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Canine & Feline Arthritis: Diagnosis, treatment and management options:

Canine & Feline Arthritis: Diagnosis, treatment and management options Ashleigh Olds, DVM Aspen Creek Veterinary Hospital

Definition of arthritis::

Definition of arthritis: Joint inflammation Pain due to degenerative disease within the joint(s). Symptoms can include warm, painful, & possibly swollen joint(s). Often associated with loss of function. May or may not involve cartilage or bony changes.

Types of arthritis::

Types of arthritis: Osteoarthritis (OA) – most common form of arthritis. Degenerative joint disease. Rheumatoid arthritis – immune mediated. Traumatic injury induced Developmental disorders Osteochondrosis dessicans (OCD) Dysplasia (hips, elbows, etc.)

Osteoarthritis (OA)::

Osteoarthritis (OA): “ Osteo ”: bone Degenerative condition involving cartilage and bony changes May be due to age and “wear and tear” Can be induced in younger dogs from injury or developmental problems Similar to OA in humans Most common in older animals and large breed dogs.

Common sites of canine OA::

Common sites of canine OA: BACK

OA Risk factors::

OA Risk factors: Older Overweight Inactive 9 out of 10 cats over 12 years will have some degree of OA Large breed dogs

Developmental joint disease:

Developmental joint disease More common in large breed dogs Rare in small breeds Purebreds more than mixed breeds Dysplasia = improper joint growth or development. Most common in hips and elbows. OCD – bone or cartilage malformation within joints – most common in elbows, shoulders, hock, stifle.

Spondylosis:

Spondylosis Arthritis and degenerative disease of the spine

Hip Dysplasia::

Hip Dysplasia: Large breeds, purebreds most common Breed disposition: St. Bernard, Great Dane, Labrador Retriever, German Shepherd, Golden Retriever, Rottweiler. Can be seen in any breed including mixed Genetics Dietary - fast growth, mineral imbalance, obesity - proper sources of protein

Slide 11:

Early hip dysplasia : Shallow sockets Bones not seated well Displaced - laxity Late stage hip dysplasia with associated OA: Bone spurs, shallow sockets.

Elbow Dysplasia::

Elbow Dysplasia: Also large breed dogs and purebred dogs Breed disposition: Golden Retriever, Labrador Retriever, English Setter, Springer Spaniel, Rottweiler, German Shepherd, Bernese Mtn Dog, Chow Chow , Sharpei , Newfoundland Form of OCD Usually diagnosed by 1 year old Leads to premature OA, worse without early treatment

Slide 13:

Early elbow dysplasia without secondary OA Late stage severe elbow OA

Shoulder OCD:

Shoulder OCD OCD: Elbow, shoulder, hock, stifle Bilateral in 50% of cases. Factors: Genetic, dietary, unknown totally

Traumatic injury: most common is ruptured cranial cruciate ligament:

Traumatic injury: most common is ruptured cranial cruciate ligament Most common in overweight spayed female dogs, but can occur in any age, breed, sex. Instability within the joint leads to premature secondary arthritic changes Treatment goals are aimed at stabilizing the joint and reducing secondary joint disease Commonly rupture the opposite leg as they favor the torn side

Symptoms of joint disease/OA::

Symptoms of joint disease/OA: Stiffness, lameness, or limping after rest. Loss of weight or sometimes weight gain Reduced activity and interest in playing Sleeping more Reluctance to climb stairs Urinating or defecating in the house Loss of appetite Altered mood, depression Crying out when touched or lifted Cats: Reluctance to jump up on furniture

Diagnosis::

Diagnosis: Veterinary exam Lameness exam Palpation Range of motion Pain on joint manipulation Radiographs (X-rays) Less likely: MRI, Scintigraphy , Ultrasound

Importance of early diagnosis:

Importance of early diagnosis Especially with developmental disease, early treatment is the key to preventing long term arthritic changes Some surgical procedures have a very limited window for effectiveness Hip dysplasia Puppy exams and regular wellness checks during the first year of life

Importance of correct diagnosis:

Importance of correct diagnosis Treat the right area(s) Direct therapy most effectively Rule out other conditions Neoplasia /bone tumor Intervertebral disk disease Infection If Rheumatoid, treatment very different Osteosarcoma

Treatment: general:

Treatment: general Physical therapy Light exercise good – maintains muscle tone and joint flexibility Swimming Weight loss if overweight Orthopedic bed – more important that you think! Massage?

Medications: NSAIDS:

Medications: NSAIDS Rimadyl , Metacam , Previcoxx , Deramaxx , etc. Similar to Ibuprofen, Acetaminophen, Aspirin Reduce inflammation and pain May slow joint degeneration slightly Side effects: GI upset, kidney & liver dysfunction Many dogs tolerate very well Blood tests regularly to monitor organ function Cats do not tend to tolerate well – kidneys are very sensitive, difficult to medicate daily

Medications:

Medications Do not give your medications to your dog or cat! Acetaminophen, Ibuprofen, Aspirin, etc. can have severe side effects in dogs and cats. Use veterinary specific products at an appropriate dose

Steroids:

Steroids Reduce inflammatory cascade similarly to NSAIDS, but less discriminately May provide short term relief stronger than NSAIDS Side effects can be profound – GI upset, reduce blood flow to kidneys, increased appetite, excessive thirst/urination, weight gain, hormonal disruption Not typically recommended for long term therapy except for auto-immune diseases or intra-articular use.

Opioids:

Opioids Similar to morphine, fentanyl Dogs: tramadol used commonly Potent pain reliever No anti-inflammatory properties Less GI upset May be an option for animals who are not tolerant of NSAIDS May be used in combination with NSAIDS Try to use short term or in extreme cases

Injectable chondroprotectant:

Injectable chondroprotectant Adequan: subcutaneous injections Loading period, then taper off Create healthier cartilage and joint fluid Reduce inflammation in the joint May stimulate cartilage repair in early stages of damage Many owners can administer at home after an in-office demonstration

Adequan:

Adequan FDA approved, scientific evidence to support Beware of “generic” versions – off label, not approved, illegal Prolific equine use

Supplements:

Supplements MSM : supplies sulfur to animals' joints. Use of MSM has been shown to reduce the rigidity of cells in the soft tissues of the body. Building block of healthy cartilage and bone. Glucosamine: provides the joints with the building blocks needed to repair the damage caused by osteoarthritis . Acting as a catalyst, Glucosamine may help animals synthesize new cartilage needed to replace damaged cartilage caused by wear and tear. Chondroitin : attracts and holds fluid within cartilage tissue helping to lubricate joints, increase mobility and reduce discomfort. Chondroitin neutralizes the destructive enzymes that are known to damage and destroy cartilage. Chondroitin may aid the entry of Glucosamine into inflamed joints. Vitamin C: Antioxidant; key factor in the immune system. Prolonged Vitamin C deficiency will cause existing tissues to deteriorate.

Supplements::

Supplements: Omega 3 fatty acids : anti-inflammatory properties, support joint, eye, hair health. Synergistic effect with glucosamine in some studies ASU – Avocado/soybean Flax seed Fish oil – omega 3,6’s. Hyaluronic Acid – unknown if oral intake affects joints?

Other herbal treatments:

Other herbal treatments Green lipped mussels, Perna Mussels -> repair damaged connective tissues? Yucca & Devil’s Claw -> Commonly used in horses. Natural steroid that reduces discomfort, providing “natural” pain relief.

Considerations:

Considerations “Joint Supplements”, herbs, and “natural” remedies are considered neutraceuticals No FDA regulation No guarantees of safety or efficacy No established requirements or “safe” doses Often little scientific evidence Sometimes product does not match the label claims, little independent testing Use cautiously!

Alternative therapies:

Alternative therapies Chiropractic Acupuncture Considered “complementary therapy” Firm diagnosis should be made prior to starting treatment Often work with conventional therapies, but rarely stand alone instead of traditional therapies Can be very beneficial for some conditions, less so for others – if in doubt consult with professionals

Acupunture/Chiropractic:

Acupunture /Chiropractic Diagnosis/consultation key prior to treatment for specific conditions May benefit “ normal”animals , especially very active and agility dogs Hip dysplasia, elbow dysplasia, spinal arthritis, non-specific neurological deficits May reduce the need for NSAIDS and other medications

Chiropractic contraindications::

Chiropractic contraindications: Unstable intervertebral disk disease Cervical vertebral instability Acute neurologic dysfuntion Chronic or diagnosed conditions may benefit with vet approval

New technology:

New technology ESWT – Extra Corporeal Shock Wave Therapy PRP – Platelet Rich Plasma IRAP Stem cell therapy – fat based Other thoughts: Intra-articular injections? Neuropathic pain blockers - Gabapentin

ESWT:

ESWT Intense ultrasound energy waves Reduce inflammation and pain, stimulate new blood vessels, stimulate healing, reduce pain? Tendon and ligament injury treatment and regeneration Reduce pain and inflammation in joint disease?

ESWT:

ESWT Elbow OA, Hips, Shoulders, Stifles Pros: Non-invasive, may reduce the need for daily medication, promote healing Cons: Sedation required, no guarantee of results 60-70% dogs respond favorably after 1-3 treatments

ESWT: Other uses:

ESWT: Other uses Hot spots Non-healing wounds Skin infections Lumbar back pain Promotes bone healing in fractures

Stem Cell Therapy:

Stem Cell Therapy Fat or bone marrow derived Harvest from patient, culture, and re-inject their own adult stem cells Indications for tendon/ligament injuries May have a role in OA, decreasing pain, improved range of motion, cartilage regeneration? Expensive, invasive $3500-4000??

Platelet Rich Plasma/IRAP:

Platelet Rich Plasma/IRAP Patient’s blood harvested, processed to concentrate platelets or interleukin factors, re-injected Tendon/ligament injuries PRP:Reduced infections in human surgeries PRP: Treatment of non-healing wounds IRAP may have a role in canine OA, hip dysplasia, etc. Less expensive and invasive than stem cells $1000-1200

Gabapentin:

Gabapentin Blocks neuropathic pain Most useful for known neuropathic pain, but may have a role in combination with other medications for some forms of arthritis pain. Side effects: drowsiness May reduce need for NSAIDS, but rarely used alone Post operative pain control for patients intolerant of NSAIDS

Intra-articular injections::

Intra-articular injections: Not commonly used in dogs, but used frequently in horses and humans Inject a combination of an anti-inflammatory (steroid), hyaluronic acid or adequan, and an antibiotic No known contraindications for dogs Stifles +/- hips, elbows are most likely sites for treatment Efficacy?

Prevention:

Prevention Thoughtful breeding Good nutrition, especially in purebred and large breed dogs Protein/lysine sources Calcium Fatty acids, omega 3’s Regular veterinary exams, especially in the first 2 years of life Weight control Orthopedic beds Regular moderate exercise Prophylactic joint supplements

Specific conditions: Cruciate rupture:

Specific conditions: Cruciate rupture Small breeds: Surgery - extra-capsular repair Larger breeds: Surgery - TPLO, TTA Other non-surgical options: Controlled exercise Physical therapy Brace? NSAIDS ESWT? Adequan/Glucosamine

TPLO:

TPLO

TTA:

TTA

Specific conditions: Hip Dysplasia:

Specific conditions: Hip Dysplasia Younger than 10 months: Triple Pelvic Osteotomy Older dogs: NSAIDS Physical therapy - swimming Supplements – Dasuquin Adequan IRAP? ESWT? Total hip replacement ($$$) $3500-5000/joint Small dogs: Femoral head osteotomy

Slide 47:

Femoral Head Osteotomy Total hip replacement Hip Dysplasia surgical treatment

Final thoughts on cats::

Final thoughts on cats: Difficult to diagnose pain or arthritis Low body weight and activity level can make symptoms hard to detect Still may benefit from treatment and supplements Difficult to medicate orally Response to treatment?

Questions?:

Questions?

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