Nonpharmacologic Therapies for a Multimodal Approach to Osteoarthritis

Sponsored by PRN® Pharmacal

Osteoarthritis (OA) is a complex disease process that requires a multimodal treatment approach that integrates environmental, nutritional, and therapeutic strategies to achieve optimal patient outcomes.^1-3 Although therapies like NSAIDs and antinerve growth factor monoclonal antibodies remain first-line OA therapies, relying on them alone may necessitate higher analgesic doses to control pain and inflammation, raising the risk for adverse effects with chronic use.^1-4 To maximize the efficacy of therapeutic recommendations and improve long-term patient outcomes, various nonpharmacologic adjunctive interventions can be selected to create tailored multimodal treatment plans.

Weight Optimization

Weight optimization is critical for every patient with OA.^1-4 Not only does excess weight cause excess joint loading, but evidence also suggests that adipose tissue itself may have deleterious metabolic activity.^2-4 Adipose tissue releases inflammatory cytokines that can accelerate joint degradation, contributing to obesity’s association with OA, even in non-weight–bearing joints.^2-4 Cohort studies have also shown that lean body condition can slow progression of OA and increase lifespan, highlighting the importance of weight management. ^1-4

Nutrition

Going hand-in-hand with weight management is a thorough nutritional evaluation.^1-4 Diets should be well-balanced and age appropriate, and feeding management (eg, frequency, portions, treats, food sharing) should be discussed to identify sources of overfeeding.^1-3,5

A joint health diet is strongly recommended for patients with any degree of clinical OA and may also be considered for pets that are clinically normal but have OA risk factors.¹ Along with being well-balanced and calorically appropriate, joint health diets should be fortified with omega-3 essential fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), at appropriate doses.^1,2,4 DHA and EPA provide natural anti-inflammatory action that reduce OA signs and progression.^1-4,6 Alpha lipoic acid is not an acceptable alternative, as it does not convert significantly to DHA and EPA.²

Supplements & Nutraceuticals

Beyond omega-3 fatty acids, a growing interest from both pet owners and veterinarians for more natural and nonpharmacologic alternatives to traditional medicine has driven research into the anti-inflammatory and chondroprotective properties of various promising nutritional supplements and nutraceuticals.² Duralactin is a prime example of one such nutritional supplement with effective anti-inflammatory action for the management of OA in cats, dogs, and horses.⁷ Duralactin’s active ingredient, MicroLactin, is a protein concentrate from the milk of hyperimmunized cows.⁷ When a cow is infected, its milk contains natural anti-inflammatory substances to protect sick calves.⁷ When healthy cows are vaccinated with killed, polyvalent bacterial vaccines, their milk becomes similarly hyperimmunized and contains the orally active hyperimmune milk factor, which can help reduce inflammation in a number of species.⁷

The clinical impact of MicroLactin has been shown in a placebo-controlled, double-blinded, randomized parallel study of 50 client-owned, geriatric, large-breed dogs displaying clinical signs of OA.⁸ After receiving MicroLactin for 8 weeks, 67% of that group showed significant improvement based on owner assessment and questionnaire scores as compared with 35% of patients in the placebo group.⁸ In the study, as a milk-derived supplement, MicroLactin was well-tolerated, with side effects limited to GI upset.⁷ This combination of anti-inflammatory action, proven efficacy, and limited adverse effects makes Duralactin an ideal supplement choice in a multimodal OA protocol.⁷

Exercise & Rehabilitation

Regular exercise helps maintain muscle strength and cartilage health while preventing joint fibrosis and weight gain.² However, exercise programs must be planned thoughtfully, avoiding high-impact activities or torsion to prevent further joint trauma.^1-3 As OA progresses and mobility reduces, exercise goals should be modified to meet patient abilities.^1-3 In-clinic rehabilitation, including manual therapy (eg, massage, cryotherapy, passive range of motion), exercise (eg, hydrotherapy, treadmill), and machine/instrument applied therapies (eg, acupuncture, ultrasound, extracorporeal shockwave therapy), may also be considered.¹ Environmental modifications (eg, nonslip flooring, well-padded beds, ramps, litter box modifications) can likewise help improve comfort and quality of life.^1-3

Conclusion

The opportunities for nonpharmacologic supportive OA therapy are robust, offering clinicians many avenues to supplement first-line treatments such as NSAIDs and anti-nerve growth factor monoclonal antibodies. Combining weight management, targeted nutrition, exercise, and supplements such as Duralactin can help enhance comfort and mobility in OA patients, complementing traditional pain management strategies without increasing the risk for adverse effects.