Arthritis Management Options
Degenerative joint disease (DJD) or (osteo)arthritis is a general term for chronic joint inflammation and pain. It can be caused by many things, for instance, general ageing wear-and-tear on the joints or a congenital defect ( eg. hip dysplasia or elbow dysplasia) or an old injury.
In normal joints, the contact areas are covered by smooth cartilage that secretes a lubricating joint fluid. With abnormal wear, the cartilage becomes inflamed and secretes inflammatory mediators that degrade the joint causing more inflammation, in a vicious cycle. Cartilage does not have nerve endings, but bone does. Once the abnormal wear and the inflammation have destroyed the cartilage, the joint starts to hurt. This is when we usually notice the limping, reluctance to run or jump, difficulty to get up from laying down, stiffness, etc. If that wasn't bad enough, limping puts extra strain on the surrounding muscles and the fascia which cause additional inflammation and pain.
Our goal with treatment is to reduce the inflammation and pain and keep as much muscle mass and movement as possible. Sometimes surgery is helpful, for instance in a dog with hip dysplasia a total hip replacement can be done. However, for general osteoarthritis we have a variety of medical options and lifestyle changes that can be used together to keep your dog as comfortable and mobile as possible.
These may include the following;
⃝ Zydax injections (Polysulfated Glycosaminoglycan) – We start with course of one injection under the skin per week for 4weeks. After this induction course we may repeat one off injections every 1-2mths depending on the individual’s response. This product helps prevent the breakdown of cartilage and may help with the synthesis of new cartilage. It also helps with joint fluid production (“lubricating the joints”).
⃝ Anti-inflammatory pain relief (e.g. Metacam (Meloxicam), carprofen etc)
These medications reduce inflammation as well as providing good pain relief.
Additional oral pain relief options, such as Tramadol or Gabapentin, can also be added in if more pain relief is needed or if your pet is not tolerating the anti-inflammatory options:
Supplement options :
Neutraceuticals are nutritional supplements that positively influence cartilage health. These take at least 6 weeks before your dog will get the full benefit and will need to continue to be given on a regular basis to exert an effect.
⃝ Formulated supplement eg. 4cyte/Joint guard/Sasha’s Blend etc
⃝ Omega 3 and 6 fatty acids /Fish oil has been shown to improve joint health by decreasing inflammatory mediators.
⃝ Glucosamine and Chondroitin - enhance the protection of cartilage and inhibit enzymes in the joint which tend to contribute to cartilage breakdown.
⃝ Weight loss / weight control – reduces impact on the joints.
Exercise : What we are trying to accomplish here is to restrict the amount of high intensity exercise, yet still maintain adequate movement to increase or maintain muscle strength. Swimming is an excellent way for dogs to maintain muscle mass, but place minimal stress on the joints. Jumping in all forms can exacerbate arthritic pain. While watching a dog play Frisbee is very enjoyable and fun for the dog, it is very hard impact activity on a dog's joints. Moderate regular exercise is important, i.e it is preferable to go for short daily walks to the park or around the block/s rather than doing a long distance walk/s on the weekend.
Provide warmth and good sleeping areas : Arthritis tends to worsen in cold weather, especially if it is also damp. Consider adjustments like providing an additional source of warmth in their bed via a dog heat mat/pad; or putting a coat on them, or allowing them more indoor access through the winter. Ideally beds should be well padded, but on the firm side as these are much easier to get in and out of.
Massage: Massage of the muscles around the joint affected with arthritis may help to relax stiff muscles and promote a good range of motion in the joints. Start slow and build trust. Start by petting the area and work up to gently kneading the muscles around the joint with your fingertips using a small, circular motion. Gradually work your way out to the surrounding muscles. Moderate heat is also beneficial.
Make daily activities less painful: Going up and down stairs is often difficult for arthritic pets, and for dogs, it can make going outside to urinate and defecate very difficult. A ramp will help your pet getting into the car and prevent putting a large amount of stress on joints when jumping out of the car. Big dogs can especially benefit from elevating their food and water bowls. Elevated feeders make eating and drinking more comfortable for arthritic pets, particularly if there is stiffness in the neck or back.