Creating a Treatment Plan for Canine Osteoarthritis

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Creating a Treatment Plan for Canine Osteoarthritis

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Early Intervention

Early disease recognition is imperative to initiate treatment of canine osteoarthritis (OA) early and improve treatment success. Patients of all ages should be evaluated at every visit to the practice, including wellness visits. Athletic patients in particular can be started on joint supplements earlier in life to potentially lower the incidence of OA secondary to joint overexertion. Additionally, in patients at an increased risk for developing OA secondary to other orthopedic conditions (eg, previous injury, conformational abnormality), the underlying disease should be corrected and joint supplementation should be started earlier in life.1 These patients should be closely monitored for the first signs of OA and treated accordingly. 

After Diagnosis

Canine OA is a complex and multifactorial disease process. The optimal treatment plan should involve a multimodal approach because any single treatment alone will not be as effective. Correcting the underlying pathology that resulted in the initiation and perpetuation of OA is key.2 

Additional recommendations should include adjustments to the pet’s environment and lifestyle. Complete cessation of exercise is not recommended, as immobility can stiffen joints, leading to more pain. Low impact activities such as short, regular walks and activities on soft surfaces should be considered for the arthritic pet. Medical management consisting of anti-inflammatory medications (NSAIDs), joint supplements, analgesic support, and even joint injections are also mainstays of OA treatment.3-6 Several studies have shown that consistent administration of NSAIDs results in improvement of clinical signs and appears advantageous to intermittent dosing.7,8 Alternative therapies such as laser therapy, hydrotherapy, and acupuncture can also be considered.2,9

Breaking the Cycle

The pathogenesis of OA results in a cycle of pain and inflammation, perpetuating the disease severity and clinical signs.10 Regardless of the inciting factor, joint inflammation and pathology occur, resulting in pain and reduced patient activity. This results in obesity and exercise intolerance, putting further strain on affected joints, and further perpetuating the cycle. 

Recognizing the cycle can allow for early intervention and can make it possible to keep pets at a healthy weight, preserve their mobility, and reduce their pain. Weight management is critical for successful OA treatment. Weight loss not only improves muscle mass and joint stabilization but also decreases inflammatory cytokines produced by excess adipose tissue.11 Multiple studies have confirmed that weight loss in obese dogs with OA has resulted in improved mobility and decreased lameness, and therefore weight management strategies should be utilized in both the prevention and treatment of OA.12-14

An Optimal Team Approach

Implementing a team approach to treatment is crucial for early disease intervention and to break the cycle of inflammation. The patient treatment team should involve all members of the veterinary staff as well as the patient’s owner. 

Owner

The owner is the first line of defense for OA prevention and early treatment initiation. By scheduling annual wellness visits and paying close attention to early clinical signs associated with OA (eg, slowing down, reluctance to jump, exercise intolerance, lameness), the owner can be an invaluable resource in early OA detection and treatment. 

Veterinary Nurse

Veterinary nurses should be encouraged to work closely with the owner and provide both verbal and hands-on client communication. This includes discussing at-home pain scores, recording important historical information and clinical signs, and demonstrating physical therapy exercises that owners can perform at home. Once the owner and patient have left the practice, the veterinary nurse can routinely check in via telephone to encourage owner compliance and accountability in following the treatment protocol. 

Veterinarian

Lastly, the veterinarian plays a pivotal role. He or she should have a detailed discussion with the owner about all aspects of OA treatment. This discussion should include an explanation of the pathogenesis and perpetuation of OA development and a review of medications, lifestyle changes, physical therapy, and alternative therapy options. The importance of weight control, diet, and exercise should be emphasized at all patient visits, including wellness visits. 

Conclusion

There is no cure for OA, and the disease process is progressive and complex. Taking advantage of multimodal treatment is more likely to result in better long-term success. Addressing multiple aspects of disease progression with medications, physical therapy and exercise, weight loss, and alternative therapy options is important in order to help break the cycle of inflammation. An earlier diagnosis and treatment approach involving all members of the veterinary team, including the client, can help ensure optimal client compliance and the best outcome for the patient.

References

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