Arthritis Stages & Protocols
One of the most important concepts when it comes to anesthesia and pain management is that of “Multimodal Therapy.” This means that using a combination of drugs or treatments usually leads to a much better outcome. For example, giving the drug butorphenol gives 1.5 hours of pain relief. Giving the drug metetomadine gives 2.5 hours of pain relief. Giving the two drugs together gives 6 hours – using the combination provides longer, better relief than using either drug alone.
This concept also applies to chronic pain conditions, such as arthritis. Using an NSAID (like aspirin or ibuprofin for people, Rimadyl, Metacam or Deramaxx for dogs or cats) by itself buys you a certain amount of relief. Combining it with glucosamine, fatty acids and/or MSM gives you better results. Adding acupuncture, weight loss or an exercise or rehabilitation program boosts results even further.
Arthritis is extremely common in pets, affecting almost all cats and dogs over the age of twelve. Joint problems such as hip dysplasia or a history of injury can lead to arthritis in even very young animals. Once present, arthritis always progresses, either quickly or slowly. The lining of the joint becomes inflamed, the cartilage slowly wears away and the bone responds by making new bone – the reason arthritic fingers become knobby over time.
The goal of treatment is to preserve and protect the cartilage. Once cartilage is gone it will never come back. The key to keeping cartilage is to intervene early. By the time pain is severe the cartilage is gone. For best results, arthritis should be diagnosed and treated very early, before cartilage damage occurs.
There are four stages of arthritic disease:
- Young animals predisposed to osteoarthritis due to conformation or injury
- Pets with current joint disease but little damage to joints and no symptoms
- Pets with moderate damage and intermittent symptoms, often with decreased range of motion in the affected joints
- Severe damage and signs, such as atrophied muscles, restricted range of motion, difficulty rising, jumping onto furniture, going up stairs or performing other activities
Multimodal therapy is a way to address arthritis, and what treatment modes are chosen will be based on the stage of disease present. As arthritis worsens over time, more modes may be added.
Stage 1: If we know that arthritis is likely down the road, we would like to start preventing it early. This means if your dog or cat has had a ligament injury, such as a torn ACL, a surgery affecting a joint, or an injury to a joint, you should consider him at stage 1. Advancing age or poor conformation, such as the little dog with kneecaps that slip in and out of place or the Basset hound whose front feet twist outwards, are reasons to think ahead.
Preventative measures include:
Hill’s J/D, Purina’s JM or equivalent diet made for joint disease. These contain fatty acids and/or glucosamine and have been shown to reduce joint inflammation. Or you can provide oral glucosamine and fish oil supplementation in addition to your pet’s regular food.
Weight control – 75% of dogs that are candidates for hip replacement surgery no longer need the surgery once they lose weight. Overweight dogs develop arthritis symptoms two years sooner than normal weight dogs. Keeping weight off is key in preserving joint health for at risk pets.
Low-impact exercise is best. Healthy cartilage is maintained by exercise, whereas damaged cartilage is further damaged by repeated impact. If we know the pet is at risk for joint problems, playing Frisbee is probably not a good idea but long walks are just the ticket. We can help you decide on an exercise program that reduces risk of injury and joint stress.
Stage 2: Arthroscopy is becoming more common in dogs. Through “scoping” of joints, we are learning that many, many dogs have inflammation in the joint before they have lameness or other symptoms. Sometimes arthritis is found by accident on xrays. Often these dogs are already overweight. This is the most difficult stage to address and treat because A) it’s not evident there is a problem and B) many owners are reluctant to believe their active, healthy appearing pet may have a serious problem simmering. Yet at this stage, the disease is the most preventable, and in fact early treatment can save years of suffering and a lot of money later on.
News Flash! Cats get arthritis, too. In fact 90% of cats over age twelve have arthritis visible on x-rays. Most cats age fifteen or older are at least at Stage 2.
Anti-inflammatory drugs at the low end of the dosage range or intermittently. For example, if you know your dog will be rough housing with the neighbor’s dog or swimming at the cottage this weekend, some Rimadyl may be in order starting on Friday.
Adequan injections are more effective than oral glucosamine, and owners can learn how to administer them at home. Using Adequan in the early stages shows an 80% positive improvement rate after one month of treatment.