Introduction:
A little about Arthritis:
Let's keep this simple: Arthritis simply means disease of the joints. The joint disease may be due to trauma, the gradual wear and tear of advancing age, poor confirmation of the joints, poor nutrition, oxidation, hormone imbalances, toxins, or, more commonly, for genetic reasons.
Hip dysplasia, for example, might be summed up as being a painful joint disease of the hips due to poor confirmation of the hip joint. What am I talking about? Well, the femur doesn't fit into the hip socket normally, so it grinds away the shock absorbing cartilage exposing the sensitve bone surfaces. Why is the joint of abnormal confirmation? Well, for the same reason none of us are perfect in everyway; genetics!
Here's another approach: arthritis, whatever the cause, and whatever the name (hip dysplasia for the hip, bursitis for the shoulder, stenosis of the lower back) involves inflammation and erosion of joint cartilage that over time gets worse and worse. Without the cushioning effect of healthy cartilage, painful nerve endings are hammered. With pain, the joint is used less and becomes stiff and losses it's range of motion.
Not only that, but with inflammation there's a release of tacky inflammatory secretions and toxins into the joint leading to further destruction, pain, and lack of mobility.
Arthritis is very common and the possible causes are injuries, cell oxidation, bacterial invasion, auto-immune diseases, as part of the a broader neuro-muscular degeneration problem, genectics, poor nutrition, toxins, and perhaps for reasons we don't yet understand.
This process is started or present in some pets and not others in different degrees for reasons we don't really understand well, but we do know that factors include genetics, old injuries, diet, cell oxidation, bacterial invasion, age, and obesity.
Speaking of bacterial invasion, you might be surprised to know that the number one cause of bacterial entry into the blood is through gum disease. Gum inflammation allows easy bacteria access into the blood stream, and once in the blood, some of the bacteria survive our defense mechanisms and are able to establish destructive colonies in different parts of our bodies.
Bacteria seems to be especially destructive to our heart valves, liver, and joints (also mammary tissue if nursing and the uterus if pregnant). Bacteria invasion may also be involved in the sequence of events leading to auto-immune inflammation of our joints. So, listen to your vet when he or she recommends dentistry.
This page is devoted to letting you know what options you have for the prevention and treatment of arthritis in dogs and cats. And as usual, "What to expect when you go to the vet".
The Symptoms of Arthritis: What we notice:
Pretty much all the symptoms revolve around pain and stiffness of the joints which show up as "morning stiffness", less activity in general, trouble climbing stairs or trouble getting into your car or truck and so forth.
Often one joint will be worse than others, so your pet will be lame on one leg. Or lame on those days when it's cold or damp or after an activity. Another similar symptom is what my vet school professor called "Monday Morning Disease" where the dog was active during the weekend when the family was home from work and school...but come Monday morning, the pet can hardly move without obvious pain and stiffness.
What to Expect at the Vet when you have an Arthritic patient:
(Of course, your vet may do things differently)
1. A good exam & History In addition to checking the rest of the body for gum disease, cataracts, ear and skin disease, lymph nodes, heart and lung sounds, we will ask a lot of questions such as the duration of the symptoms and when the symptoms are worse.
We will palpate the neck, spine, and limbs and do range of motion tests and tests that differentiate between ligament disease, old injuries, and arthritis. We will be looking for signs of inflammation, fever, and chronic bacteremia. Gait and posture will also be evaluated for telltale clues.
2. Diagnostics: We will discuss the benefits of doing blood work to see if the stiffness etc might be due to something else like kidney disease, or the poor digestion, cramps, and malaise associated with liver disease or diabetes. These same tests will make anesthesia needed for the x rays safer, and they will give us a base line for your dog to compare with later to make sure the arthritis medicines we choose aren't affecting the liver.
3. We will talk about the benefits of radiographs. To get good radiographs we will sedate your pet heavily to allow good positioning and we will take advantage of this sedation and the good muscle relaxation that goes with it to repeat palpation and manipulation of the limbs looking for excessive wear and tear and play. The x-rays will help us confirm that there is arthritis, to stage how much damage there is, to rule out fractures, little chips of bone in the joint called joint mice, and cancer. As an example; If the arthritis pain and weakness is mainly coming from the hip region, x-rays will help us determine how much destruction is present, whether the problem is mostly on one side or the other, and they will help us decide on treatment. Sometimes the arthritic destruction is so bad that a surgery called a FHO (removal of the femur head so it doesn't grind against the pelvis) would be helpful.
Other Imaging Techniques: I don't have any experience with using MRI and CAT Scans, but they're now available in veterinary medicine, especially at the specialist level. Perhaps your vet will recommend that one be done on your pet.
4. Treatment trials: Whether or not you elect to do blood testing or radiographs, we have several new medications that often work great and are safe enough to try on a trial and error basis to see if your pet shows obvious improvement.
The first medication I like to try is really a "neutraceutical"...available over the counter in health food stores, pharmacies, and even at check out counters at grocery stores! I'm talking about glucosamine, either alone or mixed with some combination of MSM, green lipped mussel, chondriton, zinc sulfate, or vitamin C.
Glucosamine is my first choice as a trial treatment for several reasons: There don't seem to be any significant side effects, there's often good and obvious improvement within just a couple of weeks of treating, and it doesn't just cover up pain...it actually increases the amount and quality of the joint fluid and slowly repairs damaged cartilage.
The glucosamine molecule is a basic part of mammalian synovial joint fluid and is also a basic building block of the cartilage matrix. The body apparently can use this molecule to increase the amount and quality of synovial fluid as well as to repair defects in cartilage. Quite a claim, but studies are pretty convincing that this is true...at least to a certain extent.
How much improvement? It seems to depend on the patient.
The bottom line is that if you try this very safe product you have about a 30% chance of seeing great improvement in the way your pets feels and moves. You have another 60% chance of seeing modest improvement.
Important Comment: When it comes to glucosamine products, stick with the name brands your veterinarian recommends. As with many neutraceuticals (not covered by FDA standards or inspection), the quality and quantity of active ingredient varies greatly among different brands.
Cox 2 Inhibitors: Lately, selection of medications have become readily available in human and animal medicine for the relief of arthritic pain and inflammation. Brand names include Rimadyl, Ectogesic, Zubrin, and Dermaxx. Each of these claim to be superior in one way or another, but all belong to the same class of drugs known as Cox 2 Inhibitors and block...quite effectively...one of the major bio-chemical pathways leading to pain and inflammation. In my experience, they all work quite well, not as a cure, but in greatly reducing the pain of arthritis.
These products tend to work much better than aspirin, tylenol, advil, ibuprofen, and bute...products we were used to using prior to the introduction of the improved cox 2 inhibitors. They also tend to have fewer side effects.
However, they are not side effect free. Usually the problems we get with these medications are minor and typically involve GI upset. Simply giving on a full stomach or switching brands often solves this particular problem. Or giving Pepcid AC at the same time will often counter the adverse GI effects. An uncommon but more serious potential side effect is liver inflammation or disease associated with long term use of these drugs (this is true of many drugs used long term).
Because of possible liver side effects, ideally we do a periodic blood test for liver disease with patients on long term courses of these meds. And some vets like to recommend liver support products like the newly available Denosyl SD4 (more about this product on our page about the liver)
Remember to keep things in perspective: All medications...including so called natural products, herbs, and neutraceuticals have potential side effects. This certainly includes aspirin, ibuprofen, phenylbutazone, and steroids.
Update, Dec 2004: Cox 2 inhibiting medications are now under extra scrutiny for potential problems. Vioxx, a cox 2 medication used in humans was recently voluntarily removed from the market because of possible adverse effects on blood pressure.
Potential dangers aside, what really makes these medications popular, though, is the amazing pain relief and improved mobility pets are likely to get. Sometimes potential side effects are worth the comfort. Besides, you have to compare the side effects of one class of medications to the alternatives; nothing is side effect free, including, in the case of arthritis, of doing nothing.
Your vet will probably encourage you to consider trying a short trial of both glucosamine and then one of the Cox 2 inhibitor drugs to see how well they work in your pet. You have about a 80% chance of being amazed at the improvement. Most of our clients end up using both; the glucsamine for the increased mobility and improved health of the joint and the cox2 inhibitor for superior pain relief and comfort.
Other Treatment Options & Considerations:
Anti-oxidants: The degeneration that occurs in arthritic joints is partly due to physical wear and tear of the joint surfaces rubbing against each other. But another part is death and destruction at the cell level due to chemical oxidation. Anti-oxidants slow down and counter this problem.
Unfortunately, once the joint is arthritic enough to show obvious pain and lack of motion, you're not likely to see improvement using anti-oxidants alone. But you'll helping to prevent the problem from getting worse and anti-oxidants are good for the whole body, slowing the "aging process" or destruction of tissues throughout the body. So, highly recommended as an adjunct to arthritic thearpy.
There's more (or will be more) about anti-oxidants on the Nutrition Page
MSM: When given orally, MSM (Methylsulfonylmethane) can be effective in relieving symptoms of physical stress, including GI upset, inflammation, the pain associated with the musculoskeletal system and allergic reactions.
Some of Methylsulfonylmethane’s functions in the body are maintaining cell membrane flexibility and permeability which allows for exchange of nutrients into and toxins out of the cell, maintenance of proper connective tissue function and aiding in the formation of collagen. The concentration of Methylsulfonylmethane in the body can be reduced through normal aging processes and stress. MSM is a good source of sulfur in the body and sulfur deficiencies have been associated with slow wound healing, immune system dysfunction, skin disorders and degenerative joint problems. More about MSM soon. Note: MSM is often combined with glucosamine in the better joint supplement formulas.
Durlactin: This is a new neutriceutical treatment for arthritis made from milk enzymes. I haven't had a lot of experience with this product yet, but I've gathered as much information as I could find for you and placed that information on a separate page.
Adequan ® Injections (POLYSULFATED GLYCOSAMINOGLYCAN)
Somewhat similar to...but sometimes more effective than glucosamine, polysulfated glycosamineoglycan relieves the pain and disability of joint damage, and the relief has been shown to last up to 6 months or longer. Adequan binds to damaged cartilage and boosts cartilage metabolism, facilitating repair processes. At the same time, it blocks the action of destructive enzymes that promote joint inflammation, break down the synovial fluid, and attack the cartilage.
Adequan stimulates the synovial membrane to manufacture new synovial fluid to replace the thin, degraded fluid of joint disease. By doing so, Adequan helps lubricate, nourish, and clean the cartilage.
The injections are given weekly at first and then at intervals of every 2-4 weeks to effect. The few times I've used it, most recently on a huge Great Pyrenee working sheep dog that was nearly crippled with arthritis, it worked well. More about this soon.
Other Injections: Some vets like to give injections of different lubricating and/or anti-inflammatory medications right into the joint...often with good results. Your vet may feel comfortable doing this, or like me, refer such treatment to a specialist.
Fatty Acid Supplementation: A lot of recent studies are concluding that certain fatty acids can be highly beneficial in the prevention, repair, and relief of arthritic damage. The newer prescription diets designed for arthritic patients contain fatty acid supplementation. More details about this soon.
Support Wraps, Bandages, and Devices: If your pet will tolerate it, support wraps sometimes have a role in managing and supporting a weak or damaged joint. They can be a lot of trouble though, keeping them on, preventing circulation problems and so forth.
Diet: Some companies are now making diets designed for older dogs with arthritis that make a lot of sense; many arthritic patients can be managed without additional pain medication. Hill's Joint Diet (JD) and Eukanuba Senior Plus are good examples that I'm familiar with...both contain antioxidants, glucosamine, and omega 3 fatty acids for joint health as well higher fiber, lower calories, and protein quality designed to be easy on the liver and kidney of older pets.
Steroids: Most veterinarians try to avoid steroid use until the very late stages of arthritis. But sometimes we get to the point when nothing is working well anymore and euthanasia becomes a possibility because the dog has such advanced arthritis it can hardly get up and is loosing control of bowel movements and urination etc.
Well, steroids have lots of potential negative side effects...especially when given long term...and especially when given in the higher doses needed to help with severe arthritis...but they often give excellent relief of inflammation giving your pet much needed pain relief and mobility for a while. And certain types of steroids can help a lot...for a while...with the muscle weakness that often accompanies arthritis of the hips. The potent group of medications known variously as steroids, cortisone, methylprednisone, Depo, and a related group of steroids known as anabolic steroids, while dangerous, are often life savers.
Another frequent and appropriate use of steroids is for occasional use for severe arthritic "flare ups". And despite the "bad press" associated with steroid use and the fairly high potential for serious side effects, a lot of arthritic pets can be managed very successfully on steroids. Your vet will likely have strong opinions about steroids use, but either way, in general, it's best to try other treatments first.
Chiropractors: My experience with sending arthritic pets to chiropractors has been limited but positive. However, most of the 10 or so patients that I referred had different degrees of rear end paralysis associated with either disc disease or lower spine trauma, not hip arthritis. These were case that were not responding to various treatments (anti-inflammatories, antibiotics, muscle relaxers, pain medicaitons, and rest). Nonetheless, chiropractic care might be helpful.
Acupunture: I'm not sure about this as a recommendation, but my very limited experience has been positive. The one case I sent to acupunturist Dr Jean Fowler in Traveler's Rest, SC was a dachund with severe rear end weakness that quickly improved. My previous treatments and those of a chiropractor had failed. So who knows?
Referral to the Heavy Metal Drummers: (Expert Specialists)
As always, if the problem is severe, or the problem is not responding to treatment...or you simply want to get a second opinion or take advantage of the sophisticated equipment and advanced expert knowledge of a specialist...they're available. You may even want to consider referral to one of our country's veterinary colleges.
On This Page:
Introduction to Arthritis
What To Expect When You Go To The Vet including a discussion of treatment options
Arthritis in Cats...coming soon
A selection of pictures, jokes, ads, and comments for your enjoyment and enlightenment.
On Other Pages:
Arthritis: Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis.
Joint and connective tissue problems associated with the many forms of arthritis rank as the number one disability in animals.
Osteoarthritis or degenerative joint disease (DJD) attacks the joint linings as well as the underlying muscles and cartilage that surround the joint. Contributing factors of arthritis can be linked to:
1.
Stress wear and tear on joints
2.Injuries
3.Infections
4.Genetic factors
5.Pharmaceutical drug side effects
6.Nutritional deficiencies
7.Age related changes
8.Altered immune system
Arthritis is generally an inflammatory disease characterized by swelling, stiffness and/or pain in joints accompanied by major morphological changes in the joint structure. The exact cause and progression of many forms of arthritis are not well understood.
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