As any of us who have been very active in our youth, or performed any activity repetitively all our lives can attest, one slight injury, compounded by repetition, can lead to painful joints.
If you were a dog chasing a ball or Frisbee or another dog in the park, or jumping on and off the sofa/into the back of the car repeatedly your joints would also begin to be uncomfortable as you age.
Regular controlled exercise won't cause arthritis by itself, however, if dogs or people exercise repeatedly on injured or abnormally loaded joints this will increase the rate of degeneration and arthritis formation. Even with arthritis present an active, but not over active, lifestyle can maintain comfort without too much intervention until a major injury or illness which reduces activity happens. Once supporting muscle begins to be lost then the downward spiral into pain and immobility looms.
There have been some exciting new medications released since we last wrote about arthritis, and although they only work to help reduce pain, not slow the progression of the disease there is a place for pain reduction to avoid muscle loss.
My personal goal for the treatment of osteoarthritis is to relieve pain, both from joints, and the associated muscle spasm. Then strengthen the supporting muscles and build stamina. This in turn helps to improve overall function for longer and improve quality of life.
Strengthening supporting muscles aids in shock absorption for the joints, with the increase in strength reducing fatigue related injuries. The Improvement in proprioception provided by rehabilitation techniques will also help to prevent more slips or falls and painful re-injury.
My recommendations when patients are being referred for rehabilitation and muscle strengthening to support painful joints are:
1. Cut down excess weight.
This is the most important first step in helping your pet, and it is the cheapest too.
The important words here are excess weight! It is important not to cut protein out of the diet as this is needed for supporting muscle bulk. Protein without added fat, such as white fish or eggs is easier for a weight loss diet than red meat, or even chicken as these often have fat within the meat or marrow if you normally feed bones.
Although veterinary diets for weight loss have changed a great deal since we last wrote about arthritis it is still important to monitor portion sizes closely and reduce extra feeding.
2. Make sure that arthritis is the only condition causing symptoms. Slowing down on walks, anxiety or aggression with handling, reluctance to go up or down stairs can all be caused by other diseases.
Your vet will be able to recommend tests for other heart of metabolic conditions if they are warranted.
3. Get baseline x-rays if arthritis has been diagnosed to see what the affected joints look like. The amount of degeneration seen on x-rays does not always correlate to the amount of pain patients are suffering, but they are always helpful for plotting the progress of disease further down the line. While your pet is sedated/anaesthetised the vet can check actual range of joint motion without pain.
4. Take blood tests to check liver and kidney function before starting on drugs to reduce symptoms. If you are concerned about any adverse effects of drugs on your pets' life, perform blood test again after 3 weeks. Any compromise to organ function will already be evident at this point.
“Despite their widespread use and obvious benefit in many cases, Non-steroidal anti-inflammatory drugs (NSAIDS) are not always sufficiently effective when used as the only therapy. Additionally, there are safety and tolerability concerns with their use in both dogs and cats. ” The Veterinary Record
The two newest medications that have become accepted for dogs suffering from arthritis are CBD oil and bedinvetmab.
“When administered appropriately as an adjunct therapy, CBD oil can benefit dogs with osteoarthritis.”( Dr Chris Lee, Veterinary Director CBD Vets Australia)
The research base on the clinical use of CBD oil is rapidly expanding, and with more vets prescribing this at carefully monitored dose rates safety and efficacy is improving.
Current evidence indicates that anti-NGF mAb therapy has positive analgesic effects and is well tolerated for up to three months in dogs and cats suffering from OA-associated pain. (Anti-nerve growth factor monoclonal antibodies for the control of pain in dogs and cats Masataka Enomoto,1 Patrick W Mantyh,2 Joanna Murrell,3 John F Innes,4 B Duncan X Lascelles1,5,6)
5. Start nutraceuticals and chondroprotectants straight away.
These help support cartilage repair and joint fluid production. Nutraceuticals can take up to 4-6 weeks to reach therapeutic levels so it is better not to reduce other medications before then.
It was not that long ago when vets were not advocating glucosamine and chondroitin for joints because there was not sufficient evidence of their efficacy. Now they are unwilling to offer different nutraceuticals on the same premise, despite being willing to offer drugs off licence for cancer patients to prolong quality of life.
6/ Reduce length or intensity of walks for at least 3-5 days and add the use of low impact exercises, with massage, heat or ice packs after exercise.
Arthritis is an inflammatory process, therefore ice packs, melting ice or standing in cold water will help bring relief immediately after exercise for acute flare ups.
Muscles stiff from protecting painful joints will feel better with heat packs and massage. These are better applied a few hours after exercise, to keep up blood flow and clear out by-products of exercise. This also helps to maintain the delivery of drugs/nutraceuticals to the painful areas.
Gentle range of movement exercises can be performed while pets are lying down following either of these applications to improve joint fluid production and maintain or improve joint mobility.
If you, as a pet parent, are concerned about putting your fur baby on drugs of any kind, refer back to the tips 1 and 4.
Keep up regular (but not excessive) exercise on surfaces that reduce joint impact, such as mown grass or firm sand, or even better, in a semi-weightless environment such as walking in the river, at the beach, or an aquatreadmill.
