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The development of OA is multifactorial, involving a cycle of physical stress, local inflammation, the release of degenerative enzymes, and disruption of normal cartilage and matrix homeostasis, ultimately leading to structural and functional failure, pain, and chronic disability.3 Early recognition and treatment are key and a multimodal treatment approach is recommended.
Early recognition of OA can help minimize lifetime discomfort and slow degenerative changes. Clients should be asked about signs of OA (lethargy, lameness, reluctance to jump or use stairs) at every visit and encouraged to monitor for these signs at home. Pet owners should also be encouraged to control the pet’s weight to prevent systemic inflammation and to continue regular exercise to delay the onset of muscle loss and weakness with age.4 Recent efforts have been focused on earlier diagnosis of OA by evaluating biomarkers of cartilage degeneration in the joint fluid, serum, and even urine.5
Instituting early pain relief not only improves patient comfort levels, but can also allow for increased exercise, better weight control, and prevention of worsening arthritic disease and musculoskeletal deterioration. Early NSAID use not only decreases inflammation but also provides improved pain control, which promotes activity and muscle strengthening, resulting in more even weight distribution and joint health.6
A multimodal approach is optimal for controlling OA. Pain control with NSAIDs is currently the cornerstone of OA treatment7; however, other analgesic modalities (eg, acupuncture, hydrotherapy) can be attempted. Possible local remedies promoting joint health include correcting underlying joint pathology as well as the utilization of intra-articular remedies such as polysulfated glycosaminoglycan, hyaluronic acid, and an autologous protein source.8,9 Oral joint supplements containing glucosamine and long chain omega-3 fatty acids can be administered at first suggestion of OA, especially for dogs with a higher risk for developing OA (eg, large- and giant-breed dogs, working dogs). These products are well tolerated, safe, and should be of particular consideration for patients unable to receive NSAID therapy.10,11
Weight control is critical; not only does appropriate weight control decrease the stress on overall joint health and help prevent OA pathology, but it also promotes exercise and physical rehabilitation, both of which are strongly suggested for dogs with OA at all stages.12
Environmental control such as soft, padded bedding and raising food and water bowls to decrease lower back pain may also improve comfort levels. Physical rehabilitation (eg, passive range-of-motion exercises, hydrotherapy) can also be of great benefit to arthritic patients.
Increasing evidence reveals that chronic joint pain and COX enzymes both play a role in central sensitization, leading to amplified pain.13 Not only does central sensitization worsen discomfort, it has also been associated with progression of joint pathology.14,15 COX inhibitors such as NSAIDS can prevent the establishment of central sensitization long term and also prevent nitrous oxide-induced cell death at the level of the joint.16,17 Although traditionally administered on an intermittent dosing regimen, continuous NSAID administration may be of more benefit for arthritic patients in the long run.6 A review of veterinary clinical studies found that long-term use of NSAIDs (28 days or longer) was more beneficial than short-term treatment in reducing lameness or clinical signs of osteoarthritis, and that there was no correlation between length of treatment and rate of adverse events.6
Client communication is key to long-term treatment success. All veterinary team members should be able and available to answer questions and address client concerns. Discuss at-home care (medications and their side effects, physical therapy, environmental modifications, joint supplements) and rechecks in detail. After OA diagnosis, maintaining communication helps to strengthen the relationship between the veterinary team and client and ultimately increases client compliance, providing better treatment and a long-term outcome.
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Clinician's Brief provides relevant diagnostic and treatment information for small animal practitioners. It has been ranked the #1 most essential publication by small animal veterinarians for 9 years.*
*2007-2017 PERQ and Essential Media Studies
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