Arthritis In Dogs: Multimodal Treatment To Help Your Dog Feel More Comfortable
By Rachele Baker, DVM – Approximately 25% of dogs are diagnosed with arthritis in their lifetimes. Arthritis in dogs is a slowly progressive disease that affects joint cartilage, bones, and the surrounding muscle tissue. Joint cartilage degeneration and inflammation of the joints due to arthritis leads to stiffness, pain, and difficulty moving and exercising.
Lack of exercise worsens arthritis due to decreased joint fluid production which results in further joint cartilage degeneration. Inactivity also results in loss of the muscle mass that is needed to support the joints.
Signs of Arthritis in Dogs
Signs that your dog may have arthritis include lameness, decreased activity, stiffness (especially after rest), difficulty getting up or lying down, difficulty climbing stairs, or reluctance to jump. Stiffness may decrease after the dog has been moving around for a while. Lameness often worsens if the dog is overly active. X-rays can be taken to confirm a diagnosis of arthritis.
Arthritis is classified as either primary or secondary. Primary arthritis is associated with aging and is typically a disease of older dogs. Secondary arthritis may develop as a result of injuries such as rupture of the cranial cruciate ligament in a dog’s stifle (similar to an ACL injury in football) or other joint problems such as joint malalignment.
Multimodal treatment of arthritis in dogs is recommended and can help to minimize pain, enhance mobility, and enable arthritic dogs to have a better quality of life.
Multimodal Treatment of Arthritis in Dogs
It is not possible to cure arthritis in dogs. The goals for treatment are to reduce pain and discomfort, slow the progression of the disease, promote the repair of damaged tissues, and restore function in the affected joints.
Multimodal treatment of arthritis in dogs may include weight control, disease-modifying dietary supplements (nutraceuticals), pain control, and rehabilitation therapy.
Excess weight in dogs can increase the severity of arthritis because extra body weight puts more force on the joints when the dog is standing, walking, or running. Studies have shown that when dogs with hip arthritis lose excess weight, they experience a significant improvement in lameness and pain. These studies have found that as little as 6% to 8% weight loss in overweight dogs can result in a significant decrease in lameness due to arthritis.
Weight problems in dogs are usually the result of the same things that cause people to become overweight, namely, excessive amounts of food and/or insufficient exercise. However, some dogs may have a medical condition that causes them to gain weight such as hypothyroidism or hyperadrenocorticism (Cushing’s disease). If you suspect that overfeeding or lack of exercise are not the reason for your dog being overweight, it is recommended that you have your veterinarian screen your dog for these conditions with some baseline bloodwork prior to starting your dog on a weight loss plan.
The most effective weight loss plans for dogs involve feeding fewer calories as well as increasing activity. For a detailed discussion about determining your dog’s ideal body weight and selecting an appropriate dog food and treat allowance for your dog, please read my article titled Is Your Dog Overweight? How To Develop A Weight Loss Plan For Your Dog.
Arthritic dogs may be reluctant to exercise due to the pain and stiffness in their joints. Pain management for dogs with arthritis will be discussed later in this article. After instituting pain relief as discussed below, an exercise program of low-impact exercises such as leash walks and swimming can be instituted. Daily low-impact exercise will help your dog lose weight, increase joint mobility, build and maintain muscle mass, and promote joint health. Building up the muscles around the joints helps to promote joint stability.
High-impact activities such as running or jumping should be discouraged because they can increase joint pain and inflammation.
Swimming is an excellent low-impact exercise for dogs with arthritis. Water exercise decreases the weight placed on limbs during movement and increases the resistance to motion. In a study comparing land and water exercise programs in people with knee arthritis, both exercise programs led to improved joint function, but the joint pain experienced was less for the patients exercising in water.
Do not assume that your dog instinctively knows how to swim. Start him or her off in shallow water no higher than belly deep and keep him or her on a long leash. Get into the water with your dog and praise your dog for venturing into the water. Do not let your dog go into deep water until you are confident that he or she is a strong swimmer. If your dog is hesitant about walking into the water, you can throw a ball or a toy a couple of feet out to encourage him or her.
If you are taking your dog swimming in a lake or the ocean, get him or her a well-fitted canine life vest. If you are taking your dog swimming in a pool, repeatedly show him or her how to find the steps to climb out of the pool until you are confident that your dog knows where the steps are and how to get out of the pool when he or she tires. Never leave your dog unsupervised in the pool.
Once your dog is good at swimming, you can throw a ball, toy, or stick out into the water for him or her to fetch. Dogs love this game and it is great exercise for them.
Dietary Supplements (Nutraceuticals)
A number of disease-modifying dietary supplements (nutraceuticals) have been shown to be helpful in the treatment of arthritis in dogs. Dietary supplements should be started as early as possible in arthritic dogs for the greatest effect. Nutraceuticals for arthritis in dogs include glucosamine and chondroitin sulfate, ASU (avocado soybean unsaponifiables), MSM (methylsulfonylmethane), and omega-3 fatty acids from fish oil (DHA and EPA).
Glucosamine and Chondroitin Sulfate
Studies in humans have shown that glucosamine significantly reduces the pain of arthritis. Glucosamine has been shown to be as effective as some commonly used pain medications in reducing joint pain and improving joint function.
Glucosamine and chondroitin sulfate stimulate joint cartilage production and inhibit joint cartilage breakdown. Glucosamine and chondroitin sulfate used together have been shown to be better than either product alone at protecting joint cartilage.
Cosequin and Dasuquin are good quality joint supplements for dogs (both manufactured by Nutramax Laboratories). Cosequin contains glucosamine and chondroitin sulfate. Dasuquin contains glucosamine and chondroitin sulfate as well as ASU (discussed below). Dasuquin is also available with MSM (discussed below). No significant side effects have been reported with Cosequin or Dasuquin.
ASU (Avocado Soybean Unsaponifiables)
ASU is concentrated directly from avocados and soybeans. Avocado-soybean unsaponifiables are one of the most commonly used treatments for humans with arthritis in Europe.
Clinical studies have demonstrated that ASU may help to inhibit joint cartilage degradation and promote joint cartilage repair. ASU can improve joint function and comfort. ASU supplementation reduced the need for oral pain medications in a clinical trial in humans with arthritis.
MSM occurs naturally in some green plants, fruits, and vegetables. Studies have shown that MSM is effective in reducing arthritis pain and stiffness as well as in improving joint function. MSM helps to decrease joint cartilage degeneration and may also have anti-inflammatory effects.
Omega-3 Fatty Acids (DHA and EPA)
Studies have shown that omega-3 fatty acids from fish oil (DHA and EPA) improve clinical signs of arthritis in dogs and may allow a reduction in pain medications. DHA and EPA from fish oil reduce destructive enzymes and inflammatory mediators in joints.
In one study, dogs fed a diet supplemented with omega-3 fatty acids from fish oil averaged a twenty-five percent decrease in the amount of NSAID (non-steroidal anti-inflammatory) pain medications needed. Similarly, in a study of humans with arthritis, omega-3 fatty acid (DHA and EPA) supplementation reduced joint stiffness and pain and decreased their use of NSAID pain medications.
In another study, eighty-two percent of dogs receiving high omega-3 fatty acid diets had reduced joint pain and improved weight bearing. A study of 127 dogs with arthritis demonstrated that omega-3 fatty acid supplementation resulted in significant improvement in the dogs’ ability to rise from a resting position, walk, and play compared to dogs not receiving omega-3 fatty acids.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
NSAIDs (non-steroidal anti-inflammatory drugs) may be used for relief of pain and inflammation in dogs with arthritis. NSAIDs can be used short term (on an as-needed basis) or long term for dogs whose pain cannot be controlled with weight control and nutraceuticals alone.
NSAIDs that have been approved for use in dogs in the United States include Rimadyl (carprofen), Deramaxx (deracoxib), EtoGesic (etodolac), Previcox (firocoxib), Metacam (meloxicam), and Zubrin (tepoxalin). Side effects that may occur with NSAID use include vomiting, diarrhea, gastrointestinal ulcers, liver problems, and kidney problems. Dogs should be screened for liver or kidney problems with bloodwork performed by your veterinarian prior to starting NSAIDs. Dogs should also have regular bloodwork performed to monitor for adverse side effects that may develop while on long-term NSAIDs.
Galliprant (grapiprant) is in a new class of NSAIDs that may cause fewer adverse side effects in dogs than other NSAIDs. Side effects that may occur with Galliprant include vomiting and diarrhea. Galliprant is expected to have similar efficacy as other NSAIDs in the treatment of arthritis in dogs.
Mild gastrointestinal (GI) side effects (occasional soft stool or vomiting) were noted in a 9-month safety study in which grapiprant was administered to dogs once a day. In that study, grapiprant did not cause GI ulceration or perforation as has been seen in dogs treated with other NSAIDS. In addition, no adverse side effects on the dogs’ livers or kidneys were observed.
Since this is a recently released drug, other adverse side effects may be discovered.
Other Pain Medications
Other oral pain medications such as tramadol and gabapentin can be used alone or in conjunction with NSAIDs if NSAIDs alone do not provide adequate pain relief.
Rehabilitation therapy can help to reduce the progression of arthritis and decrease pain. Various rehabilitation therapies can increase muscle mass, improve muscle condition, increase range of motion in the joints, and improve weight bearing in arthritic limbs.
There are many different rehabilitation therapies that can be used for arthritis in dogs. In this article, we will discuss therapeutic laser, PEMF (pulsed electromagnetic field) therapy, and hydrotherapy (underwater treadmill and swimming). Many general practice veterinary hospitals are now offering laser therapy. A broader selection of rehabilitation therapies are offered in dedicated canine rehabilitation centers.
Laser therapy is the use of light energy to relieve pain, reduce inflammation, and increase blood flow. Laser light energy penetrates deeply into the cells of the body and exerts effects on all the chemical processes within the cells. It increases the release of endorphins and decreases inflammatory mediators in the body.
The older Class III therapy lasers (Low Level Laser Therapy) are lasers with a maximum wattage of 0.5 watts. The newer Class IV therapy lasers provide from 0.5 to 15 watts of power. Class IV therapy lasers are considered deep tissue, high powered lasers.
For a chronic, painful condition like arthritis, an induction phase of more frequent laser treatment sessions is recommended. As laser therapy continues, less frequent therapy is required to maintain a dog’s comfort. Based on the dog’s response to therapy, treatments are decreased over time until a maintenance phase is established.
PEMF (Pulsed Electromagnetic Field) Therapy
PEMF (Pulsed Electromagnetic Field) therapy is a treatment that uses pulsing electromagnetic fields to provide pain relief, reduce inflammation and swelling, and promote healing. PEMF therapy has no adverse side effects. PEMF therapy can be used in conjunction with medications and supplements and may provide enough pain relief that dosages of pain medications can be reduced.
PEMF therapy can pass through fur, skin, bandages, and casts. It can be delivered via mats that animals lie on, jackets, and portable loops
Targeted PEMF (tPEMF) therapy results in upregulation of nitric oxide (NO) which promotes dilation of blood vessels and improved blood flow. This leads to a reduction in pain, swelling, and inflammation. Targeted PEMF also supports new blood vessel formation and tissue regeneration. Targeted PEMF devices are more efficient than non-targeted PEMF devices that produce weaker electric fields. Targeted PEMF devices generate an electric field that is seven times stronger than non-targeted PEMF devices.
Studies of non-targeted PEMF therapy versus targeted PEMF therapy in people have shown that both help to decrease pain in people with knee arthritis. However, targeted PEMF therapy resulted in a greater reduction in arthritis pain in much less time (30 minutes a day versus 12 hours a day). Veterinary studies have also demonstrated the benefits of PEMF therapy for arthritis in dogs.
Assisi Animal Health manufactures targeted PEMF devices for animals including portable loops, mats, and jackets. The Assisi Loop is available to pet owners directly from their veterinarian or from Assisi Animal Health with a prescription.
Hydrotherapy – Underwater Treadmill
Low-impact exercise using an underwater treadmill can help to reduce the pain of arthritis. The buoyancy of the water in an underwater treadmill unloads weight from the joints and provides support so that an arthritic dog can exercise more comfortably. The resistance to motion provided by the water helps to improve muscle strength and increase the range of motion in arthritic joints.
The warm water in an underwater treadmill increases circulation, alleviates pain, and promotes dilation of blood vessels and improved blood flow. In addition, exercise increases a dog’s heart rate which helps to improve cardiovascular fitness.
In conclusion, multimodal treatment of arthritis in dogs including weight control, disease-modifying dietary supplements (nutraceuticals), pain control, and rehabilitation therapy, can help arthritic dogs feel more comfortable and enjoy a better quality of life.