Lindale Veterinary Clinic / Arthritis/Joint Disease

Arthritis/Joint Disease

Conditions Leading to Joint Disease

Ruptured Anterior Cruciate Ligament

Hip Dysplasia

Elbow Dysplasia

OCD (Osteochondrosis)

PHYSICAL THERAPY FOR ARTHRITIC PATIENTS

Life with a dog with mobility issues is a challenge and it would be wonderful if there was a magic pill that could be given to make a stiff older dog as supple as a youngster. Unfortunately, despite advances in arthritis medications for dogs, there is more to therapy than giving pills. The more advanced the mobility problems are, the more important physical therapy becomes in maintaining function.

The Pre-Exercise Warm-Up

When one talks about a warm-up before exercise, one literally means warming the muscles. Warmth decreases stiffness and increases blood flow to the muscle. It also directly reduces pain. A warm wash cloth in a plastic baggie makes an excellent warm compress (test it on yourself to be sure it is not too hot) for application to the stiff joints. The joints can be flexed and extended passively and the muscles gently massaged. A good five minutes of this is helpful prior to exercise.

Regular Low Impact Exercise: Daily

Arthritic joints rely on strong muscles for support yet arthritis pain leads to disuse and poor muscle conditioning. For this reason, regular exercise is an important foundation. Short walks or swims which do not leave the pet unduly sore the next day should be part of the daily exercise routine. Exercise helps reduce excess weight and keeps joints flexible. Exercise should avoid sudden spurts of speed and should be done at a steady pace.

If the pet is sore after exercise, do not exercise until the pain seems to be resolved. Re-start the exercise at 50% of the duration. Fifteen minutes of ice packing can be applied to an acutely painful joint.
If one wants to try increasing the exercise, a 20% increase in exercise time should be effected.

The Cool Down

At the end of the exercise period, a reduced pace of exercise is done as a "cool down." Ideally, a 5 minute slower pace of the exercise is followed by 5 minutes of massage.

What is Passive Range of Motion Exercise?

During warm-up and cool down, one of the techniques that can be used to assist flexibility is Passive Flexion/Extension exercise, also called "passive range of motion." Here the patient lies on his or her side with the side to be exercised up. Starting with the foot, the joints are flexed and extended through their natural range of motion moving up the leg all the way to the shoulder/hip. If the exercise causes discomfort (for example, dogs with bad hips are quite painful when the rear leg is extended backward), do not continue to a painful point. Ideally 15-20 flex/extensions are performed on each joint and this is done 2-4 times daily.

How to do Massage

There are many hand motions that can be used in massage:

Stroking
This is done with the palm of the hand on the pet moving from head to tail or from shoulder/hip down to toe.
Effleurage
This is also done with the hand on the pet and even pressure on the hand. Effleurage follows the opposite direction of stroking (toe to body). Over- lapping strokes are used to cover the entire body area.
Percussion
This involves tapping of the body with a cupped hand with light brisk contact. The "karate chop" position of the hand can also be used for percussion.
Friction
This uses the tip of the fingers to make small rotary motions.

There are, of course, many other techniques that can be used. Benefits of massage include increased circulation to the area, increased lymphatic flow, improved mobility of tissues, and relaxation. Any combination of these techniques can be used on the pet as time allows.

We hope these tips are helpful in keeping the poorly mobile pet functional. If your pet seems unduly painful or is not responding as expected, please contact our office.

MEDICATIONS FOR THE TREATMENT OF DEGENERATIVE ARTHRITIS

Degenerative joint disease is the number one cause of chronic pain in the dog and cat. The condition itself is the result of long term stresses and instability of a joint either as a result of old injury or of natural development of the joint in that individual. While surgery may be able to help in some situations, most of the time the degeneration of the joint cannot be reversed and treatment focuses on preventing progression of damage. Numerous products are available on the market; some are best combined with others and some cannot be combined. The following is a summary of options:

Medications for arthritis pain are divided into two groups: Fast-Acting (Non-Steroidal Anti-Inflammatory Drugs and Cortisone-type Drugs) and Slow-Acting Drugs.

FAST-ACTING DRUGS (Non-Steroidal Anti-Inflammatory Drugs)

These medications act quickly by suppressing the inflammatory biochemicals that ultimately lead not only to the pain of arthritis but also to cartilage damage. None of these medications can safely be combined with one another.

ASPIRIN

Aspirin is a "non-steroidal anti-inflammatory drug" or NSAID. It is effective in relieving pain due to inflammation as is occurring within the arthritic joint. It has the advantage of being readily available and inexpensive. In some animals, however, it is simply not strong enough or it causes unpleasant side effects such as upset stomach or even intestinal bleeding. Aspirin also appears to inhibit the production of cartilage matrix by cartilage cells, which in the long run is not conducive to a healthy cartilage surface. Aspirin also deactivates platelets (the blood cell responsible for clotting) and thus can promote bleeding should surgery or trauma occur.

Dogs can use aspirin up to three times daily. Cats, however, metabolize aspirin extremely slowly and require a very low dose and a typical dosing schedule of twice a week usage, which usually works out to be inadequate for pain management.
Because this medication is available in almost every pet-owning household, there may be a temptation to guess a dose based on the human dose. Do not be tempted to do this. Do not use aspirin or any other medication in your pet without veterinary guidance.
Enteric coating of aspirin has become popular in human products. This coating is a problem in animals and creates unpredictable absorption. This becomes dangerous when enteric coated aspirin tablets do not digest in the stomach and instead collect in the stomach until a toxic dose is reached. To avoid this disaster, use either aspirin made specifically for pets or aspirin with a powdery covering rather than the "hard candy" type enteric coating.

Overall, aspirin use in pets is associated with enough problems to make it a second choice.

RIMADYL (Carprofen) AND ETOGESIC (Etodolac)

These medications are also NSAIDs. They were developed as an improvement upon aspirin and other NSAIDs developed for humans for which side effects have been problematic in animals. Rimadyl and Etogesic are both designed for indefinite use in dogs with minimal side effect potential. Both Rimadyl and Etogesic may be given once daily (the Rimadyl dose can be divided in two and given twice a day if desired). Typically a short trial of one of these is prescribed to see if the effect is worth continuing; as with people, some individuals respond better to different NSAIDs. If the effect is good, then the medication can be continued. Some blood testing is recommended prior to long term use and every 6 months thereafter.

Approximately one dog in 5000 will have a serious liver reaction to Rimadyl. Animals with histories of elevated liver enzymes, pre-existing liver disease, Cushing's Disease, or phenobarbital use should probably not take this medication.
Neither of these medications should be used in the cat.
Carprofen does not inhibit matrix production by cartilage cells.

DERAMAXX (Deracoxib)

As research progresses to make safer arthritis medications for both humans and animals, the coxib class of NSAIDs was developed. Inflammation is in part medicated by biochemicals called "prostaglandins." While some prostaglandins mediate inflammation, other prostaglandins are needed for normal healthy cell function. The trick is to inhibit the "bad" prostaglandins without interfering with the "good" prostaglandins.

It turns out that an enzyme called Cyclooxgenase-1 (Cox-1) is responsible for making the "good" prostaglandins while Cyclooxgenase-2 (Cox-2) produces the bad ones. Most NSAIDs (aspirin, Ibuprofen, etc.) inhibit both enzymes. Rimadyl and Etogesic primarily inhibit Cox-2, but not until the coxib class was developed was it possible to inhibit Cox-2 without also inhibiting Cox-1 in part.

Deramaxx is available as a chewable tablet and is for once a day use.
We still recommend blood work every 6 months during the long term use of any medication (including this one).
Of all the oral NSAIDs currently available for dogs, this is probably the most expensive but depending on the results obtained may be well worth it. It is not only the safest NSAID but probably the strongest pain reliever.

CORTICOSTEROIDS

The corticosteroid hormones (prednisone, dexamethasone, etc.) inhibit all production not only of prostaglandins but of leukotrienes as well. What this means in plain english is that these hormones create broad spectrum inflammation inhibition including wiping out some biochemical mediators it would be best not to wipe out. The result is relief from just about any type of inflammation: arthritis, itchy skin, immune-mediated disease and more, but in the long run side effects are problematic:

immune suppression
poor wound healing
poor ability to grow hair
excessive thirst
muscle weakness

Using thise medications to control arthritis pain is not desirable in the long term and one of the other medications mentioned would be a better idea.

SLOW-ACTING DRUGS OF ARTHRITIS

Slow-acting drugs of arthritis ultimately improve joint function and help with pain relief but they require a time frame of weeks to months to exert their effect. They may have disease-modifying properties such that their benefit continues even after their use has been curtailed. Theoretically, after months of using the slow-acting treatments it may be possible to cut back or even discontinue the fast-acting drugs listed above.

GLUCOSAMINE AND CHONDROITIN SULFATE

These products are cartilage components harvested chiefly from sea mollusks (i.e., cartilage is made up of chondroitin sulfate and glucosamine metabolites, among other things). By taking these components orally, the patient is able to have plenty of the necessary "building blocks" needed to repair damaged cartilage. It is also felt that these products may have some anti-inflammatory properties separate from their structural uses. Unlike NSAIDs, these products do not produce rapid results; one to two months are needed for them to build up to adequate amounts. There are numerous products available combining glucosamine, chondroitin sulfate, assorted vitamins, creatine (a muscle "building block), omega 3 fatty acids and more.

Because these substances are classified by the FDA as "nutriceuticals" (ie nutrients with medicinal properties) rather than as "drugs," the usual rigorous testing for efficacy has not been required. As a result, the optimal dosage has not been determined and almost every product has a different dose recommendation. Some experimentation may be necessary.
These products are not likely to be helpful for spinal arthritis as the joint composition of an intervertebral disc (the joint of the spine) is totally different from those of other bones.
These products can be used in both dogs and cats.
These products often complement treatment with NSAIDs.

ADEQUAN