Managing OA in dogs and cats

By Erica Tramuta-Drobnis, VMD, MPH, CPH

One of the most common conditions for which intervention benefits both pets and their owners revolves around the successful management of osteoarthritis (OA).

Numerous modalities for pain management are available to support our patients. Some available modalities are touted for general or acute pain management, while others may be less specific, or more specific (e.g., for OA pain).

Various degrees of evidence exist for the use of different modalities in OA therapy in our canine and feline patients. Selecting therapies based on sound evidence-based veterinary medicine is paramount, as it gives the greatest likelihood of success. However, in the absence of high-grade scientific evidence, expert opinion and clinical experience often drive therapy management recommendations. Unfortunately, these opinions and experiences are sometimes based on low-grade evidence. Ultimately, veterinarians need to combine experience and medical evidence to provide a multi-modal approach to OA management.

Not all OA management is created equal

OA estimates are likely well underreported in the animal population. According to Morris Animal Foundation research, OA affects nearly 14 million canines annually in the U.S. While estimates are more difficult to determine for cats, due to various reasons, radiographic evidence of OA in cats can be identified in 90 percent of cats over 12 years old. In 2025, a narrative by Lefort-Holguin et al. suggests that more than 25.6 percent of cats likely have OA, and many cases start in early adulthood.^1,2 Pain negatively impacts healing, increases the rapidity of cognitive decline, can decrease quality of life, and yet it is often chalked up to slowing down "just because they are older."

Treating chronic pain, such as that seen with OA, early in the disease process can slow cognitive decline, improve health outcomes, and ensure the preservation of the human-animal bond for as long as possible, while maintaining healthy activity and weight.^3–7

While OA typically results from normal wear and tear on a joint, traumatic conditions (e.g., CCL rupture) can incite early onset of arthritic changes due to joint instability. The term "OA" broadly describes an inflammatory condition that progressively leads to a breakdown in the key components of the joint, including cartilage, capsular material, and surrounding tissue/bone. This results in a loss of normal joint function and can lead to destruction of the joint capsule. Joint inflammation can also alter the production and composition of joint fluid, reducing its ability to provide cushioning and increasing the likelihood of joint pain.⁸

Thankfully, newer modalities are becoming increasingly available to aid in the management of OA in our pet population. Still, the evidence available for various options falls short due to a failure to demonstrate efficacy, a lack of generalizability, bias, insufficient sample sizes, poorly designed studies, or simply because there is a lack of sufficient data. Utilizing the best evidence, guidelines created by expert panels such as the World Small Animal Veterinary Association (WSAVA), the American Animal Hospital Association (AAHA), the American Association of Feline Practitioners (AAFP), and the International Society of Feline Medicine (ISFM) allow veterinarians to make educated decisions about treatment options that can be recommended for our patients.

What's the evidence: OA treatment with medications

Current recommendations suggest NSAIDs and anti-NGF monoclonal antibodies as first-line defenses against the inflammatory damage and pain associated with OA. Adjunctive medications may be added to control pain, lessen anxiety, and improve quality of life.

Non-steroidal anti-inflammatory drugs (NSAIDs)

A 2009 systematic review evaluated NSAIDs, nutraceuticals (e.g., glycosaminoglycans), elk velvet antler, and green-lipped mussel, as well as other management options, including extracorporeal shockwave therapy, hyaluronan, and gold wire acupuncture. They found high-grade evidence in support of three NSAIDs available at the time, firocoxib, meloxicam, and carprofen, moderate evidence for etodolac use, and a few studies suggested moderate evidence at that time in support of glycosaminoglycan polysulfate, green-lipped mussels, and elk velvet antlers, with weak to no evidence in support of acupuncture, hyaluronan, or extracorporeal shockwave therapy. This review encompassed research conducted from 1985 to 2007.

More recent reviews continue to provide high-grade evidence on the effectiveness of numerous NSAIDs in the management of OA in dogs. Cats, however, have fewer options due to a lack of sufficient data and the risks of side effects associated with off-label products. Still, evidence supports the use of meloxicam (with a black box warning in the U.S.) and robenacoxib.^1,9–13

Monoclonal antibodies

The newest first-line therapy for OA is frunevetmab for cats and bedinvetmab in dogs. These drugs are monoclonal antibodies that target and block nerve growth factor (NGF) (Anti-NGF). They can be used alone or in conjunction with NSAIDs and generally seem well-tolerated. Recently, controversy surrounding the canine product and potential neuropathic changes over time has been addressed by the manufacturer, who continues to support the safety and efficacy of the drug.^{14–17,17,18}

Evidence in support of the use of monoclonal antibodies continues to be accumulated, and additional studies with longer-term data are warranted. Still, they provide an alternative for animals with underlying liver or kidney disease where NSAIDs are contraindicated or in patients that do not tolerate NSAIDs because of side effects. They also provide veterinarians with a means to permit owners who are unable to administer daily medication to their pets to still provide pain management and improve quality of life.

Gabapentin/pregabalin

Many use gabapentin or pregabalin for nerve-specific pain, as they are commonly used similarly in human medicine. Additionally, these medications are often used as adjunctive therapies for pain management in dogs and cats due to various causes, with varying degrees of evidence. The evidence for these medications is good for behavior modification, anti-anxiety, and pre-vet visits with pregabalin; when used in combination with other medications (e.g., trazodone or phenobarbital), additive benefits can be observed. Unfortunately, most studies have small sample sizes and lack broad applicability. Nonetheless, adjunctive use of these medications for neuropathic benefits and anxiolytic properties is appreciated in practice, and their use is generally safe with low side effects. Studies specifically focusing on the benefits of managing OA in dogs and cats are lacking.^13,19

NDMA receptor antagonists

The use of ketamine in hospitals, or as an adjunctive once weekly SQ injection, appears to be becoming more commonplace. NDMA receptor antagonists, such as amantadine and ketamine, have been shown in limited research to aid in the prevention of central sensitization (wind-up). When used in combination for a multimodal approach to OA, they may provide improvement in pain management and enhance outcomes.^20,21 The current literature is limited and not specific to OA pain, but rather general to neuropathic pain and windup prevention.²²

Acetaminophen

In dogs that cannot take NSAIDs, and in those with refractory arthritis and pain, the addition of acetaminophen may be an option. While many are taught that acetaminophen should not be used in dogs at all, it can be a viable pain option in certain cases. Monitoring liver function while utilizing it is warranted. Studies on the use of acetaminophen as an adjunctive treatment for OA management are needed to confirm that it may improve outcomes if used as part of a multimodal approach; however, current research is lacking.¹³

Tramadol

To date, scientific literature does not support the use of tramadol for OA pain. Oral bioavailability is low, pain modulation is minimal (if at all), and concerns for controlled drug use and abuse by owners are justified. Thus, tramadol is not recommended as a first-line therapy by pain management specialists. Even as an adjunctive therapy, it has questionable, if any, efficacy.^23–26

Adjunctive therapies for OA treatment

Among the myriad adjunctive therapies, most lack robust evidence to support their use. Nevertheless, they are still widely employed due to perceived clinical benefits among clients, providers, and patients.

Moderate-level evidence supports weight management and maintaining an ideal body condition to help slow the progression of OA. Though weight loss can be a gradual process, it can be achieved through a combination of exercise programs and diet modifications, with or without prescribed weight loss interventions and joint-supportive foods. However, other treatment options lack strong evidence to support their effectiveness.¹³

While supportive research exists on the efficacy, side effects, and risks of NSAID use for OA in dogs, the evidence base is less strong for cats. The evidence for neutraceuticals and alternative modalities is more challenging to compare across studies due to variable or poor study designs, such as a lack of proper control groups and incomplete data provision, among other reasons. Thus, to date, equivocal evidence exists for many of the alternative modalities. These include:

1. Acupuncture with and without electrostimulation^13,27–29
2. Laser therapy^13,30,31
3. Extracorporeal shockwave therapy with and without medicated gel.^32,33
4. Nutraceuticals, including but not limited to glucosamine, chondroitin sulfates, and related compounds, elk antlers, green-lipped mussel, and omega-3 fatty acids: The number of options that have little to no evidence in support of their use is too long to list.^13,34,35 Current recommendations by experts and pain management guidelines no longer recommend the use of glucosamine supplements due to a lack of efficacy in preventing or slowing the onset or progression of OA disease.^12,13,35,36
5. Injectable polysulfated glycosaminoglycans, licensed for use in the U.S., are used, yet little evidence exists outside the original study for drug approval.^37,38

Yet more options for OA management include the use of therapies, such as platelet-rich plasma and mesenchymal cells. Research is still in its infancy, and while some studies suggest benefit, additional research is warranted. Clinically, many veterinarians are using these therapies despite the lack of scientific support. Further studies to support the use of such approaches are paramount.^39–43

What is missing from our knowledge base?

Given the frequency of use and need for drugs to modulate pain management in our aging pet population, more rigorous studies, higher study population sizes, and more generalizable studies are needed. In addition, since overall pain management options for cats are limited, further feline studies and product development are warranted.

Further, longer studies are necessary to demonstrate the long-term safety, risks, and benefits of chronic label claims on available products. For example, in other countries besides the U.S., robenacoxib has a label for long-term chronic pain management in feline patients. When options are limited, relying on globally conducted research, and with informed client consent, the use of NSAIDs, off-label, may be reasonable and taken on a case-by-case basis.

What's the bottom line?

The bottom line is that no one approach to OA management will necessarily control OA pain. That being said, owners are generally eager to do whatever they can to help. While our veterinary oath states that we must do no harm,⁴⁴ we should also strive to do some good for the animal. Thus, it is essential to determine if the various modalities employed for OA management provide any benefit to the pet, as well as the risk-benefit profile. Adjunctive therapies should only be employed after ensuring informed owner consent about the limited data supporting their efficacy in controlling OA. Additional studies are always warranted to address OA management in cats and dogs, to ensure improved quality of care, quality of life, and to preserve the human-animal bond.

Erica Tramuta-Drobnis, VMD, MPH, CPH, is the CEO and founder of ELTD One Health Consulting, LLC. Dr. Tramuta-Drobnis works as a public health professional, emergency veterinarian, freelance writer, consultant, and researcher. She is a member of the Evidence-Based Veterinary Medical Association (EBVMA). For information about the association or to join, visit the EBVMA website. While all articles are reviewed for content, the opinions and conclusions of the author(s) do not necessarily reflect the views of the EBVMA or Veterinary Practice News.

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