My Dog HasArthritis! Now What?

By Jacquelyn H. Burns, DVM

Copyright © Jacquelyn H. BurnsAll rights reserved

Material in this slide presentation is designed to present how Dr. Burns at Holmes Veterinary Hospital approaches DJD with chronic pain in her practice. It is not intended to be a substitute for examination and treatment by your licensed veterinary practitioner.

Please, visit your vet.That’s what they’re there

for.

What is osteoarthritis? When we veterinarians say

osteoarthritis or arthritis, we mean Degenerative Joint Disease or DJD◦ In dogs and cats, degenerative joint disease

means bone, muscle, tendon, ligament and/or joint changes have occurred as a result of joint instability or structural unsoundness

◦ The body attempts to rectify instability by forming extra bone at/around affected joints.

◦ There is also inflammation with a snowball effect that tends to make itself worse over time.

What causes DJD? Injury

◦ Blunt force trauma (hit by car)◦ Athletic type injury (“football player” injury)

Torn ACL ligaments Heredity

◦ Hip dysplasia◦ Patellar luxation◦ Elbow dysplasia

Acquired/Developmental/Other◦ OCD (osteochondritis dessicans)◦ Angular limb deformity

Regardless of what causes DJD

The results are the same◦ Chronic pain◦ Chronic lameness

But my dog doesn’t act like he’s in pain!

Animals are usually rather stoic and do not always show outward signs of pain

Many never cry out.◦ In a pack atmosphere,

showing outward signs of pain shows weakness and vulnerability

Dogs tend to “Keep calm and carry on.”

“If it didn’t hurt, he wouldn’t be holding his

foot up.”Dr. Burns

The main sign of pain in dogs is lameness or limping

There are only two reasons why a patient might limp◦ PAIN◦ Structural instability

Bones or ligaments that support the musculoskeletal system are broken or torn

Unusual or different posture

Decreased appetite Decreased play Decreased

interactiveness Becoming withdrawn Sleeping a lot more

than usual Irritability/snappy

Other signs of pain Gosh darn, this hurts.How am I

going to tell the big people?

Structural instability

PAIN Inflammation

So, components of DJD

What is this here thing you call inflammation?

Inflammation… a protective

tissue response to injury or

destruction of tissues, which

serves to destroy, dilute, or wall off both the injurious

agent and the injured tissues.

Unfortunately, inflammation can snowball, perpetuating pain and leading to more inflammation

Inflammation

Pain

More inflammation

More pain

NSAIDS= Non-steroidal anti-inflammatories

Pros◦ Contain no cortisone◦ Very decent painkillers

for all types of general pain

◦ Block the inflammation-pain-more inflammation –more pain cycle

Cons◦ Pets must have healthy

kidneys and livers to take these medicines

◦ All senior pets (and some non-senior) must undergo regular blood testing in order to use NSAIDS

◦ Sometimes cause GI upset

◦ Cannot be used with corticosteroids (cortisone, prednisone)

Therefore, the first line defense against DJD = Anti-inflammatories

Pros◦ Non-drowsy opiate-like

pain killer◦ Very safe, including

senior dogs and cats◦ Blood work not

necessary for prescribing these

◦ Can be used at the same time as corticosteroids (cortisone, prednisone)

Cons◦ Short half-life means

dosing three times a day for best results

◦ VERY BAD TASTING Owners who depend

on food or treats for concealment of pills may find that pets refuse them or eat around the tramadol

Second line of defense - Tramadol

Nutraceuticals are food supplements that promote healthy joints

Nutraceuticals are not all created equal. In other words, a cheap one may not work as well as a higher end one.

Generally in a pleasant flavored chewie. Most are given once daily. Note, these are not medicine and do not kill

pain. These are vitamins for joint health Ingredients vary but usually include

glucosamine, chondroitin, fish oil

Third line of defense-Nutraceuticals or Joint Diets

Gabapentin is a seizure drug but used in cases of chronic pain has proven very helpful in pain that is refractory to other drugs

Convenient one to two times a day dosing

Cons◦ Gabapentin is

formatted for human use, so sometimes we have to get it made to order in special smaller mg tablets or suspensions for very small dogs and cats

Fourth line of defense - Gabapentin

Adequan is a chondroprotectant (cartilage protector)

Give by injection Once weekly for

four weeks, then every three to four weeks as maintenance

Cons◦ Expense◦ Necessitates

bringing pet for injection every week for a month

Fifth line of defense – Adequan injections

Acupuncture Cold Therapy Laser Physical therapy or

rehabilitation ◦ Underwater

treadmill

Other possibly helpful treatment modalities

Wonder where I can

find somebody to

do that to me?

Holistic “medicines.”

Recently the AVMA has made a positionstatement that holistic medicines are not proven to be safe and effective

Treatment modalities that Dr. Burns doesn’t think have much reproducible evidence of merit Holistic

medicine? Might as well go out in the pasture and

pull a handful of weeds for

him.

NSAIDS – carprofen (Rimadyl/Novox, meloxicam (Metacam), Previcox, Deramaxx

Tramadol Joint Supplements (yummy Phycox soft

chews are Dr. Burns’ favorite) Gabapentin Adequan Physical Therapy Acupuncture Cold Therapy Laser

Review of Treatment Modalities

There have never been satisfactory safe options for home pain management—either long term or short term—in cats! While we have a few things now that we didn’t have five or six years ago, we still have needs that are unfilled.

A word about Cats (because they are so sweet they deserve it)

Man, I’m dying here. What is

wrong with the

pharmaceutical industry?

Nutraceuticals Meloxicam Onsior Gabapentin Tramadol

Cons are many!◦ Meloxicam is often used in cats,

but it is not FDA-approved for long term use in the USA.

◦ Meloxicam requires very healthy kidneys and a good hydration status. Even so, it still can cause kidney failure in some cats

◦ Onsior is only FDA-approved for 3 consecutive days in the USA

◦ Gabapentin and Tramadol have to be compounded (made to order) and are not FDA-approved for cats in the USA

Newer options for cats…

To make the pet have the best mobility and quality of life that he/she can have

To make good days outnumber bad days

Treatment goalsLike I always say, better

living through chemistry!

Chronic pain is not curable; it is a management condition

It is not reasonable to expect your pet with DJD never to limp

Your pet may not be able to do the same amount of exercise or play that he/she once did

Like people, there will be good days and bad

Realities

Realities, continued• People with DJD and chronic pain

often use mobility devices such as walking canes, walkers and wheelchairs. Unfortunately, most dogs cannot use these.

Wonder where I can

get a walking cane?

Realities, continued• People with chronic pain have

some days where they are nearly normal and walk/move pretty well with a cane or walker, some days where they really feel good…and some days when they don’t feel like getting out of bed.

• Your dog is the same.

I’m so glad I can still run and play! And that she loves

me!!!!

I’m so blessed to

have Rascal to

love!

Slide presentation written by:

Jacquelyn H. Burns, DVMHolmes Veterinary Hospital1001 Church StreetLaurens, SC 29360www.holmesvethospital.com

Copyright 2013 © Jacquelyn H. Burns, DVMAll rights reserved

Material is not intended to be construed as veterinary

medical advice and not intended to be a substitute for examination, diagnosis and treatment of your pet

by your veterinarian.

Please, visit your vet. That’s what they’re there

for.