Osteoarthritis (arthritis) is a common condition in older dogs and cats as well as people. The normal joint is designed so that throughout the range of motion the surface of the joint has minimal friction. Osteoarthritic changes occur in joints well before clinical and radiographic signs are evident. Early stages begin with chondromalacia, a softening of the cartilage. After an insult to the joint induced by age, chronic overload, congenital malformations, or injuries, collagen turnover increases. The new collagen may not be the proper type and with time collagen loss may occur. Cartilage degradation also occurs. A vicious cycle of joint surface degradation and inflammation results as the collagen is exposed. With time, mechanical destruction and physiological destruction lead to exposure of subchondral (below the cartilage) bone, and sclerosis (thickening and replacement of normal tissue with scar tissue).
Therapy of degenerative joint disease (arthritis) includes weight control, exercise, drug therapy, nutraceuticals, and possible surgical options.
Weight Control
This is an essential component of relieving arthritis pain. Every extra pound of weight on an animal can translate to many extra pounds of pressure on the joint. Getting your pet down to an ideal, or even slightly thin weight, makes a huge difference in pressure on the joints.
Exercise
It is very important to maintain and promote the tone of the muscles supporting the joint. Walking, running and swimming are all excellent exercises to maintain muscle tone. Exercises that involve a lot of jumping and impact on the joints are not good exercises for the arthritis patient. In addition, owners should keep in mind that short, frequent walks (in some instances on-leash only) are recommended for the arthritic patient instead of long walks or hikes. The pace of the exercise program needs to match the needs and abilities of the patient.
Drug Therapy
The primary drugs used to relieve pain and inflammation from arthritis belong to the group of drugs called non-steroidal anti-inflammatory drugs (NSAIDS). These drugs reduce inflammation and pain through a number of mechanisms. Since the liver metabolizes most of these drugs, with long-term use the liver function must be monitored frequently - in the form of resting every 3 to 6 months. Steroids such as prednisone are avoided for long-term use as they can cause further breakdown of the cartilage and supportive joint structures. Rimadyl (Carprofen) and Etogesic (Etodolac) are commonly used NSAIDS in veterinary practice. Other drugs can be tried on an as-needed basis. Many human preparations have been tried with varying success. These are all off-label uses as they have not undergone the extensive testing needed for approval. All NSAIDS should be used only under the direction of a veterinarian.
Other prescription drugs that may be of benefit exert their effects at different levels. Amitriptyline, a tricyclic antidepressant is being recommended as an adjunct for pain control in chronically painful conditions such as arthritis. The possible side effects of this drug are sedation and and dry mouth. Doxycycline, an antibiotic commonly used to treat Lyme disease has shown beneficial effects on blocking some of the proteases involved in cartilage destruction. These drugs are being advocated by a number of researchers as part of a treatment regimen to slow the progression of arthritis. Accolate (Singulair) is used for its anti-inflammatory effects.
Nutraceuticals
Products in this class are considered nutritional supplements, and in general do not undergo the extensive testing required for a drug to be approved by the FDA. Ongoing research by private researchers is showing strong evidence to support use of a number of nutraceuticals as part of an overall regimen for arthritis. Much better results are being reported with the use of a multifaceted program. A number of these products exert their beneficial effects as antioxidants. Combinations of various nutraceutical agents, e.g., Niacinamide, antioxidants (such as Vitamin C), SAM-e, Proanthocyanidins (grape seed extract), MSM (oral DMSO), and fish oils along with chondroprotective (protects the cartilage) agents and NSAIDS, more effectively combat all the adverse effects of osteoarthritis than one or two therapies alone. No single drug or nutraceutical can address all the damaging changes that occur in osteoarthritis and degenerative joint disease.
Chondroprotective agents include the glucosamine-based products. Adequan is an injectable product that can offer quicker relief than the oral products and is often used as the oral glucosamines are started. The oral glucosamines take 4 to 6 weeks build up in the system before a maintenance regimen is started. Always feel free to call us regarding arthritis or any other aspect of care for your pet.
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