We spoke with Denis Marcellin-Little, DVM, Dipl. ACVS, to obtain reliable information about appropriate osteoarthritis treatments in 2010. A professor at the North Carolina State University College of Veterinary Medicine, Dr. Marcellin-Little is involved in both orthopedic surgery and rehabilitation.
Dr. Denis Marcellin-Little
What is your background?
I teach orthopedic surgery at North Carolina State University, where I have been working for 19 years. I share my time between clinics, clinical research and bioengineering research. I enjoy discussing the management of common orthopedic problems in companion animals.
How did you become so interested in osteoarthritis (OA)?
OA is most likely the most common orthopedic problem in dogs and probably the most common orthopedic problem in cats. As a profession, for a variety of reasons, we do not do the best possible job at successfully managing that lifelong problem. I am particularly interested in improving our ability to detect the disease early, in providing perspective on its impact over a lifetime and in treatments with proven efficacy.
A radiograph shows severe stifle osteoarthritis in a 7-year-old Labrador retriever. Photo courtesy of Dr. Phil Zeltzman
What has been scientifically proven to help dogs with arthritis?
As reported by Aragon in the Journal of the American Veterinary Medical Association [2007;230:514-521], there is solid evidence confirming that non-steroidal anti-inflammatory drugs (NSAIDs) relieve OA pain and there is also some evidence that several nutritional supplements relieve OA pain. There is evidence that being lightweight has a profound positive impact on the course of the disease. In other words, being overweight leads to a much more rapid development of osteophytes, to limited mobility and to premature end of life. On the human side, there is strong evidence documenting the benefits of exercise for OA patients.
How much can weight loss help an arthritic patient?
An intraoperative view of stifle osteoarthritis in a 7-year-old Mastiff. Photo courtesy of Dr. Phil Zeltzman
One small clinical study suggests that arthritic dogs that lose weight walk better, something that is quite intuitive. Being lightweight slows the progression of OA. That is a claim that cannot be made by any other OA management modality.
What simple options can a client provide at home?
Clients can use many management options at home. For example, a joint that has flared may be iced. A joint that has lost some motion may be stretched manually or through exercise. These should be applied for specific purposes, after proper training and with proper supervision.
A radiograph shows severe hip dysplasia and DJD in a 6-year-old Rottweiler. Photo courtesy of Dr. Phil Zeltzman
Are steroids an appropriate treatment for osteoarthritis?
Corticosteroids may be used for brief periods of time—a week or less—as anti-inflammatory medications, but their use does not appear logical considering the side effects and that their efficacy has not been shown to equal the efficacy of NSAIDs. Side effects include loss of muscle mass, collagen and bone mass, so they are much more severe that the side effects of NSAIDs.
Are long-term NSAIDs acceptable in 2010?
Yes, absolutely. They are useful to control flares, to limit the pain perceived during daily activities and exercise programs. Once the patient is exercising wisely and regularly, their administration may become more intermittent or can even stop.
What is surgery’s role in the management of osteoarthritis?
From a scientific perspective, no surgery has been shown to have long-term protective benefit with regards to the development of OA. OA is most often the result of joint subluxation [i.e., elbow subluxation is dogs with short legs] or joint instability [i.e., hip laxity or dysplasia].
Even without solid scientific evidence to support their use, several surgeries aimed at eliminating joint subluxation [i.e., segmental midshaft ulnar ostectomies] or laxity [i.e., juvenile pubic symphysiodesis] make sense and should be considered early in the course of the disease. I think that salvage procedures [i.e., femoral head ostectomy] are overused and their benefits compared to conservative management are unclear.
Once we have treated an acute arthritis crisis, can we help protect the joints? Can we change the course of the disease in the long term?
The only modality shown to change the course of the disease is to be lightweight compared to being overweight. By extension, one could assume that losing weight is very important to OA patients to decrease the rate of future joint changes.
Maintaining strength through low-impact exercises and activities is logical but has unknown consequences on OA. Nutritional supplementation has some benefits with regard to a decrease of joint pain in OA patients, but its protective benefits for asymptomatic OA patients are not known.
How about treating arthritis in cats?
Little is known about the optimal management of OA in cats. We do not know whether feline OA follows the same pathophysiologic pathways as canine OA. The clinical and radiographic signs of feline OA are subtle and somewhat contradictory to each other. There are efforts to bring safer NSAIDs to the market for cats. Nutritional supplementation may or may not be beneficial. Little is known about therapeutic exercises in cats.
What about stem cells?
We know very little about the benefits of stems cells for companion animals with OA. We do not know the short-term and long-term effects on our patients. The methods and dosages have not been optimized. I would caution against excessive optimism with regard to any process that has been scarcely researched. As a consequence, the emphasis should be on conducting a properly sized, prospective, randomized study with objective endpoints.
What are you working on lately?
The main focus of my research, performed in collaboration with Ola Harrysson in the biomodeling laboratory within the Fitts Department of Industrial and Systems Engineering at NCSU, involves the creation and management of computer renderings and simulations of musculoskeletal structures. We also make replicas of specific structures using free-form fabrication methods, a process called “biomanufacturing.” Using these methods, we can create custom implants, rehearse surgical procedure and compare surgical methods or implants. Using these techniques, I am involved in the design and assessment of transcutaneous titanium implants that are used to replace a missing distal limb.
Phil Zeltzman is a board-certified surgeon with a mobile practice in Allentown, Pa. His website is DrPhilZeltzman.com.
This article first appared in the May 2010 issue of Veterinary Practice News