What is Arthritis?
Arthritis, otherwise know as degenerative joint disease, is the response of a joint to damage. This response includes inflammation, wearing down of cartilage, damage to the lining of the joint, and growth of scar tissue and bone tissue to help repair the damage. It is never easy to see a beloved pet and friend in pain. Medical treatment of degenerative joint disease (arthritis) has greatly improved in the last several years thanks to the introduction and approval of several new drugs and supplements. And while there isn't yet a cure for this debilitating disease, there is much you can do to control the pain, make your pet comfortable, and perhaps slow down the progression of the symptoms.
There are many different causes of arthritis. Joint instability, ligament and tendon damage, and broken bones are common causes. Some of these can be corrected with surgery. Although there is no cure for arthritis, surgery to address the underlying cause may help stop the progression and minimize the pain. Your veterinarian can evaluate your pet through examination and x-ray to help diagnose the cause and slow the progression of arthritis.
Weight Control: Weight management is the first thing that must be addressed. Weight problems are often the most important part of arthritis control. Extra weight means extra stress on damaged and weak joints. Simply helping your pet to lose weight can eliminate many symptoms of arthritis. Getting your pet down to its recommended weight and keeping it there may be the hardest but most rewarding and most important thing you as an owner can do for your dog.
Exercise: Different kinds of joint disease require different restrictions on exercise, but a good rule of thumb is that if the joint is weak, we want to support it with strong healthy muscles. We want to promote activities that help increase or maintain muscle strength and maintain range of motion. Straight-line activities such as walking, running, hills, and stair work are all good. Swimming (generally at chest height since this promotes good range of motion) may be recommended since it places minimal stress on the joints. Damaging exercises include chasing balls; running with sudden stops, starts, and turns; and jumping. Frequent mild weight bearing exercise over an extended period is important. This means consistent, daily exercise. Sporadic (weekend only) exercise may do more harm than good if the animal is sore for the rest of the week and becomes reluctant to move at all. Physical therapy or rehabilitation therapy may be recommended to keep joints and muscles working properly.
Provide warmth and good sleeping areas: Arthritis tends to worsen in cold, damp weather. A pet sweater will help keep joints warmer. You may want to consider keeping the temperature in your home a little warmer, too. Provide a firm, orthopedic foam bed. Beds with dome-shaped orthopedic foam distribute weight evenly and reduce pressure on joints. They are also much easier to get out of. Place the bed in a warm spot away from drafts. Concrete and hard surfaces are terrible for dogs with arthritis.
Make daily activities less painful: Larger breed dogs can especially benefit from elevating their food and water bowls. Elevated feeders make eating and drinking more comfortable for arthritic pets, particularly if there is stiffness in the neck or back. Going up and down stairs is often difficult for arthritic pets, and for dogs it can make going outside to urinate and defecate very difficult. Many people build ramps, especially on stairs leading to the outside, to make it easier for the dogs to go outside.
Agents to promote healthy cartilage
Glucosamine and Chondroitin: Glucosamine and chondroitin  are two of the supplements that have recently become widely used in treating both animals and humans for osteoarthritis. When a pet has degenerative joint disease, the joint wears abnormally and the protective cartilage on the surface of the joint gets worn away and the resultant bone to bone contact creates pain. Glucosamine and chondroitin give the cartilage-forming cells (chondrocytes) the building blocks they need to synthesize new cartilage and to repair the existing damaged cartilage. They can also have some anti-inflammatory effects. These products are not painkillers; they work to support the joint in repairing damage that has been done.
These products generally take at least six weeks to begin to heal the cartilage and most animals need to be maintained on these products the rest of their lives to prevent further cartilage breakdown. These products are generally very safe with few side effects. There are many different glucosamine/chondroitin products on the market but they are not all created equal. We have seen the best results and fewest side effects from products that are formulated especially for dogs that contain pure ingredients that are human grade in quality. While glucosamine products can be purchased as over the counter human supplements, the quality of these products can be quite variable. Products we recommend are Dasuquin Advanced and Cosequin. Dasuquin is Cosequin plus extra anti-inflammatories and antioxidants. Generally, patients with joint problems are started on one of these products immediately, and maintained on them for the rest of their life. Even if these supplements alone are not enough to control symptoms, then can often decrease the amount of other medications that must be used.
Chondroprotectants: Polysulfated Glycosaminoglycans - PSGAGs (Adequan): PSGAG is a product that is administered in an injection. We administer these shots generally once a week for four weeks, and then every month or monthly as needed. This product helps prevent the breakdown of cartilage and may help with the synthesis of new cartilage. It is thought to inhibit some of the key enzymes involved in the formation of arthritis. The complete mechanism of action of this product is not completely understood but appears to work on several different areas in cartilage protection and synthesis. We have seen some amazing results with PSGAGs administration. PSGAGs have been shown in studies to slow the progress of osteoarthritis. Movoflex is a supplement that contains glycosaminoglycans as well but in an oral formulation with added antioxidants. These can be used simultaneously, as the injectable form is better delivered to the joint, while the movoflex provides other benefits.
Anti-inflammatories and pain relievers
Anti-oxidants: Antioxidants have many beneficial side effects involved in decreasing inflammation and helping to promote healing. They are often used as a first line treatment initially for arthritis, and can show some rapid results. We carry Movoflex which provides anti-oxidants as well as other ingredients to support joint fluid health.
Omega Fatty Acids: Omega fatty acids are wonderful agents to decrease inflammation. Studies have shown significant improvement by placing arthritic dogs on high doses of these supplements. One option for this is Antinol or Osteo, a daily green mussel supplement which is highly specific for joint inflammation. Prescription foods for joint disease (J/D, Mobility) also provide high levels of omega fatty acids.
Immune Modulator: Flexadin Advanced is a UC II supplement that trains the immune system to not have the strong inflammatory reaction to the type II collagen released from damaged cartilage that leads to further joint damage, remodeling and progression. This supplement can slow the disease process but takes 60-90 days to see effects.
Non-steroidal Anti-inflammatories (NSAIDs): Of the anti-inflammatories, NSAIDs are definitely the best and the most effective. There are now a number of these out on the market for dogs. NSAIDs we use include carprofen (Rimadyl, Vetprofen), firocoxib (Previcox), and meloxicam (Meloxidyl, Metacam). They can be used as both strong and effective painkillers and anti-inflammatory agents. We may recommend that periodic blood work to be done on animals that are on these products to monitor any developing liver, kidney or other organ problems resulting from their use. These are often prescribed on an as-needed basis - for days when your pet is has exercised too hard, or humidity and rain are causing lots of stiffness. In severe cases, we may recommend daily administration of these products.
Corticosteroids: Corticosteroids have been used for many years to treat the pain and inflammation associated with osteoarthritis, although their use now is controversial. Corticosteroids act as a potent anti-inflammatory but unfortunately have many undesirable short and long-term side effects. They can cause damage to the liver and shorten your pet' life. Because of these side effects and the advent of newer, more specific drugs, we generally only recommend corticosteroids when all other pain control products have failed.
Buffered Aspirin: Because of the risk of bleeding and gastric upset, as well as the poor efficacy of buffered aspirin, we never recommend this as a treatment for arthritis. Regular aspirin, Tylenol, and ibuprofen have many more potential side effects and are not recommended without veterinary guidance. Note: Aspirin can be fatal if given to cats.
Class IV Laser: Laser therapy is a new pain control method that has been extremely effective in arthritis. It decreases inflammation and pain and may help stimulate stem cells for healing. It can slow the formation of arthritis and has shown amazing results in many of our patients. Our typical treatment regimen is 3 times a week for about 4 weeks (until we see results) then maintenance treatments 2-4 times a month. Treatment is really tailored to the patient and the results we are seeing.
Platelet Rich Plasma Therapy: Platelet-rich plasma (PRP) therapy uses injections of a concentration of a patient's own platelets to accelerate the healing of injured tendons, ligaments, muscles and joints. In this way, PRP injections use each individual patient's own healing system to improve musculoskeletal problems.
Stem Cell Treatment: Stem Cell treatment is another new method for treating arthritis. The process involves harvesting cells and sending them to a company to treat them so that they can become active stem cells, then injecting them into the affected area. The stem cells are then thought to turn into new cells to repair damage and slow down damage. Because of the ongoing nature of changes due to arthritis, regenerative stem cells may not permanently stop the degenerative processes. However, intra-articular regenerative stem cell administration may provide long-term anti-inflammatory effects, decrease pain, stimulate regeneration of cartilage tissue that slows the degenerative processes, and initiate healing in chronic and acute injuries. Some cases will require periodic treatment with stored (banked) doses of cells.
Chiropractic Care: Depending on the joints affected, chiropractic care can be a very effective way of controlling pain and addressing the underlying problems, as well as dealing with issues from compensation. Back/disc problems are especially amenable to chiropractic adjustment. Generally we recommend three adjustments to see if chiropractic care will help your pet.
Acupuncture: Acupuncture is an ancient Chinese practice that involves the insertion of paper-thin needles into certain points on the body to balance and regulate the flow of "chi," or energy. Proponents say it effectively reduces stress, pain and inflammation, and can help the dog regain range of motion in the affected joints. One way in which acupuncture works is by stimulating the release of endorphins, pain-killing chemicals released from the brain, and providing your dog with natural relief. Most pets accept the needles well and some even become relaxed and sleepy during the therapy.
Summary: Each pet with arthritis will need to have a management program specifically designed for his needs. What helps one pet with arthritis may not help another.
Arthritis in Cats