The ABC’s of OA/DJD by Dr “JB” Bramson Catoctin Vet Clinic
July 19, 2009
I wanted to pick up on something that my editor, Vickie Grinder, wrote about last month. Like people, animals get osteoarthritis (OA), also called arthritis or degenerative joint disease (DJD). This article will focus on OA in dogs. OA occurs when the surface layer of cartilage which covers the ends of the bones and is part of a joint, breaks down and wears away. This can ultimately result in bone rubbing on bone which causes pain, swelling and loss of motion of joints. In addition, other changes include depression, aggressive behavior, reluctance to rise, difficulty in everyday activities, and exercise intolerance. The make-up of cartilage includes a matrix which gives cartilage its structure. Two important ingredients are collagen which is like strands of rope for strength and proteoglycans which consist of hyaluronic acid attached to glycosamino-glycans (GAG’s). One such GAG is chondroitin. Hyaluronic acid (HA) is a lubricant found in joint fluid. These big words will show up later in medical treatment.
Damaged cartilage doesn’t heal easily. Pain comes from stretching the joint capsule, irritation at nerve endings in bone underneath the cartilage, and muscle soreness. OA is a disease which cannot be cured, but instead managing the pain and disability will allow for improved quality of life and ability to function.
There are two main underlying causes of OA: 1) congenital (from birth) or developmental (while bones are growing) causes and 2) acquired causes. Developmental problems include dysplasia (abnormal growth) of elbow and hips, or osteochondritis dissecans (OCD) which can occur in elbow, shoulder, knee (stifle), or ankle (hock). Factors involved include poor genetics (breeding), nutrition as a contributor (i.e. overfeeding or over-supplementing large breed dogs), and environmental factors. Acquired causes include fractures, ligament damage (i.e. cranial cruciate ligament called anterior cruciate ligament in people), infection, immune-mediated diseases such as lupus or rheumatoid arthritis, and cancer.
There are 5 pillars of treatment:
1) Weight control
2) Nutritional supplements
3) Appropriate exercise
4) Physical rehabilitation
5) Medications
- 1) First, and foremost, excess body weight is the #1 preventative factor for OA pain, discomfort and loss of motion.
2) Nutrition- There are therapeutic diets with high levels of fatty acids (FA). For example, such companies as IAM’s, Eukanuba, Hill’s and Purina have special diets that require a veterinarian’s recommendation. - 2) There is a large array of nutraceutical (nutritional pharmaceutical) supplements too. The list includes: 1) omega 3 fatty acids (FA)- rich in fish oils in OA diets or supplements. 2) Glucosamine- look for a highly purified version, not all supplements are created equal. 3) Chondroitin- controls water content in cartilage, watch out for claims as there is often less than claimed, and few companies ever meet their label claims, also contamination can be a problem. 4) MSM, 5) Vitamin C and 6) green-lipped mussel.
These products probably have more anti-inflammatory properties than actual cartilage healing properties. However, more scientific evidence and testing is needed, not just individual testimony as to effectiveness. Right now there is no required testing or regulation of nutritional supplements. Even the “guaranteed analysis” can’t be trusted. One place to find independent voluntary testing is Consumer Labs: Consumerlab.com. Also use this site for guidance choosing supplements courtesy of the FDA: www.cfsan.gov/~dms/ds-savvy.html.
3) Exercise- Swimming is one of the best physical activities because it is low impact and allows full range of motion for joints.
4) Canine physical rehabilitation will not be discussed here.
5) Medications- Non-steroidal anti- inflammatories (NSAID’s). Aspirin was first used in dogs, now there are safer, better alternatives. Any dog can have an adverse reaction to any medicine and yet tolerate another. It takes trial and error to sort this out. Some examples are Rimadyl, Deramaxx, Previcox and Metacam. There is a need to monitor pets for symptoms of GI upset with poor appetite, vomiting and diarrhea. Also liver and kidneys can be affected. Some NSAID’s used by people are dangerous to dogs such as Ibuprofen (Motrin). No NSAID should be used in combination with another NSAID or steroid. The lowest effective dose and lowest frequency should be used. Steroids should only be used for immune-mediated arthritis. Tramadol is an anti- inflammatory that is related to opiates. It can even be used with NSAIDS. Poly sulfated GAG’s (PSGAG) - Adequan is one example of an injectable medication that works in theory like chondroitin, but it is a larger molecule more like what is found in joints. Hyaluronic acid (HA) is like oil that lubricates an engine. It is also used in people and is injected directly into joints.
Surgical options.
Be aware that surgical options for dogs are available just like there are for people. Orthopedic surgeons can perform arthroscopy to visualize joints and clean them out. Even joint replacements can be done.
Alternative and Complementary therapies.
There are a lot of treatments out there but limited scientific evidence to prove that they work.
1) Acupuncture- look for a licensed veterinarian, certified in acupuncture. 2) Chiropractic- “Because of the lack of any proven usefulness, the absence of adequate regulation and certification and the risks of serious injury; we strongly discourage the use of chiropractic techniques in the treatment of joint disease and osteoarthritis in dogs.” p.221 The Pet Lover’s Guide to Canine Arthritis and Joint Problems. This quotes the four board certified veterinary orthopedic surgeons who wrote this book.
Other alternative therapies:1) Homeopathy- very small doses of theoretically toxic substances to boost the immune system.2) Holistic- alternative therapy and dietary focus. 3) Herbal therapy- herbal remedies. Once again these modalities lack scientific evidence in treating canine joint disease to back them up. Also there is the possible risk of toxicity or allergic reaction.
Massage therapy- a treatment that should be used by a licensed veterinary physical rehabilitation therapist.Very often multiple types of treatments are needed (multi-modal approach). It is important to work with your veterinarian to formulate an individualized plan which can include referral to specialists such as orthopedists, rehabilitation specialists, etc. The goal should be improved quality of life for your pet and improved mobility.
The Pet Lover’s Guide to Canine Arthritis and Joint Problems by Kurt Schulz, DVM et al served as the source of information for this article. It is one in a series of guides found below.
The Pet Lover’s Guide to First Aid and Energy.
The Pet Lover’s Guide to Cat and Dog Skin Diseases.
The Pet Lover’s Guide to Natural Healing for Cats and Dogs.
The Pet Lover’s Guide to Feline Behavior.
The Pet Lover’s Guide to Canine Behavior.
The Pet Lover’s Guide to Nutrition for Cats and Dogs.
The Pet Lover’s Guide to Weight Management and Exercising with Your Dog.
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