The easy run becomes a stiff walk; the jump to a favorite chair is no longer possible; lying down is accompanied by a deep groan. As our dogs age, things that were once second nature become an effort. Today, thanks to advances in veterinary medicine and companion animal care, many dogs are living to a ripe old age. On the downside, that longevity also increases the odds that they’ll suffer from some form of degenerative joint disease (DJD), or osteoarthritis. There are several types of canine arthritis, but in this article, we’ll address the most common, the age-related degenerative form.
As dogs get older, the cartilage surfaces of their joints begin to thin, and cartilage cells die. When the cells die, they release enzymes that cause inflammation of the joint capsule and release of excessive joint fluid. Extra bony growths (osteophytes) can develop. With severe cartilage thinning, the normal joint space narrows and the bone beneath the cartilage deteriorates. All of these processes set in motion further changes in the normal functioning of the dog’s joint, and an ongoing spiral of pain, lameness, limb disuse/inactivity and muscle atrophy sets in. Many of these changes may be seen on X-rays.
On physical exam, veterinarians rely on a dog’s pain response to joint palpation, detection of crepitus (a crackling or grating sensation felt within the joint), observation of gait and the presence of muscle atrophy to diagnose osteoarthritis. Not all dogs—even those with significant DJD—vocalize when they’re in pain, but a dog whose muscles are atrophied and limbs are stiff, who requires assistance to rise, and does little more than teeter outside to go to the bathroom is without question suffering pain.
DJD isn’t the only reason for a decrease in a dog’s normal activity level, weakness or reluctance to move, so other conditions that could be causing or contributing to this change need to be ruled out. Among the entries on a lengthy list are infectious and metabolic illnesses, cardiac conditions, cancer (particularly bone cancer), anemia, and endocrine conditions such as hypothyroidism or Cushing’s disease. In an ideal world, all dogs would start life with genetically sound conformation and joints. For purebreds, the importance of responsible breeding and the use of OFA (Orthopedic Foundation for Animals) certification or other screening tests to evaluate hip and elbow conformation of prospective breeding animals cannot be overstated. Regardless of a dog’s origins, feeding her a high-quality diet throughout life and maintaining her at her optimal lean body weight are also crucial. If she’s overweight, a healthy weight reduction plan should be instituted immediately.
When it comes to relief, reaching for a single “big gun” pharmaceutical is rarely the most effective approach. Rather, best results are achieved by working with your vet to develop a plan tailored to help with your dog’s specific issues. An integrative, multimodal therapy regime can maximize your dog’s comfort and well-being as it minimizes the potential side effects of certain therapies, and is often more gentle to boot.
Following are a few strategies that have been found to be beneficial.
Around the house: Provide well-padded bedding away from cold or damp drafts. (This will also help prevent the development of pressure-point calluses.) Carpeted or padded steps or a ramp to get on and off the bed or couch are advised. Nonskid flooring wherever surfaces are slippery is also very helpful. Outside, your dog may find a gently sloped ramp easier to negotiate than steps.
Body work: Many arthritic dogs appreciate muscle massages, which stimulate blood flow to atrophying muscles. Certified canine massage therapists are available in most areas of the country; many are willing to demonstrate techniques to owners. (Start your search here: members.iaamb.org/users) Warm compresses over sore joints can be soothing, but care must be used to avoid injury from excess heat.
Supplementation: Countless joint supplements are available to promote healthy cartilage and joint health. These contain varying combinations of glucosamine, chondroitin, MSM, green-lipped mussel and other chondroprotective substances. Many veterinarians and owners have found that a small number of these products seem to be helpful. We don’t yet know whether beginning supplementation at a young age benefits every dog. This decision is best made with your veterinarian, taking into consideration factors such as diet and genetics/conformation (e.g., has a dog been diagnosed early on with hip or other joint abnormalities?). The anti-inflammatory effects of omega-3 fatty acids (EPA, DHA) have also been documented to be of help in dogs with arthritis. These are included in some canine arthritis diets, but to be effective, higher levels via separate supplements may be needed.
Exercise: Maintaining mobility through reasonable exercise is important regardless of a dog’s age and the extent of her arthritis. (I’m convinced that what kept a certain red Dober-gal of mine going to 15-plus was her daily quarter-mile walk down the driveway, albeit at her own pace.) A dog with mild, early arthritis can and should get more exercise than an ancient pooch with severe cartilage erosion. Non-weight–bearing exercise— swimming, for example—is excellent if not contraindicated by other medical conditions. Look for a Certified Canine Rehabilitation Practitioner (CCRP) for help with designing an appropriate exercise program. (Visit canineequinerehab.com to see if there’s one in your area.)
Complementary therapy: Many arthritic dogs can be made more comfortable and more mobile by acupuncture. Alternative veterinary practitioners sometimes prescribe formulations of Chinese herbs to support the benefits of acupuncture. (Click on “Find an Acupuncturist” at aava.org.)
Laser: Class IV therapeutic laser is a newer form of treatment that stimulates blood flow to tissues and can greatly improve arthritic conditions.
Pharmaceuticals: When it comes to drugs, there are several options. Adequan injections have long been considered the gold standard for treating arthritis and other degenerative joint diseases in dogs. A potent chondroprotective agent, Adequan (polysulfated glycosaminoglycan, or PSGAG) provides the body with the building blocks of cartilage it needs to assist in repairing its own tissues. Unfortunately, it is often not employed because the initial treatment consists of six injections over three weeks, and it is somewhat expensive. However, rarely have I seen an arthritis patient it did not help, and in my own senior dogs, I get clear reminders if I forget one of their maintenance injections (every three to six weeks, depending on the dog). Adequan is largely without side effects; the main reported side effect is the potential for increased bleeding, but in 20 years of use in dozens of patients (including von Willebrand disease-affected dogs), I have never encountered this problem.
We can add an analgesic such as tramadol, a synthetic opioid. While not an anti-inflammatory, tramadol is a fairly potent pain medication, as well as being inexpensive and reasonably safe. Sedation and constipation are possible side effects, but in my experience, dogs tolerate tramadol wonderfully within the proper dose range. Gabapentin and amantadine also target the nervous system, altering the transmission and strength of pain signals.
We can elect to try a steroid for its anti-inflammatory effect. The caveat with steroids, of course, is that over time, they have a “breakdown” effect on body tissues, including joints. Also, if used for any length of time, they may contribute to the development of diabetes, medically caused Cushing’s disease, liver inflammation, immune suppression or other problems. In order to prevent gastric erosion or ulceration, vets will often prescribe medications such as histamine blockers (famotidine, cimetidine), proton-pump inhibitors (omeprazole) or gastrointestinal protectants (sucralfate). If ulcer symptoms develop, steroids should be discontinued. All this having been said, many ancient dogs with advanced arthritis can get four to eight weeks of benefit from a long-lasting steroid injection.
If none of the above provides sufficient relief, one of the veterinary NSAIDs (non-steroidal anti-inflammatory drugs) might be considered. Canine NSAIDs include Rimadyl, EtoGesic, Deramaxx, Previcox, Metacam and Feldene. While these drugs are highly effective at reducing inflammation and pain, they should not be casually dispensed. I use them on a very limited basis with exceeding caution.
Few drugs are without possible side effects. The potential side effects of veterinary NSAIDs are numerous; they can be severe, and even fatal; their development can be completely unpredictable; and most importantly, they can be irreversible. I hold the “above all, do no harm” portion of our oath close to heart at all times. Unpredictable, irreversible side effects are scary.
For dogs whose systems tolerate an NSAID well, they can be wonderful. However, more than a few dogs, including healthy non-geriatrics, have succumbed to irreversible organ-system failure from sometimes no more than a few days’ worth of NSAID therapy. I have also heard of fatalities from perforating gastric ulcers, seizures and other “adverse events.” The FDA has documented thousands of such deaths, which by their own estimation represent a fraction of total cases.
Blood work should be done before an NSAID is dispensed to confirm normal liver and kidney function, red blood cell count, and other parameters. These tests should be repeated at regular intervals to confirm that the NSAID is being tolerated. Ask your veterinarian for a copy of the pharmaceutical company’s Client Information Sheet; he or she should also advise you about symptoms to watch for, including, importantly, any increase in water consumption or urination. The medication should be stopped immediately if symptoms develop. NSAIDs must never be given with aspirin or any form of steroid; doing so can result in death.
And please, do not give your dog over-the-counter pain medicines without consulting your veterinarian! Dogs have died tragic, unnecessary deaths from a variety of seemingly innocuous pills, including a healthy five-year-old dog whose owner gave her several days’ worth of Ibuprofen, which is toxic to canines (and, for that matter, felines too).
Let’s strive to support fit, structurally sound dogs; maintain them with excellent nutrition and age and breed appropriate exercise and at optimal body weights; and begin supplemental integrative therapies when they show symptoms of and are diagnosed with degenerative arthritis. Let’s work our way up to the “big guns” prudently and judiciously.
Here’s to long, happy and comfortable lives for all our dogs!