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Don't Slow Down! - Dealing with Arthritis

"Oh, he's fine, he's just slowing down." It's a common comment I hear during exams of middle-aged and senior pets. Just like us, arthritis is one of the most common reasons pets "slow down" as they age, and just like us there are many options for managing discomfort, improving quality of life, and ultimately "speeding them up" again. Like most problems, the key to dealing with arthritis effectively is understanding what it is and why it happens. 

A visibly swollen ankle.Osteoarthritis, simply put, is discomfort and inflammation of the joints. It's the long-term result of abnormal wear and tear, which may be due to irregularities in the joints or cartilage pets are born with - such as hip dysplasia or unstable kneecaps - or, they may damage the cartilage, ligaments, or bone later on. Major abnormalities or trauma will likely be noticed early on and may be dealt with surgically, but minor abnormalities may only be evident much later as arthritis develops over time. Likewise, pets that ask a lot of their joints over their lives - such as athletes, or conversely, obese pets - may ultimately develop arthritis even without other abnormalities or damage.

The most important thing to understand is that arthritis is an inflammatory process. I intentionally emphasize both words. Inflammation is the body's response to damage. Irritated cells release proteins into the bloodstream, which in turn recruit specialized cells and more proteins back to the site. These cells and proteins are intended to repair damaged tissue or fight off infection. This is why a cut on your skin inevitably swells up and turns red - the area is filling with fluid and cells. The inflammatory process cleans up, repairs the damaged skin with a bit of scar tissue, and subsides. However, when the process can not fix the underlying problem - such as with a defect in joint cartilage or a misaligned joint - it just keeps going and going. Thus arthritic joints tend to stays wollen and painful (though how much may vary daily). Moreover, with time the inflammation will induce production of new bone, similar to scar tissue left in skin. Unfortunately, the end result is more irregular joints, and thus more inflammation, more arthritis, more pain, and less mobility. Inflammation is a process, and unless we interrupt it things will only get worse.

Arthritis itself is rarely a surgical disease; however, it is worth pointing out that many of the problems that lead to arthritis can be corrected surgically. Most joint diseases that can be treated surgically don't see the vet initially, and they run a course like this: the pet becomes acutely lame, improves back to normal-ish over a few weeks or months (while we "wait and see"), then a few months or years down the road the lameness returns (arthritis) and slowly gets worse. If abnormalities in the joints of young animals are recognized early it is often possible to correct them surgically and prevent a lifetime of progressive arthritis and pain. Traumatic damage to the joints of adult pets, such as torn ligaments in the knee, also doesn't have to turn into serious arthritis if it's fixed right away. For this reason alone, at the first concern of lameness you should see your veterinarian.

So, that's arthritis in a nutshell - joints are abnormal or damaged, the body tries to fix it with inflammation, but it can't and ultimately just winds up making things worse. In the next part, we'll talk about the different therapies available to interrupt the inflammatory process, slowing or stopping the ongoing joint damage it causes. That's the key to reducing pain, increasing mobility, and ultimately improving quality of life for pets suffering from arthritis.

Treating Arthritis

Since arthritis ultimately both results from and causes long-term changes to the joints themselves, we can't really expect to cure it. Fortunately, there are many options to improve comfort and interrupt the inflammatory process. A multimodal approach - one using multiple strategies in combination - is by far the most effective and safest; your veterinarian can tailor a plan to your pet's individual problems, monitor improvement, and adjust therapy when and if their arthritis worsens. The ultimate goal is always to keep pets happy and comfortable while slowing progression.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
These are drugs that work in the same manner as aspirin or ibuprofen, but in pets we use different drugs such as carprofen (Rimadyl), meloxicam (Metacam), deracoxib (Deramaxx) and others. They are the medical treatment with the most proven benefits - the right NSAID will make pets more comfortable - but they also have the most risk of side effects. Major concerns include stomach ulceration, as well as kidney and liver damage. Dogs, and particularly cats, are much more sensitive to side effects from these drugs than people, and for this reason they should only be used under the supervision of your veterinarian. That said, when used properly they are incredibly valuable in treating arthritis because they both reduce pain and directly interrupt the inflammatory process, potentially slowing progression.

A practical note - while aspirin can relieve pain in dogs, please don't take it upon yourself to give it to your dog without talking to your veterinarian. It has a high incidence of gastric side effects, and due to the subtle differences in the way it works from other NSAIDs we have to stop aspirin and wait several days before starting more appropriate pain medications. Not doing so can have life-threatening consequences.

Exercise, Weight Loss, and Physical Therapy
While heavy exercise can exacerbate arthritis, moderate exercise is a pillar of dealing with it. Walking is ideal for keeping joints flexible and improving blood flow; swimming is even better when possible, since there's no impact involved. Weight loss is another pillar - it doesn't take a medical degree to realize painful joints hurt more when loaded with unnecessary weight. Fat also produces proteins that encourage inflammation, so it might even directly worsen arthritis. Check out this article for weight loss tips.

Just like with people, physical therapy can be immensely valuable for dealing with arthritis. Often this includes low-impact exercise such as underwater treadmills and specialized stretching. In many urban areas there are veterinarians with special training and facilities for physical therapy; ask your regular vet for recommendations.

There's a laundry list of nutritional products with claims to reduce arthritis. I habitually start arthritic pets on omega-3 fatty acid supplementation, as much research supports their effectiveness at reducing inflammation. Glucosamine and chondroitin sulfate also have some support. I try to keep an open mind - if there's a reasonable body of evidence a supplement is safe for pets, it's worth trying if owners are interested. One thing to keep in mind about nutraceuticals - they are virtually unregulated, so there's no real guarantee of the amount or quality of the product on the label like there would be for an actual drug. For this reason, it's probably best to avoid the bargain product off the shelf at Wal-Mart. Your veterinarian likely carries some supplements who's quality they trust, or they can recommend specific products.

PSGAGs (polysulfated glycosaminoglycans) also have reasonable scientific support for improving comfort and function. They are given as an injection, and having personally seen some dramatic improvement from them recently, I strongly recommend talking to your veterinarian about them early on when trying to address arthritis.

Novel Therapies
Arthritis is very prevalent in older animals; not surprisingly, new treatments are constantly being proposed. Some of these hold promise - stem cell therapy, for example, is already being used in pets, has shown promising results, and has growing research support. Therapeutic lasers have also become very popular. Just like with people, many swear by things like acupuncture, herbs and the like. Myself, I'm skeptical of anything without verifiable research to support it. Believe it or not, the placebo effect has a prominent effect in animals too.  On the other hand, when proven therapies become insufficient, it's hard to argue against trying other modalities so long as there is reasonable evidence they are safe.

When treating any disease, our ultimate goal is to improve pet's quality of life. Considering that, treating arthritis is one of the most rewarding parts of being a veterinarian, because we so often see dramatic improvement in activity, energy, and enjoyment. It all starts with you recognizing that there is a problem, though. So if Muffy doesn't seem to have the spring in her step she used to, ask your veterinarian if there's a way to get it back!