Friday, August 17, 2018

Arthritis in Pets

Just like with people, pets are prone to aches and pains as they get older.  Many times the underlying culprit is osteoarthritis.  With arthritis, the cartilage within the normal joint breaks down, leading to abnormal rubbing of bone resulting in inflammation and pain.  Sometimes this occurs early in life secondary to an underlying conformational problem like hip or elbow dysplasia, but many times it is a result of getting older.

In dogs, the common signs of arthritis are:
  • ·         Stiffness after rest, which tends to improve after activity
  • ·         Pain over a joint or “guarding” of a joint
  • ·         Muscle atrophy (loss)
  • ·         Crepitus (popping) of joints

Cats typically hide their pain better than dogs and you may not notice a lot of changes at home besides a decrease in jumping, a hunched appearance, or decreased grooming

A thorough physical examination can help pinpoint which joints may be causing a problem for a pet and then x-rays can be taken to confirm arthritis.

If your pet is diagnosed with arthritis, there are a wide variety of treatments ranging from weight loss to medications to physical therapy. 

A wide variety of medications are available to help ease the inflammation and pain associated with arthritis.  There are numerous over the counter supplements available that aid in arthritis relief.  The two most common supplements are omega fatty acids (fish oil) and glucosamine/chondroitin.  However, the mainstay of treatment typically revolves around non-steroidal anti-inflammatory medications (NSAIDS).

Fish Oil
Fish oil contains high amounts of omega fatty acids, which are beneficial in reducing inflammation associated with arthritis.  Specifically, the omega 3 fatty acids, EPA and DHA, are the most helpful in arthritis.  Ideally, a pet should receive between 50-100 mg/kg of EPA to help with arthritis. 

Glucosamine/Chondrotin and other Disease Modifying Osteoarthritis Drugs (DMOAD)
Supplementing with glucosamine can give relief to some pets.  These medications help decrease the inflammation within the synovial fluid of the joint and can help decrease cartilage degradation.  There are numerous oral medications available like Cosequin and Dasqauin, along with an injectable form called Adaquan.  There are also prescription foods that have added glucosamine and omega fatty acids, so additional supplementation is not needed.  A couple examples of food are Science Diet J/D and Royal Canin Mobility Support.

Non-steroidal anti-inflammatory medications target an enzyme called cyclooxygenase that creates prostaglandins in the body, which leads to inflammation.  There are numerous drugs within this class including:
  • ·         Carprofen (brand names Rimadyl and Quellin)
  • ·         Meloxicam (brand names Metacam and Meloxidyl)
  • ·         Firocoxib (brand name Previcox)
  • ·         Deracoxib (brand name Deramaxx)

Which brand of NSAID that your pet is started on depends on your veterinarian, how often you can medicate, and what your pet tolerates.  Every pet is different and may respond to one NSAID over another.  These medications typically are tolerated well, but stomach upset or ulceration can happen and kidney and liver values should be checked every 3-6 months if your pet is taking them regularly.

NSAIDS are used very commonly with dogs, but the use in cats can be controversial.  In 2010, a black-box warning was added to metacam in the U.S. stating that it can cause acute kidney failure and death in cats.  It is only labeled for one time use with post-operatively pain in the U.S.; however, It can still be used off-label for chronic pain.  In the U.K. it is used very frequently in cats suffering from osteoarthritis without major complications and can be used successfully in cats by adjusting the dosage and monitoring kidney values.  Having a thorough discussion with your veterinarian prior to starting your cat on meloxicam is recommended.

Piprant Class
Recently, a new class of medications called the Piprant medications have become available to help with arthritis.  These medications target the receptors of prostaglandins instead of production to control arthritis pain.  Currently, only one medication (Grapiprant) is available from this class.

Other Pain Drugs:
  • ·         Gabapentin was originally used as an anti-seizure medication, but more recently has been found helpful in alleviating pain, specifically chronic neuropathic pain.  It can be used in both dogs and cats
  • ·         Tramadol is frequently added with an NSAID to help alleviate arthritis pain in dogs.  It is less frequently used in cats since it can be bitter tasting

Stem Cell Therapy
This is a regenerative therapy that uses fat from a patient and processes it to acquire stem cells.  To collect the fat, general anesthesia is required and the fat is then sent to a laboratory for treatment.  There are also some in-hospital kits that are available and allow for processing without sending the sample out.  This is a newer therapy and while it has been shown to benefit patients with arthritis, it hasn’t been compared head to head with other therapies.

As noted above, there are numerous options to help control arthritis pain in pets.  Having a discussion with your veterinarian about arthritis concerns in your pet is the first step in the road to arthritis pain control.