By Kendra Freeman DVM, MS, DACVS (Large Animal/Small Animal)

Osteoarthritis (OA) remains the most common joint concern diagnosed in veterinary medicine. It is estimated 61 percent of cats six years and older will have evidence of OA.¹

According to the World Health Organization (WHO), OA starts in human patients 40-50 years of age. In veterinary medicine, we often see osteoarthritis in younger patients, with 40 percent of canine patients aged eight months to four years presenting radiographic evidence of this disease.² The degenerative condition is characterized by inflammation of the synovial structures, ultimately leading to erosion of the cartilage, thinning of the joint fluid, and osteophyte formation. In our patients, the stifles, hips, and elbows are some of the most commonly affected joints. Management of OA may vary from prevention, minimizing progression, and treatment of clinically affected patients. Identifying which of our patients are at risk is key to limiting the effects of this common concern in our patient population.

Treatment of the underlying disease

As a surgeon, a good portion of my practice is identifying young patients at risk of developing OA. Young patients with developmental orthopedic diseases (dysplasia, angular limb deformity, joint incongruity, and osteochondritis dissecans) are at risk for developing the disease at a young age.

Treating the primary problem can minimize the development of osteoarthritis in these young patients in the future. Arthroscopic removal of a cartilage flap from the caudal humeral head can minimize the progression of OA in the shoulder joint with OCD. Surgical management of elbow dysplasia (specifically medial coronoid disease) improves patient comfort. The effect of surgery on osteoarthritis in the elbow remains debated (Figure 1).

Patients with hip dysplasia will eventually develop osteoarthritis. If the hip dysplasia is identified at a very young age (<20 weeks), surgical intervention with a juvenile pubic symphysis procedure can improve joint congruity. This is a simple procedure that requires minimal equipment. If the dysplasia is not identified early and patients are allowed to reach skeletal maturity, the surgical options are limited to salvage procedures, such as total hip arthroplasty or femoral head and neck excision. Identifying these dysplastic patients while they are very young offers less invasive options with good outcomes.

Cranial cruciate ligament (CCL) injuries and medial patella luxation are common orthopedic conditions seen at our practice. Kim et al. determined 47 percent of patients with medial patella luxation have cartilage erosion at the time of surgery.³ Unfortunately, many patients with cranial cruciate ligament injury also have evidence of osteoarthritis at the time of surgery (Figure 2). Stabilizing the affected stifles with a tibia plateau leveling osteotomy (TPLO) or surgical correction of the medial patella luxation can improve patient comfort and has the potential to limit or at least slow down the progression of osteoarthritis in the future.

Even after successful recovery from these surgical procedures, these patients will need lifelong management of osteoarthritis.

Management

Osteoarthritis cannot be undone except through joint replacement surgery. Management often requires a multimodal approach, using a combination of lifestyle changes, medications, and supplements throughout the patient's life.

Treating inflammation remains central to the management of osteoarthritis. This can be achieved in several ways:

• Non-steroidal anti-inflammatory drugs (NSAIDs) remain one of the most effective treatments for pain and inflammation associated with osteoarthritis. With several FDA-approved NSAIDs on the market, patient tolerance and cost play a role in which medication to choose.Carprofen is generally well tolerated, with minimal side effects noted after two months of administration.⁴ Carprofen has the advantage of the availability of generic forms making it reasonably affordable for pet owners.
  Grapiprant is an EP4 prostaglandin receptor antagonist that has been shown to improve symptoms of osteoarthritis and has a wide safety margin.⁵ Once-daily administration may be easier for some pet owners; however, cost may be an issue for some.
• One of the most effective management tools, as well as the most challenging for most pet owners to implement, is weight management. We know dogs that are appropriately calorie-restricted and encouraged to maintain lean body mass, live longer and have a later onset of chronic diseases.⁶

  Extra body weight puts additional stress on joints, limits mobility, and the adipose tissue itself is pro-inflammatory. Many clients overestimate their pet's activity and underestimate how many calories the pet is consuming. I find giving pet owners specific instructions about daily calorie intake and periodic check-ins makes weight loss more successful.

• For joint supplements, omega-3 fatty acids have shown the most consistent benefits in canine patients. Fish oil supplements with omega-3 fatty acids have been shown to decrease inflammation by decreasing arachidonic acid (AA), as well as improve mobility in canine patients.⁷
  
  Literature supporting the effectiveness of glucosamine supplementation has been inconsistent. A study in the Veterinary Journal showed glucosamine and chondroitin supplements had a slower onset of benefit compared to carprofen, but were beneficial.⁸
  
  A more recent study showed no benefit to glucosamine and chondroitin sulfate supplementation.⁹ Clinically, I have seen the benefit of glucosamine and chondroitin sulfate supplementation. If a client is going to spend their financial resources on a glucosamine supplement, I encourage a veterinary-specific product that also contains chondroitin sulfate and eggshell membrane.¹⁰

• Numerous additional modalities, including platelet-rich plasma, acupuncture, laser therapy, and physical therapy, can be used in conjunction with medications and supplements to manage osteoarthritis. Bedinvetmab targets nerve growth factor and is effective at improving symptoms of osteoarthritis, but it has no known anti-inflammatory effects.

The core strategy for osteoarthritis management and treatment remains inflammation management—non–steroidal anti-inflammatory medications, omega-3 supplements, and weight reduction/management and correction of underlying disease processes. Additional therapies and activity modifications can be tailored for each patient, and many of these patients can live comfortable and reasonably active lives.

Kendra Freeman DVM, MS, DACVS (Large Animal/Small Animal), is a graduate of Colorado State University and maintains dual certification with the American College of Veterinary Surgeons. Dr. Freeman is an associate surgeon in Albuquerque, N.M. Her case load consists of orthopedics, general soft tissue, and sports medicine cases with the occasional return to her roots in large animal lameness and surgery.

References

1. Slingerland LI, Hazewinkel HA, Meij BP, Picavet P, Voorhout G. Cross-sectional study of the prevalence and clinical features of osteoarthritis in 100 cats. Vet J. 2011 Mar;187(3):304-9
2. Enomoto M, de Castro N, Hash J, Thomson A, Nakanishi-Hester A, Perry E, Aker S, Haupt E, Opperman L, Roe S, Cole T, Thompson NA, Innes JF, Lascelles BDX. Prevalence of radiographic appendicular osteoarthritis and associated clinical signs in young dogs. Sci Rep. 2024 Feb 3;14(1):2827.
3. Kim HW, Kim YS, Kim WK, Kang KW, Kang BJ. Medial patellar luxation induces cartilage erosion in dogs: a retrospective study of prevalence and risk factors. Am J Vet Res. 2024 Sep 9;85(11)
4. Raekallio MR, Hielm-Björkman AK, Kejonen J, Salonen HM, Sankari SM. Evaluation of adverse effects of long-term orally administered carprofen in dogs. J Am Vet Med Assoc. 2006 Mar 15;228(6):876-80.
5. Rausch-Derra L, Huebner M, Wofford J, Rhodes L. A Prospective, Randomized, Masked, Placebo-Controlled Multisite Clinical Study of Grapiprant, an EP4 Prostaglandin Receptor Antagonist (PRA), in Dogs with Osteoarthritis. J Vet Intern Med. 2016 May;30(3):756-63.
6. Salt C, Morris PJ, Wilson D, Lund EM, German AJ. Association between life span and body condition in neutered client-owned dogs. J Vet Intern Med. 2019 Jan;33(1):89-99.
7. Roush JK, Dodd CE, Fritsch DA, Allen TA, Jewell DE, Schoenherr WD, Richardson DC, Leventhal PS, Hahn KA. Multicenter veterinary practice assessment of the effects of omega-3 fatty acids on osteoarthritis in dogs. J Am Vet Med Assoc. 2010 Jan 1;236(1):59-66. doi: 10.2460/javma.236.1.59. Erratum in: J Am Vet Med Assoc. 2010 Jun 1;236(11):1191.
8. McCarthy G, O'Donovan J, Jones B, McAllister H, Seed M, Mooney C. Randomised double-blind, positive-controlled trial to assess the efficacy of glucosamine/chondroitin sulfate for the treatment of dogs with osteoarthritis. Vet J. 2007 Jul;174(1):54-61.
9. Kampa N, Kaenkangploo D, Jitpean S, Srithunyarat T, Seesupa S, Hoisang S, Yongvanit K, Kamlangchai P, Tuchpramuk P, Lascelles BDX. Study of the effectiveness of glucosamine and chondroitin sulfate, marine based fatty acid compounds (PCSO-524 and EAB-277), and carprofen for the treatment of dogs with hip osteoarthritis: A prospective, block-randomized, double-blinded, placebo-controlled clinical trial. Front Vet Sci. 2023 Feb 1;10:1033188.
10. Ragetly GR, Martins A, Ober CA, Boiocchi S, Nicolas CS. Efficacy of a joint supplement containing eggshell membrane among other ingredients to improve the mobility of dogs with osteoarthritis: a multicenter double-blind randomized placebo-controlled study. Front. Vet. Sci. 2025; April 24; 10:3389