Joint Efforts - Treatment options for canine osteoarthritis

Treatment options for canine osteoarthritis abound, from homeopathy, supplements and exercise right through to drugs and stem cell therapy. But what do they all do? Lucy Jones asked the experts.

As your dog ages it is inevitable that it will lose some of the spring in its step. It will find it harder to jump into the car, take more time to come down the stairs and have a tough time standing up on cold winter mornings. While it is easy to think of these changes as part of the natural ageing process, they may actually be evidence of an underlying medical problem.

Osteoarthritis (OA) is a degenerative joint disease characterised by chronic breakdown of cartilage in the joints. Although is is common in older dogs, Dr Helen Nicholson from Sydney’s Animal Physiotherapy Services points out that it also affects younger dogs.

“Some of these younger dogs have developed arthritis as a result of injuries, such as cruciate ligament ruptures,” Dr Nicholson says, “while others may have worn away their joints too soon due to obesity or because they have hip or elbow dysplasia.”

Without cartilage acting as a cushion, bones rub directly against each other, causing inflammation and pain. The naturally lubricating synovial fluid found in the joints thins and, as the joints swell, movement becomes restricted.

OA is a progressive disease, meaning it will continue to get worse over time. There are a number of treatments available to slow the progression of the disease and make your dog more comfortable.

Stem cell therapy

An emerging therapy for the treatment of dogs with OA uses stem cell technologies.

Mesenchymal stem cells are cells that have yet to form any kind of tissue. “They are dormant building blocks throughout our body,” explains Dr Quentin Brown from North Nowra Veterinary Hospital. High concentrations of these cells are found in fat, which is actually a specialised form of connective tissue.

 “If these stem cells are extracted and activated they can then be incorporated into tissue to help rebuild,” said Dr Brown. Stem cells are harvested from the animal’s own fatty tissue to accelerate healing time of muscles and damaged joints.

The treatment generally involves a general anaesthetic. While the dog is under anaesthetic, the fat cells are removed from the stomach and x-rays are taken. The cells are prepared and then injected into the damaged joints. Each joint requires only one injection and the procedure is generally completed in one day.

Dr Brown believes that stem cell therapy can rejuvenate the quality of life for dogs suffering from arthritis, lameness, pain and a restricted range of motion. The treatment costs approximately $1950, though this can vary, and not all dogs with OA are suitable candidates for stem cell treatment so individual assessment is necessary.

Medical management

Two types of drugs are commonly used in the treatment of OA – non-steroidal anti-inflammatories (NSAIDs) and chondroprotective drugs.

During the first weeks of treatment with chondroprotective drugs, Dr Grant Poolman from Bowral Veterinary Hospital often uses NSAIDs as well to manage pain and inflammation, but he prefers not to use them long term.

“We need to be able to see if the dog has improved and that we’re not just masking the pain,” he explains. NSAIDs must also be used with care as overuse of these drugs can cause vomiting, stomach ulcers and liver and kidney damage.

Chondroprotective agents work to inhibit the breakdown of cartilage, stimulate cartilage repair, encourage the production of natural lubricants (synovial fluid), improve circulation and normalise immune response.

Dr Poolman recommends chondroprotective injections, such as Pentosan or Cartrophen Vet, for the long term treatment of elderly dogs suffering from OA, but says they are generally not as effective for younger dogs suffering injury-related OA.

“The dogs receive one injection a week for four weeks,” says Dr Poolman. “I would expect to see some improvement by the third injection and a significant improvement by the fourth.”

If the dog responds well to treatment, it can receive ongoing monthly injections to manage its condition and prevent pain returning, says Dr Poolman. “We used to give one course of injections and then wait a few months to give another course. Now we focus on preventative treatment, rather than waiting for the dog to be in pain again.”

Nutraceuticals

If you are wary of treating your dog with drugs, there are many natural arthritis treatments available. Glycosaminoglycans, such as glucosamine and chondroitin, are key nutrients that make up cartilage and can be found in many supplements used to treat OA.

They can assist in the natural repair and regeneration of your dog’s cartilage. Natural marine concentrates, such as green-lipped mussel, abalone and marine cartilage, are also used in joint products as they can contain a larger range of glycosaminoglycans and have a slower rate of absorption.

Dr Poolman recommends the use of supplements that contain several of these ingredients, including glucosamine, chondroitin and biomarine extracts, to achieve the best results.

Many supplements also contain other natural ingredients, such as Manganese, Vitamin C and Zinc to assist in cartilage production. “Omega 3 and 6 fatty acids are thought to be useful in the control of some inflammatory mediators so may help paid, inflammation and degeneration,” says Dr Brown.

These are found in high concentrations in fish-based products and fish oils. Supplements are easy to administer, coming in tablet form, in a powder that can be sprinkled on food or as treats. Some specially formulated dog foods contain glycosaminoglycans and offer an easy way to incorporate the supplements into your dog’s diet.

“The supplements are useful if your dog’s condition is worsening and they need something extra,” Dr Poolman said. Keep in mind that natural supplements will not have the same immediate effect on your dog as drugs, and four to six weeks of treatment at a high dosage may be needed before you see results.

Natural treatments

Dr Manuela Trueby from Balmain Village Vet offers a range of natural treatments for OA, including homeopathy and acupuncture. “There’s no standard remedy and we don’t use the same thing for every dog. We assess each dog’s condition and devise an individual treatment,” she says.

Homeopathic remedies can be used for joint mobility, hips and old trauma sites, according to Dr Trueby, who also prescribes combination homeopathic remedies in tablet form. Products containing shark or bovine cartilage are also used as they can work to constrict blood vessels and reduce inflammation.

Acupuncture may also help dogs with injuries and OA. “It is particularly successful on old traumas,” says Dr Trueby. Dr Trueby recommends treating dogs as soon as symptoms begin to appear to achieve a quicker and more complete recovery.

Natural and homeopathic remedies can be used in conjunction with more traditional treatments, like Cartrophen and glycosaminoglycans, so let your vet know if your dog is being treated with natural remedies – they will be able to tailor a treatment plan.

Exercise

Whether exercise is used in conjunction with the treatments above or on its own, it may help to keep your dog moving. Marian Murray from Fit Fur Life recommends simple exercises like sit to stand, walking in large figure eights or gentle balance exercises to keep the joints loose. “These are simple homework exercises that owners can do without equipment to improve their dog’s health,” says Marian.

Dog treadmills can also be used, and Marian points out that they offer controlled speed and variable incline. “Treadmills provide a consistent pace for the walk, without the stop-start or uneven ground of a walk outside,” she says. “The incline feature allows your dog to build and condition specific muscles, especially in the rear.”

Canine hydrotherapy can also be used to loosen joints and condition muscles. Dogs can walk on underwater treadmills or perform exercises while the water and, sometimes, buoyancy jackets, support their weight. “Swimming is always good exercise for a dog as it is strenuous but low impact,” explains Marian. “But hydrotherapy allows you to control the temperature, viscosity and depth of the water to achieve better results.”

Marian stresses that to ensure the success of these professional treatments, owners must continue to exercise their dogs at home. “Owners have to follow through after treatment. There is no point seeing the hydrotherapist or physiotherapist twice and thinking that your dog will be cured.”

Physiotherapy

Weight loss, joint mobility, muscle strengthening – physiotherapy could do it all. But it’s not just about what the therapist does, says Dr Helen Nicholson; owners must continue the treatment at home.

Regardless of the cause, osteoarthritis (OA) can improve with a multi-faceted treatment approach. Qualified physiotherapists aim to reduce pain, maximise comfortable flexibility, promote repair of damaged tissue where possible, and improve balance, coordination and strength to maximise quality of life.

Weight and joints

Research shows that small reductions in weight significantly improve arthritic lameness, but it’s hard to lose weight when it hurts to move! Animal physios help reduce weight through controlled exercise programs that address the physical restrictions of the individual dog.

 A typical cardiovascular program may be inadequate if the dog also requires its joint-supporting muscles to be strengthened and its affected joints gently mobilised to increase its ability to comfortably exercise.

Correctly done, weight-bearing exercise also helps stimulate cartilage and joint nutrition. Many physiotherapy exercises therefore aim to improve the delivery of glucosamine and chondroitin, while protecting the joint from overload.

Strengthening muscles

Physiotherapists design exercises to increase the strength of the muscles that support the joints, improving the balance between these and the muscles that move the joints, which helps to reduce pain and improve function.

Specific exercises to improve balance and coordination also help the dog learn when and how much to contract its muscles when moving to protect its joints from injury.

Although these exercises are quite technical, they can be easily taught by luring and rewarding the dog, similarly to how we teach puppies to 'sit' or adult dogs more advanced obedience or agility skills.

Other tools in the physio’s box

The appropriate use of warmth or cold can also be very beneficial to arthritic patients, as can special machines such as muscle stimulators, which can be safely employed by physiotherapists to relieve pain or improve muscle strength.

Massage can be very beneficial to arthritis patients, but it must be done gently and to the right body parts. Properly done, it can relieve pain, improve circulation and prevent the feeling of 'muscles you never knew you had' after activity.

Additionally, physiotherapists are well trained in movement analysis and in suggesting alternate ways of performing tasks to reduce pain and strain for owner and pet alike. Special splints or harnesses can be supplied to make movement more comfortable.

Do your homework

It is vital that the exercises are performed correctly and frequently enough to have the desired effect, so physios will usually instruct their patients regarding extra exercise sessions that can be done at home.

Depending on the severity of the arthritis, between one and three batches of physiotherapy ‘homework’ may be needed each day for the initial six to eight weeks as, although physio can’t cure arthritis, it can certainly improve comfort and quality of life when done correctly.

Long term, once or twice a week is usually all that is required to maintain the improvements made by physiotherapy. Usually, the dogs have their owners so well trained by that point that's it's easy to include, for example, some balance exercises for food rewards at dinner time, or a massage as you relax together on the couch before bedtime.

A referral from a vet is essential before consulting an animal physiotherapist. This maximises the dog's safety and the effectiveness of treatment as, by working together as a team, your physio and vet can best integrate their complementary treatments of osteoarthritis.

Dr Helen Nicholson

Dr Helen Nicholson is an Australian Physiotherapy Association-registered Animal Physiotherapist and the first physiotherapist in the world to achieve a PhD in small animal physiotherapy.

Dr Nicholson has written textbooks on canine osteoarthritis and teaches the subject to physiotherapists and veterinarians internationally. Together with Emma Cordell, Dr Nicholson runs the Animal Physiotherapy Services practice in the Sydney region. W: www.k9physio.com.