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 for genetic reasons. Auto-immune diseases are another possible cause of this common disease. Infection can also cause joint disease... and so can infectious agents transferred by tick bites. Certain medications including aspirin and steroids which help with inflammation, which is good, can also be chondro destructive (damaging to cartilage), which is bad.
Genetics play a really big role. Because of genetics, none of us are perfect in every detail, and if or genetic reasons the hip sockets ... or any other joint... are perfectly formed, there's going to be friction, abrasion, uneven stress, and with time significant lameness.
Whatever the cause, and whatever the name (hip dysplasia for the hip, bursitis for the shoulder, stenosis of the lower back) arthritis 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.
Friction, rubbing, and abrasion causes inflammation of the joint and not only does this hurt, but as part of the inflammatory process, there's a release of tacky, sticky, secretions and toxins into the joint leading to further destruction, pain, and lack of mobility.
Here's something interesting. Excessive weight is a big factor in joint inflammation .... but NOT just because of the extra load the joints have to withstand in overweight pets (or people). It seems that adipose tissue (FAT) produces chemicals and hormones that are quite bio active in the body, and unfortunately are quite inflammatory and destructive to other tissues.
Here's something else that's interesting: The viscous fluid that nurishes and lubricates a healthy joint is also a favorite place for bacteria to grow and bacteria can be highly destructive of cartilage.
You might be surprised to know that the number one cause of bacterial entry into the blood is through gum disease. Gum inflammation allows bacteria in the mouth easy 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.
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. Blood Work: 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 may need to sedate your pet 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.
GlycoFlex, Cosequin, or Dasuquin: These high quality products contain top grades of glucosamine combined with MSM, chondrition, and various anti-oxidants and anti-inflammatories. Other vets favor other brands of glucosamine combinations. Glucosamine based products claim to help lubricate the joints, slow the progression of the disease, and even help repair damaged cartilage.
It's up to debate how beneficial these products actually are to your arthritic pet ... or for yourself, but in my experience, about 30-50% of pets show obvious improvement in mobility and comfort after a few weeks of taking glucosamine products... especially if you stick with high quality brands. (Nutrimax and VetriScience are well known for quality)
Rimadyl and other Cox 2 Inhibitors: Newer pain management medications are now available and are far superior and safer than older pain medications like aspirin, ibuprofen, and Tylenol. 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.
While cox 2 inhibitor medications are generally safe, they are not side effect free. Usually the problems we get with these medications are minor but sometimes the liver is adversely affected
Because of possible liver side effects, ideally we recommend a periodic screening test for liver disease with patients on long term courses of these meds.
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.
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 a good 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:
Durlactin: This is a new neutriceutical treatment for arthritis made from milk enzymes. It's super safe, much less expensive than the Cox 2 inhibiting medications, it safe to use in combination with all the other meds mentioned on this page, it reduces the need to use other pain meds, and I've become quite impressed with the results.
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.
Adequan ® Injections (POLYSULFATED GLYCOSAMINOGLYCAN) Sometimes combined w Vit B12
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.
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.
