There is no animal treatment that provokes more debate than arthritis medication. The sheer number of treatments on offer is bewildering. Why??
- Arthritis is common: it’s a big market with a lot of competition from different products
- It’s hard to tell when treatment helps: real improvements is often hard to distinguish from the placebo effect
- There’s no silver bullet: despite some good options, owners of badly affected dogs know that we still can’t do enough to help them
Your dog isn’t going to complain if you get it wrong. If you have an arthritic dog, you need to know what works. Here I’ll try to show you what the evidence for arthritis treatments tells us.
Dog Arthritis Treatments
I’ll do my best to be as open-minded as I can but I’m also going to be blunt about where the evidence doesn’t sit. Using an ineffective treatment is not just useless, it gets in the way of using something else that might actually work.
Fish Oil Arthritis Diets
Fish oil is the most evidence-based dietary supplement for canine arthritis, However, when given on its own it can be disappointing. It is most effective when integrated into a diet.
Most arthritis diets just add fish oil, glucosamine, plus some other ingredients, and hope for the best. Personally, I don’t think any of these work very well and the evidence is generally lacking.
The diet with the best experimental and clinical evidence is Hills j/d®. The diet has omega-3 fatty acids added and the competing omega-6 fatty acids reduced giving an over 30-fold increase in the omega 3 to omega 6 ratio. This allows the food to exert a greater effect in reducing joint inflammation.
The effects are significant and repeatable especially in mild to moderate arthritis. Even in severe cases, it can help in combination with other treatments. The only time I don’t recommend j/d is in dogs sensitive to changing their food or those prone to pancreatitis.
Glucosamine & Chondroitin
Most vets believe that there is insufficient evidence to support the use of glucosamine or chondroitin supplements in dogs. The evidence that exists is of low quality and prone to bias. In particular, any improvement in a study without a placebo group needs to treated very suspiciously. You can read a recent review here.
It is noteworthy that in human medicine, crystalline glucosamine sulfate has superior bioavailability and efficacy compared with the commonly used veterinary form, glucosamine HCl. Any effect, if it exists, will take up to 2 months to appear after starting treatment.
Other Supplements & Home Remedies
Heres a list of the supplements we see being used in dogs. Only one of these has enough evidence to recommend it. Can you guess which one?
- Green lipped mussel extract
- MSM (methylsulfonylmethane)
- Turmeric (curcumin)
- Undenatured collagen
- Avocado & soya unsaponifiables
- Rosehip oil
- Cannabis oil
The answer is green-lipped mussel or GLM. The evidence is only low-grade but it fits with our clinical experience.
Many dog owners will remember Sasha’s Blend. Nowadays most Australian vets have moved on to two other purified products, Antinol and 4Cyte, which have better clinical trials and efficacy in our experience. There are also many over-the-counter GLM supplements. All are given as a daily tablet or capsule.
Dog Arthritis Injections
Cartrophen-Vet, Zydax, Synovan, and Arthropen are all brands of pentosan polysulfate sodium. It produces excellent results in mild to moderate arthritis and is almost completely free of side effects. There is virtually no arthritic dog that cannot be given Cartrophen safely.
Cartrophen is part of our first line treatment when a diagnosis is made. A course of four injections is given at weekly intervals, and then repeated six months later. Its use can often delay the need for other treatments for many years.
The cost of each Cartrophen injection is not excessive- see current prices here.
In the USA, many vets use and recommend Adequan® Canine (polysulfated glycosaminoglycan). It is not available in Australia and I have no information on its efficacy compared with pentosan.
There are no other recommended arthritis injections. In the past, long-acting cortisone was also used. This is outdated and rarely a good idea due to poor results and significant side effects.
Dog Anti Inflammatory Drugs
Non-steroidal anti-inflammatory drugs (NSAIDs) have the highest level of evidence for controlling the signs of arthritis. The biggest mistake I see is dog owners worrying so much about medication side effects that they won’t use them. Once your dog needs pain relief, these drugs are lifesavers and nearly always very safe.
The picture is from a pain management lecture I attended in the UK. It shows the relative importance of different drugs in controlling pain. It’s a welfare issue.
There are plenty of dog NSAIDs to choose from with different side effect risks, efficacy, and costs. They include carprofen, meloxicam, firocoxib, mavacoxib, etodolac, and robenacoxib. We use four of these based on our experience and owner preferences. In other countries, there are also grapiprant and deracoxib.
When side effects occur they are mainly vomiting and diarrhoea due to gastrointestinal ulcers. If this happens, a pause or change in medication is required. Liver or kidney damage can occur but should be rare if blood testing is performed before, and then again shortly after starting.
Prednisolone and other cortisone drugs are also anti-inflammatory but should definitely be avoided unless there’s no alternative. They do not work well and cause serious side effects at the doses that are needed.
Other Pain Relief Drugs
Tramadol, amantadine, and gabapentin can be used as second-line pain treatments. None of them is likely to work as well as an anti-inflammatory but they often work well in combination with one.
Our favourite second-line drug is gabapentin. If used carefully, the only side effects are mild sedation when given at higher doses.
Over The Counter Pain Relief
If you visit our page on over the counter and pharmacy dog medicines you’ll see I discuss human drugs for dogs. You’ll also see how dangerous nearly all of these are to dogs.
The only exception is paracetamol (acetaminophen in the US). On its own, it’s fairly useless but is sometimes added to existing pain protocols to improve the response. However, even in this case, there’s usually a better option elsewhere.
Dog Stem Cells
Tricky one. There’s a lot of confusion about stem cells. What they don’t do is regenerate anything in arthritic joints. Instead they are thought to act by releasing chemical signals that shut down inflammation. In other words, as living anti-inflammatories.
There is some evidence that fat-derived mesenchymal stem cells can relieve the signs of canine arthritis. Based on this, we administered stem cell therapy to dogs between 2012 and 2015, with some success.
Why did we stop? Despite the glowing reports, the majority of our patients showed minimal improvement. We feel that until there is more clinical evidence, the cost and effort are better spent elsewhere.
Lastly, we should never overlook other ways of treating arthritis. First among these is weight loss. I have seen dogs who were still in pain on maximum doses of everything then come off all treatments after successfully losing weight. That’s why I’m a bit too much of a nag about it.
The same goes for moderating the exercise. Still throwing the tennis ball may be what your old Kelpie wants, but they are likely to suffer for it over the rest of the day. Far better to go for long, steady, low-impact walks than too much running or jumping on bad joints. Dogs need you to tell them when to stop.
There is only limited evidence for cold laser treatment, physical therapy, acupuncture, chiropractic or other alternative remedies. All I will say is this: if it’s working, keep doing it.
By ‘working’ I don’t mean, “he’s looking much more energetic”. I mean being able to show that your dog can definitely do something specific after treatment that they couldn’t do before. Having a good working definition of success like that should minimise any caregiver placebo bias.
This page on the caregiver placebo effect is my attempt to explain the confusion we all face. Thanks for reading this most important topic. If you want to dive deeper, visit our page on the causes and symptoms of arthritis.
Cannabis Oil (CBD, cannibidiol) For Dogs
And finally a note on this controversy. There is very limited evidence of efficacy. A study of 16 dogs found improvements in pain scores for dogs taking oil at 2mg/kg. There was no observed improvement in lameness scores.
Given the very mixed results from human trials and the small size of this trial, we need more evidence to recommend cannabis oil. Access is also very difficult in Australia. I would appreciate comments below from anyone who has found a reliable supply for dogs.
Have something to add? Comments are welcome below and will appear within 24 hours of lodging.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. These help topics are from a series regularly posted on email and Twitter. Subscribe via email here to never miss a story! The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.