How we diagnose and treat age-related joint pain or ‘osteoarthritis’ in cats and dogs

What we mean when we use the term ‘osteoarthritis’

Arthritis is the medical term for inflammation of the joints. Osteoarthritis or OA is the term for slowly progressive and irreversible joint inflammation caused by deterioration of joint cartilage and underlying bone.

Osteoarthritis ranges in severity from a mild, intermittent condition causing mild discomfort to an advanced clinical state with, if not treated, constant pain and severe disability.

Causes of OA include age-related wear, trauma and congenital defects. Obesity, diabetes and excessive looseness of joints are risk factors for OA and hence ‘degenerative joint disease’ or DJD.

How we diagnose osteoarthritis

With your help we can almost always diagnose osteoarthritis without the need for x-ray, CT, MRI or ultrasound examination.

Please take a short video of your cat or dog moving around at home and either email it to us or bring it with you when you visit. For tips on capturing good footage, watch this short guide.
We will watch your dog’s movement while walking and trotting at the clinic.
We will ask you specifically about your pet’s behaviour: upon arising, after exercise, using steps or stairs, getting on furniture, toileting, on slippery floors.
We will ask you to complete the Helsinki Chronic Pain Index to ‘score’ the level of your pet’s discomfort. This internationally recognised questionnaire helps assess discomfort in dogs and cats, and we will continue using it to monitor progress throughout treatment.

Possible Treatments

Treatment includes reviewing your companion’s weight, body score and exercise routine

Regularly ‘score’ pain

We will ask you to continue using the chronic pain index on this website so that we can both monitor progress. We will also routinely complete a score to compare how we think we are progressing with how you think treatment is progressing.

We will provide an individual treatment plan that is targeted for your companion

Oral medicines

We usually start by trying a ‘non-steroid anti-inflammatory drugs (NSAIDs) such as Loxicom, Previcox or Rimadyl. Loxicom is the generally preferred NSAID. When possible we will do a urine check for protein. If NSAIDs are effective and will be used routinely we will do a blood test to check kidney and liver function. If there’s a breed predisposition to NSAID side effects we will also dispense omeprazole to protect the stomach lining.

We may add gabapentin or paracetamol tablets as they work on different pain pathways.

Injectable medicines

When NSAIDs are effective we often suggest continuing treatment. If there is concern about possible side effects we often suggest moving to monthly injections with LIBRELA for dogs or SOLENSIA for cats. These are highly sophisticated ‘monoclonal antibody’ medicines. A trial is for 2-3 months and stopped if scores don’t show continuing improvement.

LIBRELA and SOLENSIA: The two to three months trial is continued when both your observations and the scores we’re taking show a continuing improvement. At the first injection we will give you the medicine insert. This explains the rare side-effects that may occur. After the trial the nurses will give follow-up injections at 20 minute Nurse Consultations. They will ask you questions about weight management, exercise and signs of increasing or decreasing pain and will ask you to continue scoring joint discomfort. (Nurse Consultations are around one third the cost of Vet Consultations.)
Chondroprotective drugs: Cartrophen/Pentosan injections: Chondroprotective agents work to stimulate cartilage repair and inhibit ongoing damage. Occasionally we may suggest a course of injections commencing once weekly for 4 weeks, with booster injections every 3 months.
Epidural cortisone: Long acting corticosteroids (cortisone) can be injected into the lower lumbar spine to relieve chronic nerve pain due to sciatica (lumbosacral disease). This option can be very effective for this debilitating nerve pain. John Parker, our Veterinary Neurologist, gives three injections under short general anaesthetics within a six-week period. Repeats can be performed in future if and when clinical signs indicate that back pain has returned. This can be anywhere from 6 months to 18 months from the initial course and depends on the severity of the lumbosacral disease at the time of treatment. Lumbosacral disease is an ongoing, progressive problem that continues throughout life.

Acupuncture

Acupuncture uses needles placed into the skin to stimulate a response that alleviates pain. Independent studies suggest that when a state of chronic pain has developed, acupuncture has a greater than placebo effect at reducing that pain. Most dogs and cats tolerate acupuncture needles surprisingly well even falling asleep during the procedure. The benefits of acupuncture are ‘segmental’. That means that the correct placement of the acupuncture needles is vital. Dr Philippa Hanslip BSc MA VetMB MRCVS who previously practiced here at the London Vet Clinic, provides acupuncture and hydrotherapy at Active Pet located around 45 minutes from the clinic off the A40 this side of High Wycombe. Dr Hanslip is one of the most experienced providers in the Greater London region.

Hydrotherapy and physiotherapy

The buoyancy of water reduces the load on painful joints and allows dogs to stand and comfortably exercise in ways they otherwise can’t. Underwater treadmill therapy may sound scary for pets that dislike water but usually isn’t and can be therapeutic building up muscle and improving mobility. Dr Hanslip has an underwater hydrotherapy treadmill at Active Pet. Bruce is President of RSPCA Sussex West near Chichester and can arrange for your dog to have hydrotherapy sessions using their underwater treadmill.

Physiotherapy exercises improve joint mobility, build muscle and improve core strength. (Think pilates for dogs.) Dr Hanslip’s team can devise a home exercise program for you to maintain. We can refer you other Association of Chartered Physiotherapists in Animal Therapy (ACPAT) members including Holly Soper-Doyle at Integrum Physiotherapy.

Home adaptations

Home adaptations include switching to memory foam beds, using raised food and water bowls, covering slippery floor surfaces with rubber-backed mats, using ramps to get on furniture or into cars and other modifications that make moving easier and that reduce risk of more damage. Adaptations vary for each dog or cat. We will discuss these in detail with you.

Diet and weight loss

Weight management is at the core of managing osteoarthritis. Weight reduction reduces stress on joints.

If you provide Butternut Box or Marro fresh food to your dog or cat we will discuss the present size of each meal and suggest by how many grams the next order should be reduced.

If you are offering processed wet or dry food we will suggest gradual changes to lower calorie diets containing supplements such as green-lipped muscle extract, chondroitin and glucosamine that may help maintain healthy joints. For dogs we may recommend Virbac’s Joint & Mobility food. For cats we may suggest Virbac’s range of Kidney & Joint Support foods.

Oral supplements

Omega 3 and Omega 6 fatty acids are essential fatty acids not produced by your dog or cat itself. These fatty acids may act as natural anti-inflammatories. There is good evidence that they are therapeutic for dogs and cats with rare rheumatoid arthritis although the scientific evidence that they reduce discomfort from osteoarthritis remains thin. Fish oil capsules, high in these fatty acids, will do no harm and may be beneficial.

Chondroitin and glucosamine are key nutrients that makeup cartilage. They can assist in the natural repair and regeneration of your dog or cat’s cartilage. There are few peer-reviewed studies that confirm their clinical effect but as with fish oil, supplements such as Yumove Joint Care will do no harm and may be beneficial.

We use gabapentin if we suspect neurological pain. Because it is metabolised by the liver and eliminated by the kidneys we usually run a routine blood sample before starting a course. The most common side effect is mild sedation.

Paracetemol is generally safe for dogs BUT HIGHLY TOXIC TO CATS. On its own it is not a very potent analgesic but when combined with an NSAID, gabapentin or tramadol it can be an effective pain killer. Paracetemol should be avoided in any dog with a severe liver problem.

We may also use tramadol when pain affects your dog’s mood or behaviour. Lameness may not diminish but as with gabapentin your dog may appear happier even though it still limps. The most common side effect from tramadol is mild sedation.

NSAIDs, tramadol and gabapentin appear safe to use alongside each other.

Exercise

Light activities such as walking and swimming help strengthen muscles while keeping ligaments and tendons flexible. Physical activity helps to prevent obesity and aids in circulating blood to stiff joints. Don’t stop exercising your dog when chronic osteoarthritis develops. Exercise is good. A 15-30 minute walk every day is a great start. Swimming is especially great for dogs with osteoarthritis who love water because the water supports much of the body weight and inhibits sudden excessive movements. If your dog is a ball retrieving addict, we’re sorry but ball throwing should be avoided. Sudden stops or leaps should be avoided. Walking up and down stairs is good and should be encouraged for as long as possible.

Other potential treatments

CBD Oil has been reported to be an effective supplement for reducing osteoarthritis pain but in the UK at present there are no CBD oil products licenced for veterinary use. We are monitoring this and when a product becomes available we will tell you through our monthly newsletter.

Stem Cell Therapy uses a dog’s own stem cells (usually collected from fat) that are then lab-grown and injected into the joint, to relieve pain, regenerate and repair. The Royal Veterinary College has an ongoing study into possible benefits but the results are at best inconclusive. We will continue to monitor their research.

Laser Therapy is a non-invasive treatment using light energy to reduce both inflammation and pain. We have been impressed by the statistics shown to us by Laser Therapy manufacturers on how profitable it is to offer this simple treatment at York Street. Unfortunately we can’t find any respected scientific articles confirming that laser therapy actually reduces pain and inflammation, either in people dogs or cats. So we don’t offer low level laser therapy but if you would like to try this for your companion we will refer you to a facility that does.

Please feel free to make an appointment to discuss any of these treatment options for your animal.

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