Osteoarthritis (OA) is one of the most common health conditions in our canine companions and likely the most common orthopedic problem in dogs. The prevalence has not been established exactly, but most medical writers quote 20 percent of dogs have this disease.1 Dogs of all ages can develop OA; unfortunately, it is often overlooked in younger dogs. While there is no simple cure that erases osteoarthritis, several strategies make a significant positive impact on its progression and effects. This article presents a comprehensive, evidence-based approach to managing this disease in every stage over a dog’s lifetime.
Why dogs get OA
From a scientific standpoint, the causes of canine OA have not been strictly established. The most common appear to be developmental orthopedic diseases, such as hip and elbow dysplasia. These are multifactorial (influenced by genetic and environmental factors) and polygenic (influenced by multiple genes) diseases. Regarding the 50 most affected breeds, the Orthopedic Foundation for Animals (OFA) estimates the prevalence of hip dysplasia at 21 percent, while for elbow dysplasia it is 16 percent.
A 40-year study tracking dogs treated at 27 veterinary teaching hospitals showed 16 breeds were at increased risk for hip dysplasia with an overall occurrence of eight percent.2
OA is also prevalent in the shoulder joint, but less is known about how it develops in this location. In a lifelong observational study of Labrador retrievers, the prevalence of shoulder OA at eight years of age was 57 percent in slender dogs and 86 percent in overweight dogs.3 OA also results from cranial cruciate ligament injuries. OFA’s study identified 13 breeds at risk of cranial cruciate ligament injury, with an overall prevalence of 4.6 percent.2 Patellar luxation is another cause of OA, with one survey identifying a prevalence of 1.3 percent.4
The mechanism most often responsible for canine OA appears to be joint subluxation. The OA present in hip dysplasia results from subluxation of the femoral head, while osteoarthritis associated with elbow dysplasia results from humero-ulnar or radio-ulnar subluxation. There is no scientific evidence that age and exercise cause OA in dogs,5 even if the dog-owning public tends to think wear and tear of joints and exercise cause osteoarthritis. (See Table 1 for more common myths about OA.)
The functional impact of OA: Four stages
Dividing the predictable functional impact of OA in dogs into four stages allows trends to emerge (See Table 2). Osteoarthritis in the first two stages often goes undetected or ignored, as signs are generally mild and because OA is often erroneously considered a problem affecting older dogs. In most instances, the clinical signs of OA in its first two stages result from acute joint pain, causing minor loss of strength or fitness.
OA is often diagnosed in Stage 3 because the clinical signs are harder to ignore or dismiss—chronic pain and loss of strength are often present.
At the fourth stage, dogs with OA lose the ability to walk. This is linked to severe chronic pain, declining strength, loss of fitness, and possibly decreased joint motion. These clinical signs are sometimes interpreted as dogs giving up; however, this is an exaggeration. When dogs with Stage 4 OA exercise on an underwater treadmill, they generally walk well.
Management options: Proactive versus retroactive
Managing OA throughout the stages can be proactive or retroactive. The former protects joints from degeneration and slows the progression of OA, while the latter alleviates OA pain and minimizes clinical signs without impacting the course of the disease. Proactive OA management is more effective because maintaining strength is much easier than recovering it.
Proactive OA management steps can include:
- Optimizing (i.e. slowing) bone growth. Achieved by mildly limiting food consumption during growth and avoiding calcium supplementation.6,7
- Protecting cartilage with glycosaminoglycan polysulfates. Use of prescription injectable glycosaminoglycan polysulfates in early studies, prior to its approval in 1997, was shown to protect the cartilage of dogs with hip dysplasia during their first year of life. The mechanism of action for this drug effect is unknown.8
- Keeping dogs slender. Maintaining a healthy weight dramatically decreases the rate of OA progression3,9 and increases longevity in dogs.10,11
Retroactive OA management options include:
- Relieving pain. Achieved through medications, particularly nonsteroidal anti-inflammatory drugs (NSAIDs),12,13 nutritional supplementation, and the use of electrophysical modalities, such as cold therapy for superficial joint pain.14 Medications beyond anti-inflammatories offer limited pain relief to dogs with OA.13 Amantadine, an N-Methyl-D-aspartate receptor antagonist, may offer small benefits over time.15 Nutritional supplements such as omega-3 fatty acids and undenatured collagen can decrease OA pain.12 Dogs with osteoarthritis may or may not experience a limited pain-relieving benefit from a range of modalities, including acupuncture and laser therapy. Massage most likely can offer modest short-term pain relief to some canine OA patients, based on its short-term efficacy to relieve osteoarthritic pain in human shoulder and knee.16
- Therapeutic exercise. People with OA who exercise are less painful and less depressed, plus they function better. These benefits last as long as exercise is sustained17,18 and are on par with the benefits of NSAID therapy.18 In dogs with OA, exercising more is associated with a lower lameness score.19
- Weight loss. When dogs with OA lose weight, their lameness decreases. In one study, weight loss of six percent led to a decrease in lameness and weight loss of nine percent led to objectively improved kinetic force plate parameters.20
- Stretching. The motion of most arthritic joints is not particularly restricted. For example, in one study, hip joints with OA lost one degree of extension per year.19 Therefore, stretching probably offers no benefits for most joints with OA. However, some joints with OA lose a lot of motion.19 Since joint pain appears to result from stretching the joint capsule, those dogs are likely to benefit from a stretching program.
Proactively managing OA over a dog’s lifetime
Managing OA is a complex undertaking, due to the wide range of clinical signs and severity, plus the large number of management approaches. The best way to manage OA over a dog’s lifetime is to create a culture in your veterinary hospital that emphasizes proactivity. This approach includes educating owners about OA early in their dog’s life, detecting and diagnosing the disease in its first or second stages, and implementing proactive management strategies, such as slow bone growth resulting from eating limited quantities of food, cartilage protection with a prescription (polysulfated glycosaminoglycan [PSGAG]), and weight optimization. To support this approach, use retroactive strategies like NSAIDs and exercise to manage clinical signs.
When managing OA, resist the tendency to rely solely on pain relief, as this approach only controls the clinical signs of the disease for a few hours at a time, making it a costly, relatively ineffective strategy that is difficult to sustain long term. When selecting pain relief approaches, be sure to consider cost, convenience, and scientific effectiveness. Pain relief should represent a means rather than an end. At the first functional stage of OA, pain relief allows dogs to be less painful while they are socialized and trained. At the second stage, pain relief helps dogs return to an active lifestyle, even if their activity is adapted to their problem. In Stage 3, relieving pain allows dogs to engage in strengthening therapeutic exercises. At the fourth stage, it can help dogs recover some mobility so they can also improve their strength and fitness.
Several options described as alternative, complementary, or adjunctive can be used to help manage canine OA, including photobiomodulation (laser therapy), acupuncture, and herbal medicine. Even if dog owners report positive anecdotal impressions and even if limited positive results have been detected in small trials, these options have no scientifically detectable benefits when evaluated in prospective, controlled trials or when systematically reviewed.12,21 The debate about whether alternative OA management strategies offer benefits may be a distraction from the larger issue of their place in managing OA at various functional stages. Alternative OA management strategies most often are intended to offer short-term pain relief.
For short-term pain relief during the first two functional stages of OA, rest, cold therapy, NSAIDs, and omega-3 fatty acids are more convenient and less costly than adjunctive strategies. During the third and fourth stage of OA, adjunctive strategies are unlikely to make a significant positive impact toward achieving the key management objectives of maintaining or recovering the ability to perform daily activities (Stage 3) or mobility (Stage 4). Therefore, relying extensively on adjunctive methods to manage OA is probably less than ideal. The pain associated with the third and fourth stages of OA is generally chronic and severe, and most likely cannot be controlled using a single, simple strategy. Therefore, it is reasonable to seek potential additional pain relief from alternative OA management options along with the basic strategies (rest, ice, NSAID, omega-3 fatty acids) and in combination with strengthening and stretching.
Evidence shows the most predictably successful method to managing osteoarthritis in dogs is a proactive approach emphasizing prevention. Engaging the veterinary team in pet owner education and support can improve outcomes for canine OA patients. Doing so increases the chance this disease is noticed and diagnosed in Stages 1 or 2, so proactive medical management can begin before a dog’s joints and strength are damaged beyond repair.
Denis J. Marcellin-Little, DEDV, DACVS, DACVSMR, is a veterinarian specializing in surgery and rehabilitation. He teaches and practices at the University of California, Davis. Over the last 20 years, Dr. Marcellin-Little has focused on helping dogs with osteoarthritis.
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