Advances in Arthritis Care
What Is Arthritis?
Arthritis is inflammation of the joints. This means the soft tissues that make up the joint are thickened and often painful. This causes symptoms in dogs such as being less active, stiffness especially after rest, difficulty jumping up and reluctance to exercise.
The common form of arthritis in dogs is osteoarthritis, also called degenerative joint disease. Over time,the condition worsens as smooth articular cartilage is lost, joint fluid becomes less lubricating, the underlying bone remodels and muscles become shrunken.
Common causes of arthritis in dogs include age-related wear and tear, joint injuries and developmental disorders such as hip or elbow dysplasia. All of these are worsened by excessive weight.
Treatment Of Canine Arthritis
The last 20 years have seen great leaps in our ability to manage the pain and disability brought to dogs and cats with arthritis. As they live longer they need us to do better and better.
What is surprising is that our patients have effective and safe options that aren’t available to humans. What is frustrating is the large number of other products making unproven and often false claims. So here are the evidence-based ways you and we together can manage arthritis.
Pentosan polysulphate (Cartrophen)
It was a discussion with a client about pentosan which started this article. When it’s used in the right dog (it’s not registered for cats), it never ceases to amaze (especially when you know where it’s derived from). It’s a sulphated pentose sugar extracted from the bark of the European Beech (pictured), purified and injected subcutaneously. When it came on to the market 20 years ago, many vets including myself were sceptical. The clear improvements in our patients and the accumulated scientific evidence (examples are at the end) have reached a point where most vets now reach for this drug first.
It works by increasing the concentration of hyaluronic acid in joints, which contributes to the lubricating effect of joint fluid and the thickness and flexibility of the cartilage. It also has direct anti inflammatory and anti thrombotic effects. The result is reduced inflammation, pain and wear on the joints, giving the visible improvement in comfort and use.
In people as in dogs its safety profile is excellent, it has proven efficacy and is cost effective to use. So we are always asked “why isn’t it widely available for humans?” It seems to work just as well, but causes a large bruise at the injection site.
Gunnie is pictured 10 days after surgery to repair an cranial (or anterior) cruciate ligament rupture. She’s currently having a course of Cartrophen injections for its proven benefits in recovery from joint surgery.
Fish Oil Omega 3 Fatty Acids
There is evidence of improvement in dog and cat arthritis with the simple addition of fish oil to the diet. The problem with omega 3 fatty acid supplementation is that the effects are small and hard to measure. This is partly because the large amounts of omega 6 fatty acids in the diet out-compete the omega 3.
We can make omega 3 an effective remedy as long as we can get the ratio of dietary 3 to 6 close to 1:1. To do this requires a diet that has had the omega 6 fatty acids removed. This is where dogs and cats are the perfect candidates; after all, they happily eat balanced formulated diets every day.
This food exists for dogs and cats, and is called Hill’s Prescription Diet j/d
It is the only diet making an arthritis claim to have proven its effect in a randomised double-blinded clinical trial. These dogs showed improvement in symptoms and reduced progression of arthritis. It works by reducing inflammation-mediated damage to the joint surfaces and fluid. We love it, and so do dogs. For cats, like all new diets, we need to introduce it slowly so they accept it.
Green-lipped mussel (GLM) extract
There is consistent evidence for the addition of green lipped mussel extract to the diet of dogs. We stock a GLM extract which does not contain shark cartilage. GLM extract be added economically to other strategies for improved control of arthritis but only has mild effects on its own.
There is some evidence of a mild positive effect of glucosamine on arthritic dogs. This fits with our experience of glucosamine & chondroitin as being helpful, but not particularly effective, additional treatments. Certainly not something to rely on alone.
Other Natural Arthritis Remedies?
There are many products and treatments claiming to help arthritis, and some of them may also be helpful. However, we are not aware of any other evidence-based ways to treat arthritis.
The greatest veterinary advance of the last 20 years has to be in pain control. I can remember the early nineties when there was no safe or effective remedy. We used to consider hip dysplasia a disease which caused premature death simply because these dogs could not go on. Dogs are living longer and living better.
Also cats get arthritis but the problem in the past was that no one was recognising that they were in pain. See Myth 1: My pet will cry if they are in pain People would say cats don’t have a problem because they didn’t limp or cry. We now know cats are more likely to have significant arthritis than dogs of the same age. They just stop moving or jumping so much.
Nowadays we always ask owners of old cats about their mobility. The results of treatment can be amazing.
If you haven’t seen it, please read our article Myth 8: My dog knows when to stop. Using examples, it will help you understand why dogs need us to be their fitness coach. High impact running and jumping just make these guys worse.
If you can keep a dog with arthritis walking only, their pain is much easier to control.
I think it goes without saying that the less weight on a painful joint, the less pain and wear. Unfortunately many people have a lot of trouble with this ‘tough love’ approach. If you need help, read Myth 6: My pet needs treats
There are a lot of ways to help dogs move. We’re not very happy about carts for dogs with arthritis, but other items such as foot scuffing protectors, ramps, plastic grip mats for smooth floors and harnesses can really help.
That’s all the treatments we recommend. If you’ve heard of other products and want advice, please get in touch and we’ll be happy to give an opinion or look it up.
Further reading on Cartrophen.
One of the earliest papers is R. A. Read 1996 Systemic use of pentosan polysulphate in the treatment of osteoarthritis. This study trialled various Cartrophen doses and established the dose we have since used as being the most effective.
Smith et al in 2002 published A multicentre clinical study of the efficacy of sodium pentosan polysulfate and carprofen in canine osteoarthritis (osteoarthrosis), using a sample of 104 dogs with naturally occurring arthritis. Using Cartrophen, they showed significant improvement compared with untreated controls.
39 dogs were studied in Budsberg et al 2007 Evaluation of Pentosan Polysulfate Sodium in the Postoperative Recovery from Cranial Cruciate Injury in Dogs: A Randomized, Placebo-Controlled Clinical Trial. This study showed better use of the operated leg and lower levels of biomarkers of tissue damage in Cartrophen-treated compared with placebo-treated dogs.
There has been a few tantlising human studies: Ghosh et al 2005 Effects of pentosan polysulfate in osteoarthritis of the knee: A randomized, double-blind, placebo-controlled pilot study. In this pilot study of 114 people, 4 weekly injections of Cartrophen (at the same dose as dogs!) were associated with significantly reduced joint stiffness and pain at rest compared with controls for 20 weeks after the cessation of treatment, and significantly improved pain on walking and overall function for 8 weeks.
There are also several studies like: Kumagai et al (2010) Sodium pentosan polysulfate resulted in cartilage improvement in knee osteoarthritis – An open clinical trial.