Arthritis


Arthritis is a very common problem in older dogs and cats.  When properly treated, your pet can experience a greatly-improved mobility and quality of life.  There are a variety of supplements and medications that can be used to treat arthritis


Arthritis is a major problem in both dogs and cats.  It is often easier to recognize in dogs, but many cats also suffer from this affliction.  Signs include difficulty rising, difficulty lying down, stiffness, decreased jumping, decreased playing, weight loss in the hindquarters, and increased sleeping.  Click here for a video presentation made by the pain management specialists at the Colorado State University College of Veterinary Medicine entitled Is Your Pet in Pain?

Arthritis is what happens when the joints wear out.  Joints are biomechanical marvels, consisting of layers of articular cartilage which cover the ends of the bones, joint fluid, which acts as a very sophisticated biological lubricant, and ligaments and the joint capsule, which provide mechanical support and stabilization for the joint. 

With age, wear and tear, or injury, any or all of the components of the joint can be damaged, and once that happens the whole structure begins to spiral down-hill.  Tissue damage leads to inflammation, which in turn causes the joint fluid to become thinner, causes damage to the articular cartilage, and causes swelling and pain in the ligaments and joint capsule.

Diagnosing arthritis is done mainly with a physical exam and history.  X-rays can be helpful, especially in severe cases or when the lameness seems worse on one side.  In many larger dogs, arthritis is a consequence of Hip Dysplasia, a degenerative condition caused by abnormal conformation of the hip joints.  Click the link to go to a more detailed discussion of Hip Dysplasia, including some good x-rays.

Arthritis can and does strike many joints besides the hips.  Elbow arthritis is also especially common.  Cats quite frequently get spinal arthritis.  Arthritis can happen anywhere, and quite frequently does.

Arthritis is readily treated with a variety of medications and supplements.  In no particluar order, here is a brief listing of some of the more common treatments.Nutritional SupplementsMany people are personally acquainted with the benefits of glucosamine and chondroitin.  These are nutrients that help build good joints by building better joint fluid and articular cartilage.  Nutrients like this with medicinal properties are often called Nutraceuticals.  In  many cases, significant pain relief is obtained through the use of glucosamine and chondroitin.  There are literally hundreds of brand names out there.  Some are good, some not-so-good.  Because they are not regulated by the FDA like drugs are, their label content and their actual content can and does vary widely, depending on the brand.  I usually tell my clients that if they are taking a glucosamine and think it works, use that one on their dog.  If they are not taking one personally, I recommend picking a mid-priced product and trying that on their dog.  If they don't see any response, I then recommend using the brand name Cosequin for their dog.  In general, most dogs do well on one-half the glucosamine dose that a person would take.   The product Cosequin for Cats is a good first-choice product for arthritic cats.  These products have no side effects or other adverse effects, and for this reason I think every arthritic dog should be on glucosamine.

Adequan is another glucosamine-like product sometimes used to treat arthritis.  Adequan is injected, however.  Injecting the product avoids the loss due to digestion, and so large doses can be given.

J/D is a food marketed by Hills Pet Nutrition, the Science Diet folks.  It contains significant quantities of glucosamine and chondroitin as well as omega-three fatty acids, eicosapentaenoic acid, and other anti-oxidants and industry buzz-words that are believed to be beneficial in the treatment of arthritis.  J/D is a fairly new product, and although independent research has not to date been done to validate all of the label claims, Hills' in-house data are reasonably convincing, and I believe J/D is worth a try.  Click here to see some videos of J/D in action.  Warning:  This is marketing at it's best.  While I do think J/D helps many dogs, let's just say that your results may not be so striking.

All of these nutraceutical-type products are aimed more at prevention rather than cure.  Althought they often do provide significant relief of minor arthritic pain, alone they tend to have limited value in the more severe cases of arthritis.  When combined with other, more potent treatments, they often act synergistically.  They take considerable time, weeks to months, to have full effect.Non-Steroidal Anti-Inflammatory Drugs.Called NSAID's for short, this class of drugs includes such familiar characters as aspirin, ibuprofen, Aleve, Mobic, Rimadyl, Feldene, Clinoril, Lodine, Orudis, Deramaxx, and Celebrexx.  Many people, and many dogs, for that matter, experience significant relief from their arthritis symptoms by using these drugs.  They act by reducing inflammation in the joint. They are common, and many are available without a prescription.       
       

DO NOT GIVE YOUR PET ANY OF THEM WITHOUT CONSULTING ME!!!
The reason is that every year, about 12,000 people die from side effects associated with NSAID's.  Now, we're not talking about 12,000 people who "got sick" from adverse reactions to NSAID's, or 12,000 people who "were hospitalized" with adverse reactions to NSAID's, we are talking about 12,000 people who flat-out died.  The fact is that NSAID's have some real and serious side-effects, and if they are used in the wrong patient at the wrong doses and are not monitored, you can expect to have problems with them.  Even aspirin or ibuprofen.

One of the reasons we see so many problems with NSAID's is their availability.  People who should never be taking NSAID's in the first place just go down to Walgreens and buy them.  Then there are the people who take several different NSAID's at a time.  NSAID's don't play well together, and their adverse effects tend to be additive while their beneficial effects are not.  Then there are interactions with other drugs.  There are certain other drugs which can not be taken safely along with NSAID's.  Then there are people who take a whole handfull of ibuprofen at a time.  More is not better. 

There are also species differences, too.  There are only two NSAID's that I would even consider giving to cats.  The rest are uniformly toxic to cats.  Dogs don't tolerate ibuprofen well, and if you want to see what bad things happen to dogs' stomachs after only five days of aspirin, click the link Aspirin for Dogs and Cats.  Phenylbutazone is a great drug for horses, but causes severe blood dyscrasias and liver toxicity in people.  Rimadyl is a great drug for dogs, and is the main NSAID we use at Sunnyside Veterinary Clinic.

NSAID's can be used safely with great success.  Let me repeat that:  NSAID's can be used safely with great success.  The keys to safe and happy NSAID use are 
1) to use it in the right patient
2) use it at correct doses
3) be careful to avoid bad drug interactions
4) monitor for adverse events.

At Sunnyside Vetrinary Clinic, we have used Rimadyl for years, and feel that when used properly, it is a safe and effective treatment for dogs with all stages of arthritis.  We do this by doing blood testing on older patients before beginning NSAID therapy to make sure there are no pre-existing medical conditions that would make NSAID's a bad idea.  We then evaluate your pet's medical record to see that there will be no adverse drug reactions to anything previously prescribed, and we talk about how to never give any other drug without talking to me first.  Then we use the lowest possible dose that provides adequate relief, and we have a long talk about how more is not better.  Then we set up a monitoring plan to make sure problems don't creep up on us. 
When prescribed and used in a safe way, NSAID's can be a real blessing to your older dog.Other Drugs  

There are several other drugs that are useful in treating arthritis pain.  Tramadol, also known as Ultram, is a potent pain killer that can be used alone in patients who are not good candidates for NSAID therapy, or it can be used in addition to NSAID's like Rimadyl.  Amantadine is a drug that is useful in combatting chronic pain.  It acts on the spinal cord to decrease the pain response.  Dextromethorphan is more commonly known as a cough-suppresant, but has properties similar to amantadine and is occasionally used in a similar way.  


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