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Non-surgical Treatment of Arthritis
Veterinary & Aquatic Services Department, Drs. Foster & Smith
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Older dog

It is never easy to see a beloved pet and friend in pain. Medical treatment of degenerative joint disease (commonly called arthritis or osteoarthritis) has greatly improved in the last several years thanks to the introduction and approval of several new drugs and supplements. And while there is not yet a cure for this debilitating disease, there is much you can do to control the pain, make your pet comfortable, and perhaps slow down the progression of the symptoms.

Drs. Foster & Smith Adult Lite Dog FoodWeight Management: Helping a dog maintain his recommended weight may be the single most important thing owner scan do for their pets. Surgical procedures and medical therapies will be far more successful if the animal is not overweight. You, as the owner, have control over what your dog eats. If you feed a quality food in an amount appropriate for your dog's size, breed and activity level and keep treats to a minimum, your dog should be able to maintain an ideal weight. Considering that more than half of the pets in the U.S. are overweight, there is a fair chance that many of the dogs with arthritis are also overweight. If your dog is overweight, seek the advice of your veterinarian concerning a lower calorie dog food and an exercise program.

Exercise: Exercise is equally important in losing and/or maintaining the appropriate weight. Exercise that provides good range of motion and muscle building as well as limiting wear and tear on the joints is best. Leash walks, swimming, walking on treadmills, and slow jogging are excellent low-impact exercises. Bear in mind that an exercise program needs to be individualized for each dog based on the severity of the osteoarthritis, his weight, age, and physical condition. In general, too little exercise can be more detrimental than too much, however the wrong type of exercise can actually cause harm. While playing Frisbee can be very enjoyable and fun for the dog, it is extremely hard on his joints.

Remember, it is important to exercise daily; only exercising on weekends, for example, may cause more harm than good. Regular exercise in shorter sessions is always better than long work-outs on weekends. Warming the muscles prior to exercise and following exercise with a "warm-down" period are beneficial. Consult with your veterinarian regarding an exercise program appropriate for your dog.

Warmth and good sleeping areas: Most people with arthritis find that the symptoms tend to worsen in cold, damp weather. Keeping your pet warm, may help him be more comfortable. A pet sweater will help keep joints warmer. In addition, you may want to consider keeping the temperature in your home a little warmer.

Providing an orthopedic foam bed helps many dogs with arthritis. Beds with dome-shaped, orthopedic foam distribute weight evenly and reduce pressure on joints. They are also much easier for the pet to get out of. Place the bed in a warm spot away from drafts.

Massage and physical therapy: Your veterinarian or the veterinary staff can show you how to perform physical therapy and massage on your dog to help relax stiff muscles and promote a good range of motion in the joints. Remember, your dog is in pain, so start slowly and build trust. Begin by petting the area and work up to gently kneading the muscles around the joint with your fingertips using small, circular motions. Gradually work your way out to the surrounding muscles. Moist heat may also be beneficial.

Dog using rampMaking daily activities less painful: Going up and down stairs is often difficult for arthritic dogs; it can make going outside to urinate and defecate very difficult. Many people build or buy ramps, especially on stairs leading to their yard, to make it easier for their dogs to go outside. Ramps also make car travel easier for arthritic dogs.

Oral Supplements

Glucosamine and Chondroitin: Glucosamine and chondroitin are two compounds that have been widely used to help manage osteoarthritis in both animals and humans.

Glucosamine is the major sugar found in glycosaminoglycans and hyaluronate, which are important building blocks in the synthesis and maintenance of joint cartilage in the joint. Chondroitin enhances the synthesis of glycosaminoglycans and inhibits damaging enzymes within the joint.

When a dog has degenerative joint disease, the joint wears abnormally and the protective cartilage on the surface of the joint gets worn away and the resultant bone-to-bone contact creates pain. Glucosamine and chondroitin give the cartilage-forming cells (chondrocytes) the building blocks they need to synthesize new cartilage and to repair the existing damaged cartilage. These products are not painkillers; they work by actually healing the damage that has been done. These products generally take at least six weeks to begin to help heal the cartilage and most animals need to be maintained on these products the rest of their lives. These products are safe and show very few side effects. There are many different glucosamine/chondroitin products on the market, but they are not all created equal. Drs. Foster and Smith's line of Joint Care products or Cosequin are recommended.

Perna Mussels: Perna canaliculus, or green-lipped mussel, is an edible shellfish found off the shores of New Zealand. The soft tissue is separated from the shell, washed several times, frozen, and freeze-dried. It is then processed into a fine powder and added to joint care products. It is made up of 61% protein, 13% carbohydrates, 12% glycosaminoglycans (GAGs-an important component of connective tissue), 5% lipids, 5% minerals, and 4% water. It also contains glucosamine, a GAG precursor and one of the building blocks of cartilage. Glucosamine and GAGs are the compounds in the mussel believed to contribute to its beneficial effects.

Omega-3 Fatty Acids: Omega-3 fatty acids are often used for the management of the signs of atopy in dogs. Because of their anti-inflammatory properties, some have advocated their use in dogs with osteoarthritis.

Golden RetrieverAvocado/Soybean Unsaponifiables (ASUs): ASU's are an extract of avocados and soybeans. There is some very promising research that indicates that ASU's can help protect cartilage, support cartilage repair, and decrease the discomfort associated with osteoarthritis. ASU's are thought to enhance the action of glucosamine and chondroitin. ASU's are found in Doctors Foster and Smith Premium Joint Care 3.

Duralactin: Duralactin is a patented product obtained from the milk of grass-fed cows. It has been studied and marketed for the management of musculoskeletal disorders in dogs. This compound has anti-inflammatory properties and is available without a prescription.

It may be used as a primary supportive nutritional aid to help manage inflammation or in conjunction with non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids.

Methyl-sulfonyl-methane (MSM): MSM is a natural, sulfur-containing compound produced by kelp. Sulfur is necessary for the production of collagen, glucosamine, and chondroitin. MSM is reported to enhance the structural integrity of connective tissue, and help reduce scar tissue by altering components that contribute to scar formation. MSM has been promoted as having powerful anti-inflammatory and pain reducing properties, and is thought to work by blocking the pain perception in certain nerve fibers before the pain impulse reaches the brain.

S-Adenosyl-L-methionine (SAMe, Denosyl SD4): A recent product, Denosyl SD4, has been advocated for the management of osteoarthritis in people. The efficacy of this product for the management of osteoarthritis in animals has not been fully determined; however it is being used as a treatment for liver disease in dogs and cats. It has both anti-inflammatory and pain relieving properties.

Injectable Disease-Modifying Osteoarthritis Agents:

Polysulfated Glycosaminoglycan (Adequan): Adequan is a product that is administered as an intramuscular injection. A series of shots are given over four weeks and very often this product produces favorable results. This product helps prevent the breakdown of cartilage and may help with the synthesis of new cartilage. The complete mechanism of action of this product is not completely understood, but appears to work on several different areas in cartilage protection and synthesis. The cost and the inconvenience of twice weekly injections are a deterrent to some owners, especially with the ease of giving oral glucosamine products.

Hyaluronic Acid (Legend): Hyaluronic acid is an important component of joint fluid. Including it in the management of osteoarthritis may protect the joint by increasing the viscosity of the joint fluid, reducing inflammation and scavenging free radicals. Most of the research on hyaluronic acid has been done in people and horses, but it may also be beneficial in dogs. Because this product is injected directly into the joint and it is not labeled for dogs its use must be under the direct supervision of a veterinarian.

Anti-inflammatory Drugs:

Never give human NSAID's to your pet without consulting your veterinarian.

Carprofen (Rimadyl), etodolac (EtoGesic), deracoxib (Deramaxx), firocoxib (Previcox), tepoxalin (Zubrin) meloxicam (Metacam): These are non-steroidal anti-inflammatory drugs (NSAIDs) developed for use in dogs with osteoarthritis. They are very effective painkillers that also reduce inflammation. They are prescription products and because of potential side effects, careful adherence to dosing quantity and frequency must be followed. The manufacturers recommend that patients taking these medications have a thorough physical examination along with appropriate blood-work (especially tests for liver health) performed before starting these medications. In addition, patients taking these products should be periodically monitored to make sure that they are tolerating the medication. These products are often used initially with glucosamine therapy and then as the glucosamine product begins to work, the NSAID dose may be reduced or even eliminated. NSAID's (including aspirin) should never be combined unless directed by your veterinarian. Acetaminophen (Tylenol), and ibuprofen (Advil) have many potential side effects and are not recommended without veterinary guidance.

Buffered Aspirin: Buffered aspirin is also an anti-inflammatory and painkiller used in dogs. It can be used along with glucosamine/chondroitin products. With all aspirin products used in dogs, there is a risk of intestinal upset or in rare cases, gastric ulceration. Using buffered aspirin formulated for dogs makes dosage and administration much easier. Do NOT give your cat aspirin unless prescribed by your veterinarian.

Corticosteroids: Corticosteroids have been used for many years to treat the pain and inflammation associated with osteoarthritis, however, their use is controversial. Corticosteroids act as a potent anti-inflammatory, but unfortunately, they have many undesirable short and long-term side effects. Because of these side effects and the advent of newer, more specific drugs, corticosteroids are generally only used in older animals with flare-ups where all other pain control products have failed. Corticosteroids are a prescription product and come in both a pill and injectable form.

Surgery

Some forms of degenerative joint disease can be treated with surgery. For example, hip replacements in dogs with hip dysplasia are becoming more common. Other procedures can also be performed, but their success rests upon how many bony changes have occurred in and around the joint. Please see the article on the specific joint disease for extended discussion on the surgical treatment options for that disease.

Summary

Each dog with arthritis will need to have a management program specifically designed for his needs. What helps one dog with arthritis may not help another. Work with your veterinarian and watch your dog carefully so that between you, your dog, and your veterinarian you can determine what is best for your dog. Realize, too, the program may need to be changed as your pet ages, or if symptoms improve.

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