If your dog has osteoarthritis, he has lots of company. It’s the most common joint disease in canines. One in every five dogs older than a year is affected, and by the time a dog is ten or older, that incidence has increased to one in two.
Managing osteoarthritis (OA) often involves the palliative treatment of well-established disease using just a few therapies. But early intervention, coupled with a multimodal treatment regime, could do a lot more to reduce the effects of this prevalent disease.
1. Diet and supplements
Nutrition plays a role in developmental skeletal disease. An excess of specific nutrients can exacerbate musculoskeletal disorders, and fast-growing, large breed puppies are at particular risk. For these dogs, controlled growth, optimum levels of calcium, phosphorus and essential fatty acids, and specific nutrients to enhance development are all essential to reduce the risk of developmental skeletal disease. In all dogs, providing proper nutrition during growth, and maintaining a healthy weight through life, can help minimize OA.
• EPA and DHA, two components of Omega-3 fatty acids, reduce inflammation and reduce pain associated with OA. EPA suppresses the enzymes associated with cartilage destruction.
• Glucosamine is a precursor for glycosaminoglycans (GAGs), a primary component of joint cartilage. It may influence cartilage structure and restore synovial fluid. GAGs may aid in the prevention of OA.
• Chondrotin sulfate is an important structural component of cartilage and helps it resist compression. It may reduce inflammation, stimulate synthesis of proteoglycans and hyaluronic acid, and decrease catabolic activity.
• ASUs (avocado/soybean unsaponifiables) help protect cartilage from degradation. Studies have shown a synergy when glucosamine hydrochloride, chondrotin sulfate and AUS are combined. They help inhibit the expression of agents involved in cartilage breakdown.
• MSM (methylsulfonylmethane) may have anti-inflammatory effects. Research suggests there may be increased benefits when MSM is combined with glucosamine and chondrotin.
• SAM-e (S-Adenosyl methionine) can reduce discomfort associated with OA. Some studies even found it to be as effective for relieving pain as NSAIDs.
• Vitamin E is an antioxidant. Oxidative damage caused by free radicals can contribute to degenerative joint disease. Vitamin E inhibits oxidation, but the levels must be higher than minimal requirements to achieve these benefits.
• Vitamin C is well known for its antioxidant activity. Although dogs can synthesize enough to meet minimal requirements, supplementation may improve antioxidant performance. It is important to note that vitamin C supplementation can contribute to calcium oxalate crystal formation in susceptible dogs.
• DLPA (DL-phenylalanine) is a natural amino acid used to treat chronic pain. It inhibits several enzymes responsible for the destruction of endorphins, pain-killing hormones. DLPA can be used as an alternative to NSAIDs.
• Traumeel is a homeopathic formulation of 12 botanical substances and one mineral substance. It is purported to have anti-inflammatory, anti-edematous and anti-exudative properties. Traumeel is often used as an alternative to NSAIDs.
• GLM (green-lipped mussel) contains anti-inflammatory components that may benefit joint health. Clinical studies of GLM powder added to diets showed it to be effective in reducing symptoms.
• Several herbs have anti-inflammatory and analgesic properties, including boswellia, yucca root, turmeric, hawthorn, nettle leaf, licorice, meadowsweet and willow bark. Consult with a veterinarian experienced in using herbs.
• Hyaluronic acid (HA) has been shown to slow the progression of osteoarthritis and decrease inflammation within the joint. Specifically, it increases joint fluid viscosity, increases cartilage (GAG) formation, and decreases degrading enzymes and cytokines. Over 70% of dogs have been reported to respond well to HA and improvement can be noted for over six months following administration. My clinical impression is that HA used alone is useful for synovitis and mild to moderate OA.
2. Weight management and exercise
Obesity is a known risk factor for osteoarthritis. Dogs with excess weight should be placed on a diet management program, which may include food and treat restriction, a change of diet, exercise and behavior modification. Weight management alone may result in significant clinical improvement.
Light to moderate low impact exercise is recommended to reduce stiffness and maintain joint mobility. Specific exercise requirements vary based on the individual dog, but short walks (15 to 20 minutes) two to three times daily are typically recommended. Swimming is an excellent low impact activity that can improve muscle mass and joint range of motion. Consistency is critical – exercise should be performed on a routine basis. Excessive and/ or high impact exercise should be avoided.
3. Acupuncture and chiropractic
Dogs have approximately 360 acupuncture points throughout their bodies. Response varies, with some dogs showing significant improvements in discomfort and mobility. Some experience no obvious benefits and a few do not tolerate needling. Consulting a veterinarian trained in TCVM provides the best chance of successful treatment. TCVM can help with weight management as well as joint issues.
Chiropractic can improve comfort and mobility in dogs with osteoarthritis. These dogs often develop improper spinal biomechanics secondary to gait changes. Adjustments can restore proper bony relationships and re-set receptors responsible for maintaining correct posture, balance and mobility.
4. Rehabilitation therapy
This may be used in conjunction with other therapies. In some cases of mild to moderate OA, it may actually eliminate the need for additional medical therapies. The goals of rehabilitation therapy for dogs with OA include pain relief, maintaining or building muscle strength, flexibility, and joint range of motion, core strengthening and overall conditioning.
• Cold therapy causes vasoconstriction to reduce inflammation, muscle spasms and pain. It benefits dogs with acute exacerbation of chronic osteoarthritis.
• Heat therapy causes vasodilation. It reduces muscle tension and spasm, improves flexibility of joint capsules and surrounding tendons and ligaments, and provides pain relief.
• Transcutaneous electrical nerve stimulation (TENS) reduces pain. It stimulates large cutaneous nerve fibers that transmit sensory impulses faster than pain fibers. TENS also increases the release of endorphins, which block pain perception.
• Neuromuscular electrical stimulation (NMES) involves the stimulation of muscle fibers for strengthening. Dogs with OA typically lose muscle mass due to weakness and disuse. NMES may help minimize atrophy, and provide proprioceptive, kinesthetic and sensory input directly to the muscle as well as give pain relief.
• Therapeutic ultrasound (TUS) uses sound energy to affect biological tissues. It provides deep heating of tissues and can increase blood fl ow, collagen extensibility, metabolic rate and pain thresholds. It can also decrease muscle spasm.
• Low level laser therapy (LLLT) may have positive effects on injured cartilage and may also reduce pain.
• Extracorporeal shock wave therapy (ESWT) uses sound waves characterized by a rapid and steep rise in pressure followed by a period of negative pressure. Mechanical and chemical effects on a cellular level may stimulate healing and modulate pain signals.
• Manual modalities – Stretching – Most dogs with OA have some inflexibility due to shortened muscles and joint restriction. Performing gentle passive range of motion therapy and stretching can increase overall range of motion. Heat therapy applied prior to these therapies enables collagen fibers to be maximally stretched. – Joint mobilization – May help improve joint range of motion and decrease pain in dogs with mild to moderate OA. It involves low-velocity movements within or at the limit of the dog’s range of motion. – Massage – Decreases myofascial pain, adhesion formation and muscle tension, and increases vascular and lymphatic circulation. Can help reduce edema, improve blood fl ow, decrease muscle stiffness and improve muscle flexibility and joint mobility.
• Therapeutic exercises can be of significant benefit. Most dogs with OA have moderate to severe muscle atrophy and loss of motion within affected joints. Therapeutic exercises maintain and rebuild muscle mass, strengthen muscle force, maintain and improve joint range of motion and overall function and conditioning.
• Hydrotherapy includes underwater treadmill and swim therapy. It encourages range of motion, and improves muscle tone and mass with reduced stress to joints and tissues. Hydrotherapy can help relieve pain, swelling and stiffness, improve muscle mass and tone, increase joint range of motion, and improve circulation.
5. Regenerative medicine therapy
a) Stem cell therapy
Published literature supports the use of stem cell therapy (SCT) to treat osteoarthritis in dogs. Most veterinary research has focused on adult stem cells, specifically mesenchymal stem cells. MSCs decrease pro-inflammatory and increase anti-inflammatory mediators.
b) Platelet-rich plasma (PRP)
The concentrated platelets found in PRP contain bioactive proteins and growth factors. These work by binding to cell surface receptors and activating intra-cellular signaling cascades. They promote cell proliferation, cell migration and differentiation, and work as antiinflammatory factors counteracting the inflammatory cytokines at work in OA.
SCT and PRP are often administered together.
6. Assistive devices
These provide assistance with mobility. Booties can provide traction for slippery surfaces. Orthotics provide support to joints and can improve comfort. Slings and harnesses can be used to assist dogs when rising, walking, climbing stairs and during elimination. Carts provide independent mobility for dogs that have difficulty walking.
7. Conventional medications – NSAIDs and corticosteroids
NSAIDs have been the conventional foundation for treating symptoms of OA. They have anti-inflammatory, analgesic and antipyretic properties. However, serious adverse effects can occur, especially with chronic use. These most commonly include gastrointestinal, renal, hepatic and coagulation disorders. The goal is to use the minimal effective dose when other treatments are not successful.
In the treatment of severe OA, an intra-articular corticosteroid may be beneficial.
It can provide pain relief for end-stage osteoarthritis. Response to treatment is typically seen within a week and benefits may last a year or more.
Once established, canine osteoarthritis is incurable. But if joint problems are diagnosed early on, and managed with a range of integrative therapies, you can help stave off the debilitating effects of OA, and that means greater longevity and quality of life.