Veterinary Acronym of the Month: OA - Osteoarthritis

Breaking down our recommendations for OA management in dogs and cats

What is OA?

Osteoarthritis, or commonly referred to as just "arthritis", is an inflammatory condition in the joints. Most often this inflammation leads to loss of cartilage, the protective layer on the surface of bones within joints. It also leads to break down of hyaluronic acid, which helps to cushion the joints. When this shock absorbing system is broken down, the bone beneath begins to remodel trying to compensate for the change in force within the joint. As such, we end up with an irregular joint surface and thickened joint capsule that can decrease the range of motion of joints and lead to pain.

What are clinical signs of OA?

Some of the most obvious signs of arthritis will include lameness or limping. As mentioned above, this condition is painful and makes it harder to get around. Some dogs may only show lameness after bursts of activity while others seem to be painful at all times.

There are less obvious signs of discomfort, however. Some pets will hesitate before climbing up and down stairs, or hop up them rather than take individual steps to climb. They may be slow to lay down or to stand back up. Pets may be slower going for walks or show less interest in play.

Many times, signs of arthritis may be misinterpreted as anxious behavior. These signs can include an inability to settle, panting, licking the joints (especially the ankles and knees). Dogs and cats may have difficulty grooming themselves if they have arthritis within the spine. Some dogs may have urinary or fecal accidents in the home because they struggle to posture appropriately due to discomfort, leading to holding it longer than they should and eventually eliminating when they can no longer hold it. Cats may urinate or defecate outside of the litterbox for similar reasons.

In addition to physical signs, pets may show behavioral changes as well. They may seem like they're sleeping more often or lethargic. They may also show signs of aggression or seem to be grumpy if they're uncomfortable.

Most vets will agree that cats are much more subtle when it comes to showing signs of discomfort, especially with arthritis. Our friends at Zoetis developed a checklist you can access by following this link to evaluate for potential arthritis in your cat. They also have a canine checklist that you can read through here.

Who gets OA?

When we think of the typical arthritic patient, most of us picture elderly pets. While it is true that this is a common disease of senior pets, arthritis can start in patients as young as two. It can start even earlier if there is a history of previous injury or trauma. Certain procedures, such as declawing a cat (which is no longer legal in New York State) will lead to the development of arthritis over time. Some pets are born with conformation that makes them prone to arthritis development, such as hip dysplasia. And some pets are more likely to develop arthritis due to their lifestyle, such as pets who are obese.

In short, any pet is at risk of developing osteoarthritis.

What treatment options exist for OA?

Despite our current advances in medicine, we don't have a true treatment available for arthritis. That being said, we have a wide range of options available to manage the discomfort associated with arthritis. Here at RAVH, we have our approach, but it is important to remember that different veterinarians will all have their own way of managing disease processes and this is no exception. It is also important to remember that each pet is an individual and some treatments may not be appropriate depending on their case.

My first goal is to try and prevent arthritis development. Many things can't be helped, like unexpected trauma or congenital issues (though we strongly recommend not breeding animals with a history of congenital issues to reduce the number of pets effected by this!) but obesity is a very preventable disease. Monitoring your pets body condition is extremely important for preventing numerous disease processes, but orthopedic disease will always be negatively impacted by an over-conditioned animal (we're talking MORE than just fluffy!). This chart, courtesy of the American Animal Hospital Association, helps evaluate your pets body condition -

Healthy weight maintenance is all about calorie control - reducing excessive treats and trying to stick to a recommended caloric intake set by your veterinarian. Most pet foods will have a suggested amount to feed written on the bag that you can use as a general guideline and adjust based off of their body condition score. That being said, the recommendation on the bag is made with the assumption that your pet is not getting any treats or snacks, so be sure to consider everything that the consume.

Moderate exercise is an important component of arthritis prevention and management as well. Just like people, sudden increases in exercise without any conditioning can be traumatic to muscles and joints. It is important to practice regular low impact exercises such as gentle walks or swimming, to keep your pets moving and active.

There are many supplements out there to help support healthy joint function, but they're not all created equal. Like any nutraceutical, they do not require FDA approval or regulation, so supplements can make claims on their labels without extensive proof. I personally prefer Dasuquin Advanced (available for cats and dogs) because it is heavily researched, so we know what is in each chew and how it works. I recommend these be started fairly early in pets to help slow the development of OA. Another great option for joint supplements is Movoflex. I usually encourage owners to choose one, whichever they find that their pet prefers.

For dogs who are showing clinical signs, I typically reach for pain control and anti-inflammatories. For pain, I prefer gabapentin, a neuropathic pain medication. This medication is unlikely to cause changes to the liver or kidney with the major side effect being sedation. This medication has a wide safety margin, allowing us as veterinarians to increase doses as needed. Non-steroidal anti-inflammatories are fantastic for helping reduce inflammation which provides increased comfort, but they do have an increased side effect profile. They must be given on a full stomach as they are more prone to causing GI upset. While pets taking any medication long term should have routine lab work, NSAIDs typically require more as they have a chance of increasing liver and kidney values. With routine monitoring and proper administration, they are a safe and effective management tool. It is essential that these medications are only given as prescribed for your pet. Over the counter NSAIDs for humans are extremely toxic to cats and dogs, but there are veterinary products available. We have newer NSAIDs available now, such as Galliprant, which are more specific to arthritis inflammation and thus have fewer side effects, however routine monitoring is still recommended.

A product that was more recently introduced for cats has been making waves in the veterinary community. While I like using gabapentin for them, it usually has to be compounded due to its markedly bitter taste. There aren't many great options available as far as NSAIDs go for cats - they have a higher risk of renal damage with prolonged use. With this in mind, we were really excited to hear about Solensia from Zoetis. This medication is injected under the skin in cats once monthly by a veterinarian and essentially tells the body not to create the inflammatory mediators that contribute to discomfort in OA. The most common side effect seen has been injection site soreness and vomiting after injection, but this is typically short lived. Thus far, it does not appear that this medication has long term effects on the kidney or other organs, making it a very promising treatment option for cats. I have started using this in my own cats and have noticed a considerable increase in mobility and comfort from before. My clients have reported similar stories.

Zoetis will be bringing Librela to the United States later this year after successfully releasing it in the UK. This is the canine equivalent to Solensia and I hope to share more about that with you when it becomes available.

If you've had an appointment with me, you'll know that I typically have a multimodal approach to pain management. In other words, I think that medications are extremely helpful, but feel that non-traditional medicine can also increase comfort when everything is used together. Examples of this include massage, laser therapy, and chiropractic work. Massage can be demonstrated in the office for owners to complete at home, along with range of motion exercises where appropriate. Laser therapy is a treatment using, you guessed it, a laser, in order to stimulate blood flow and reduce inflammation. Side note: did you know laser is an acronym itself? It stands for light amplification of stimulated emission of radiation. But laser is easier to say and more fun. Laser therapy can be completed at home if owners purchase a machine recommended by their veterinarian (some vets will rent them out, too), but research shows it must be done every day to truly see an effect. As for chiropractic work, I always recommend owners only seek this care from a licensed professional - not all veterinarians have undergone training for this treatment. I personally refer my clients to a local specialist for this work.

Other things you can do to help your pet include providing traction on slippery surfaces to help provide stability and prevent falls. Reducing the number of steps they need to climb by providing ramp options can also be very beneficial. There are also harness options available that you can use to help support your pet to stand. A brand that I like is the Help ' Em Up Harness which you can read more about here.

Why do we care about OA?

OA is painful. Many owners fail to recognize the significance because animals don't show pain the same way that we might. I often hear owners say something along the lines of "well he doesn't cry out" or "he's not painful, he just limps". It's important to remember that animals often don't cry when in pain, especially chronic pain. If an animal is injured in the wild and cries out, it's just a more obvious target for predators. And despite cute videos on TikTok, animals don't know to limp for attention - limping means they're painful.

While aimed at veterinarians, this article goes into detail about chronic pain in animals and how it effects them. According to Dr. Mark E. Epstein who has dedicated his work to chronic pain, this type of discomfort can lead to cognitive dysfunction, progression of other comorbidities, and short lifespans. This disease is more than just discomfort - it's about keeping our best friends healthy long term.

Final Thoughts

Osteoarthritis is an inflammatory condition of joints that causes chronic pain in our pets. Pets are not always obvious about their discomfort, so we use checklists and guidelines to monitor their behavior and try to gauge their comfort levels. All animals are affected by this disease and they don't need to be old to develop it! And while we cannot treat this disease, we have management options available (and new ones on the way!) to help slow the progression and keep our pets comfortable so they can lead long healthy lives.

If you still have questions or are concerned that your pet may be developing signs of OA, schedule an appointment so we can talk about the most appropriate options for you and your furry friend.