphate) can mimic the cartilage-nurturing effect of glucosamine. This product provides pain relief because it helps repair cartilage damage, it boosts the synthesis of hyaluronic acid (the main component of joint fluid), and it inhibits the enzymes which contribute to inflammation. There are no significant side effects from Cartrophen. Injections are given once weekly for 4 weeks then every 6-8 weeks for life if necessary.
For more information: www.arthritis.au.com/DMOAD.2006.FINAL.pdf
 
The arthritis diets, nutritional supplements and Cartrophen injections all take 6-8 weeks to see maximum benefits!
 
Physical Rehabilitation

Exercise
Exercise helps to maintain range of motion of the joints, which stimulates joint fluid production which maintains healthy cartilage and joints. It helps to lose weight and strengthen the muscles. Short walks that do not leave the pet unduly sore the next day should be part of the daily exercise routine. Climbing hills and stairs and doing sit to stand exercises help to strengthen the back and hips.

"Exercise should avoid sudden spurts of speed and should be done at a steady pace."

" If your pet is sore after exercise, do not exercise until the pain seems to be resolved. Re-start the exercise at 50% of the duration. Fifteen minutes of ice packing can be applied to an acutely painful joint."

" If one wants to try increasing the exercise, try a 20% increase in exercise time."

What is Passive Range of Motion Exercise?
One of the techniques that can be used to assist flexibility is passive flexion/extension exercise, also called "passive range of motion." Here the patient lies on his or her side with the side to be exercised up. Starting with the foot, the joints are flexed and extended through their natural range of motion moving up the leg all the way to the shoulder/hip. If the exercise causes discomfort (for example, dogs with bad hips are quite painful when the rear leg is extended backward), do not continue to a painful point. Ideally 15 to 20 flex/extensions are performed on each joint and this is done 2 to 4 times daily.
There are many other therapeutic exercises that can be tailored to your pet's needs.

Hydrotherapy
Swimming and underwater treadmill walking is an excellent form of exercise for arthritic dogs. It doesn't work as well for cats! The increased buoyancy of water helps to take stress off of the joints and allow more comfortable walking. The resistance of water allows strengthening of the muscles and gets the heart working harder which helps with weight loss. Warm water is best for arthritis as it helps to heat the muscles, which leads to more mobility and pain reduction. Hydrotherapy will often allow overweight, painful dogs to exercise where they could not on land alone. Once they get more mobile and lose weight they can do more at home.

K Laser Therapy
Laser therapy has been used in humans for many years. The K Laser is a class 4 laser which s the most powerful therapy laser available. Previous classes of lasers were effective for superficial problems but class 4 lasers can penetrate deep in to tissue to allow treatment of large joints like hips, backs and shoulders. Laser therapy works by applying light energy at the cellular level to stimulate the cells and promote healing, increased blood flow and reduced pain. It is non painful and is applied 6 times over a 3 weeks period. Many patients show almost immediate results. Monthly maintenance treatments can often reduce the need for medication. This is especially useful in arthritic cats that do not want to swim or do exercises and are sensitive to many medications.
For more information: www.k-laserUSA.com

Pulsed Signal Therapy
Pulsed Signal Therapy (PST) is the name of a proprietary medical technology developed in the United States to treat patients with arthritis and other musculoskeletal disorders. PST Pulsed Signal Therapy¹s mode of action is described as emulating the body¹s electrical energy signals (streaming potentials) that stimulate cartilage regeneration, repair and maintenance. Clinical studies have now been conducted over a ten year period to determine its effectiveness. The treatment is administered on nine consecutive days, for one complete half hour treatment per day without interruptions. Interruptions on weekends may be a maximum of 2-3 days, provided that at least 2 to 3 treatment sessions have already taken place. PST is a non-surgical, painless therapy without any known side effects. Best results are seen 4-6 weeks after treatment and last from months to years.
We recently got a new mobile unit that can be rented out and used at home for ease of treatments.
For more information: www.pstvet.com

Group Rehabilitation
The SPAW is now offering a rehabilitation/physiotherapy program to help pets with chronic joint problems, such as arthritis. This specialized program can be purchased in packages of 4 sessions, 1 hour each, working in a group of 4 to 5 dogs and one of our rehabilitation therapists. We teach you how to warm up your dog before exercising and stretch after exercise; provide specific strengthening exercises for front and back legs; and allow your dog to work out on our underwater treadmill.

Drugs
There are many drugs that can be very helpful in arthritis, but they can also cause stomach, kidney and liver problems.
 

NSAIDs (Non Steroidal Anti Inflammatory Drugs)
This class of drug includes aspirin and ibuprofen but they can be very dangerous for pets and should never be given. It also includes safer drugs that have been developed to be used long term in pets. Metacam and Deramaxx are 2 of the drugs that have been developed for pets. Even these drugs should be used very carefully and stopped if there is any sign of stomach upset. (lack of eating, vomiting, diarrhea, black stool) NSAIDs can be very effective and used long term in pets as long as they are used with caution and you always try to achieve the minimum once daily or even every other day dose. If your dog is more active on the week ends you may be able to get away with less medication during the week.

Summary

Arthritis can be a crippling disease but it does not have to be. We have many tools available based on your pet's health and level of activity, your time commitment and your budget.

Stage 1
1. Arthritis diet or else high quality reduced calorie senior diet and glucosamine/MSM supplement
2. Cartrophen injections once weekly for 4 weeks then every 6-8 weeks thereafter.
3. Weight loss if necessary
4. Regular controlled exercise

Stage 2 (Stage 1 plus add)
5. More intensive rehabilitation exercises
6. Hydrotherapy 2-3 times per week
7. K Laser +/- PST
8. Anti-inflammatories if necessary.  

Arthritis Treatment for Cats

Due to their unpredictable nature many of the exercises listed above will be difficult to perform with cats. But there are some things that you can do!
1. Weight control
2. Exercise: walks or some controlled play with toys
3. Nutritional supplements (if the cat will eat them)
4. Cartrophen Injections
5. K Laser (one of my favourites as the cat does not have to sit still very long)
6. Anti-inflammatories if necessary

Ask us about a customized plan to help diagnose and deal with your pet's arthritis!
604 856 7707
www.thespaw.ca