Degenerative Joint Disease (Osteoarthritis)

Condition Overview

Osteoarthritis is a common disease that affects 1 out of 5 dogs during their lifetime. This problem is not just linked to older dogs.

Symptoms

Dogs with degenerative arthritis experience varying degrees of lameness, stiffness, and joint pain, which is more apparent in the morning and after getting up from a nap. They often exhibit irritability and behavioral changes associated with increasing disability. Cold and damp surroundings increase pain and stiffness. Degenerative arthritis is progressive, and in time makes the dog's life miserable.

All symptoms +

Causes

Hip dysplasia, ruptured cruciate ligaments, patella luxation, joint trauma, and other joint conditions can cause degenerative arthritis, even in young dogs. Large breed dogs are affected more often than small dogs. Heavy dogs are more likely to experience symptoms because of the extra strain placed on ligaments and joints.

Diagnosis

The diagnosis is made by joint X-rays that show bone spurs at points where the ligaments ans the joint capsule attach to the bone. There may be varying degrees of joint space narrowing and increased density of bone around the joint.

Treatment

Degenerative joint disease is incurable, but treatment can substantially improve the dog's life. Treatment involves physical therapy and weight control, the use of analgesics and corticosteroids to relieve pain and improve function, and the use of chondroprotective agents to repair joint cartilage and prevent further damage. Acupuncture is another therapy that has shown good results for arthritic dogs. All of these should be used at the same time.

Acupuncture and physical therapy are alternative or additional ways to make arthritic dogs comfortable.

In severe cases, surgical fusion of painful joints, such as the hock or elbow, relieves pain and restores limb movement in some dogs.

Physical Therapy

Moderate exercise is beneficial because it maintains muscle mass and preserves joint flexibility. Excessive exercise however, is counterproductive. Arthritic dogs should not be allowed to jump up and down and should never be encouraged to stand up on their back legs. Dogs with pain and lameness should be exercised on a leash or harness. There are veterinary physical therapists who can help design an exercise (and weight loss) program.

Swimming is an excellent exercise that improves muscle mass without over-stressing the joints. Exercise can be increased as the dog improves with the use of medications.

Overweight dogs should be encouraged to lose weight. Being overweight seriously complicates the treatment of this condition.

Non-steroidal Anti-inflammatory Drugs

These are anti-inflammatory medication, but they do not repair or heal cartilage. Ideally, they would be used along with suppplements and given with food. These do not provide rapid relief from pain.

A few NSAIDs have chondroprotective characteristics, which means they protect against the breakdown of cartilage. Others, such as aspirin, actually destroy cartilage in the dosage required for pain relief. This is one reason why aspirin is used less frequently for treating osteoarthritis.

The NSAIDs most often recommended are prescription medications. Newer medications have been developed that offer significant advantages over aspirin and the older NSAIDs. Rimadyl (carprofen) is an excellent drug with a low incidence off gastrointestinal side effects that has proven itself over time. It must be given daily. Rimadyl provides good pain relief and seems to slow the arthritic process. There are no detrimental effects on cartilage. Labrador Retrievers, and possible a few other breeds, may show a higher predisposition for liver toxicity with Rimadyl.

Etogesic (etodolac) is another newer NSAID. It requires only one dose a day. This drug may prove as effective as Rimadyl. These drugs are available through your veterinarian by prescription.

Note: many over-the-counter NSAIDs used for pain control in people are dangerous when given to dogs. DO NOT use any drugs without veterinary approval, and never use more than one NSAID at the same time.

Due to potential serious side effects, dogs on these drugs should have blood work first to assess the liver and kidney function. The drugs may prolong bleeding times and interfere with clotting, and also have the potential to cause life-threatening liver and kidney problems and gastrointestinal ulcerations. Nausea and vomiting may be the first indication of trouble. Blood work should be re-checked every 6 months, or earlier if there are problems. These drugs should not be given with steroids.

The most common side effect is GI bleeding. This can be difficult to diagnose and quite extensive before signs become apparent. Misoprostol (Cytotec) is a drug that prevents ulceration and helps heal ulcers caused by NSAIDs. Sulcrafate (Carafate) is another drug that protects against mucosal damage. Your veterinarian may prescribe one of these stomach protectants if your dog is taking an NSAID for chronic arthritis.

Steroids

Oral glucocorticoids (corticosteroids) are used for their anti-inflammatory effects. Low dosages appear to protect cartilage, while high dosages (those needed to relieve pain) destroy cartilage. Future formulations may have better protective effects and a wider margin of safety.

Unfortunately, dogs are unusually sensitive to the adverse effects of both the NSAIDs and glucocorticoids. Glucocorticoids are best used for short periods in dogs with osteoarthritis who have failed to respond to NSAIDs. Long-term therapy should be reserved for dogs with immune-mediated arthritis.

Steroids are regarded as highly dangerous medications with many side effects. These can range from interfering with cartilage repair to causing increased eating and drinking. Long-term use can lead to liver and adrenal problems. Still, steroids can provide quick relief for many conditions, and for immune problems, they may be the drug of choice. They should not be combined with any of the NSAIDs.

Most steroids, such as prednisone, are given orally, but long lasting injections may also be used. Dosing schedules will vary greatly and usually operate on a decreasing dose schedule to wean the dog off the medication and (if possible) minimize side effects.

Chondroprotectants

These compounds appear to modify the progression of osetoarthritis by preventing further breakdown of cartilage. Breakdown of cartilage is the first step in the development of degenerative joint disease. Chondroprotectants are most effective when used early in the course of osteoarthritis.

Adequan (a polysulfated glycosaminoglycan similar to glucosamine) is a chondroprotective given by intramuscular injection twice a week for 4 or more weeks. It can be used as a preventive in dogs who are at high risk of developing degenerative joint disease, such as those with hip dysplasia.

Other chondroprotective agents are nutraceuticals - products that lie between a nutrient and a drug. Nutraceuticals are believed to have medical value based on subjective evidence of their effectiveness, although clinical evidence based on controlled studies is lacking for many of these.

Unlike drugs, nutraceuticals do not undergo an approval process and are not regulated by a federal agency. Numerous controlled studies in humans, limited studies done on dogs, and canine anecdotal reports suggest these substances do have medical value for arthritic dogs.

Most nutraceuticals used to treat osteoarthritis contain glucosamine, polysulfated glycosaminoglycans, and chondroitin sulfates - compounds known to be involved in the synthesis and repair of joint cartilage. Examples include Cosequin and Glucoflex. These compounds are given orally and can be considered as follow-up therapy after Adequan, or in any condition in which joint damage is anticipated or expected - such as trauma, surgery, degenerative joint disease, or immune-mediated arthritis.

Chondroprotectives may be given along with an NSAID. The combination reduces pain and alleviates joint inflammation. The chondroprotectants can also be used to help prevent the development of osteoarthritis.

Note: Always check with your veterinarian before adding any supplements to your dogs food to avoid adverse reactions with medications your dog may currently be taking. Supplements will generally take about a month to show positive effects.

Prevention

Information needed.

Support

Please contact your veterinarian with questions regarding this condition.