Long Beach Animal Hospital

3816 E. Anaheim St.
Long Beach, CA 90804
(562) 434-9966
Fax (562) 597-4226

Long Beach Animal Hospital

We are open M-TH 7:30 AM to 9 PM
Friday 7:30 AM to 8 PM
Saturday 8 AM to 6 PM
Sunday 10 AM to 6 PM

Hospital Information
Meet Our Staff
What's New
New Clients and Their Pets
Medical Services
Boarding & Bathing
You Make the Diagnosis
Conservation Trips
Digital Photography
Wildlife Program

Please call for an appointment or click here to Contact Us

Arthritis

Introduction
anatomy
Cause
Symptoms
Diagnosis
Treatment

Click Here to Learn How a Frustrated Veterinary Doctor Reveals Simple Secrets
To Safeguard Your Pet's Health, Slash Vet Bills, And Even Save Your Pet's Life!

Join Our Newsletter Today to Receive Great Tips on Keeping Your Pet Healthy!

E-mail Address:

Name:

Introduction

Dogs are prone to many different types of bone problems. This page will focus on the arthritis that tends to occur in dogs, especially as they age (Geriatric). Arthritis literally means inflammation of the joint, but the term is used more generally to describe several different processes. These include degenerative joint disease (DJD), infectious joint disease, immune mediated joint disease, and crystal-induced joint diseases. Many people use the term arthritis synonymously with osteoarthritis (OA), a complex, slowly progressive, and degenerative arthritis that is characterized by the gradual development of joint pain, stiffness, and a decreased range of motion.

OA, the most common form of joint disease in dogs, is relatively uncommon in cats. It can be seen in dogs of all ages, but is more commonly associated with older pets. OA is becoming more prevalent as the longevity of our pets increases.

As we learn more about the subtleties of feline medicine we realize that many cats get significant problems in their lower back. This problem, also know as feline hypersethesia syndrome, causes tremendous discomfort and decreases the quality of life from many cats.

Please read our discussion of VOM at the end of this page. It has made a significant change in how we treat pets with arthritis. This is especially true for cats with feline hyperesthesia syndrome.


Anatomy

Anormal joint is lined with hyaline cartilage, which is the covering over the end of the bone. It provides an almost frictionless surface for the bones to articulate, and also acts as a shock absorber. Hyaline cartilage is comprised of chondrocytes, proteoglycans, and collegan.

A normal joint is encased in a fibrous structure called the joint capsule. The joint capsule helps stabilize the joint and keeps the cartilage bathed in synovial fluid. Ligaments, which attach bone to bone, also provide joint stability.

This is what cartilage looks like in the knee joint. It is glistening because it is very smooth and has a lubricating layer over it called synovial fluid.


This picture is from an actual surgery on the knee of a dog with a ruptured anterior cruciate ligament. The ridge of bone running vertically at the left is arthritis. Compated its roughened surface to the picture above.


Cause

The cause of this complex and multi factorial disease can be primary or secondary. Primary OA results from normal stresses acting on abnormal cartilage. Secondary OA is more common, and results from abnormal stresses acting on normal cartilage, such as an unstable joint caused by canine hip dysplasia , fragmented coronoid process, ununited anconela process, patellar luxation, or a ruptured cruciate ligament. Some of the factors that can cause OA include over- exercising, obesity, poor nutrition, trauma, immune reactions, and genetic predispositions.

The radiograph on the left is from a normal shoulder joint. The one on the right has an abnormal flap of cartilage at the arrow. This is know as osteochondritis dissecans, and is a primary OA.


Damage to cartilage might occur as one event, or be the culmination of many small events over years. As swelling occurs and the joint capusle becomes stretched pain occurs. Your pet will use the joint less because of this pain, leading to muscle atrophy and the inablity of the surrounding tendons and msucles to support the joint. As the muscular support of the joint weakens the joint capsule, ligaments, and cartilage become further stressed and stretched, leading to even further pain. At this point the body releases chemicals called inflammatory mediators, which further damage the cartilage and add to even more swelling. It is obvious that this rapidly becomes a vicious cycle leading to debilitating pain.

When OA progresses to the point that you notice your pet in discomfort or pain the damage to the joint might be irreversible.


Symptoms

Symptoms are related to joint pain and stiffness. Most owners notice a pet losing its ability to perform normally, such as a reluctance to jump or climb stairs, or even limping. Stiffness after rest that diminishes rapidly is a hallmark sign of OA. Dogs that will not go on extended walks or pant excessively during a walk could also indicate OA. Symptoms can be worsened by obesity, too much exercise, and by cold or damp conditions.

It is important to understand the intial symptoms might be subtle. Your pet will be experiencing pain or discomfort, yet it might not show any external signs.


Diagnosis

Signalment

OA is commonly diagnosed in older dogs and cats. Some breeds are prone to getting it because of the conformation of their joints.

Dogs like Dachshunds have abnormally shaped long bones that might predispose them to OA.


History

Most dogs show a reluctance to run or move about. Some will be reluctant to go up or down stairs, or might even be limping. As the disease progresses these dogs might be in overt pain and lose their appetite. Some of these symptoms occur in other diseases, notably hip dysplasia and intervertebral disk disease. The are treated in different ways in many cases, so a proper diagnosis is imperative.

Physical Exam

In many cases there are no abnormalities detected during a physical exam.Pain or discomfort might be found by palpating a joint or pushing on the spinal cord. Dogs with longer standing OA might show atrophy of muscles.

Diagnostic Tests

Radiography is an important diagnostic test to perform on a dog or cat suspected of having OA. Even though a radiograph can be normal in a pet that has OA, it is a substantial help in verifying the diagnosis and determining the degree of involvement. There are many diseases that can mimic the symptoms of OA, so a radiograph should be taken on every suspected OA cause to eliminate these other causes.

This is a normal knee joint radiographically.


This one has arthritis. The arrows point to all of the rough edges that are indicative of OA. Compare these rough edges to the smooth edges on the radiograph above. Also, the bone has a stronger whitish appearance, another indication of OA.


This dog was originally suspected of having arthritis based on a history of soreness in the hip area. Radiographs revealed a different story, as can be seen at the arrow at the far left of the radiograph. The white circular area in the bone has the potential to be many things, some of them serious, so a biopsy is need to know for sure.


A close-up view gives you a better idea of this dog's problem.


This form of OA is called spondylosis, which is arthritis of the vertebrae in the spine.

You can learn more about the bones of the spine by going to our intervertebral disk page.


This dog was sore around its rear quarters when petted by the owner. This could easily be arthritis, but as you probably already figured out, something else was amiss.

Did you figure out what is going on? Those circular white objects towards the top right of the radiograph are 3 pennies in the rectum! At least its a safe place to store your money.


A very important differential when diagnosis OA on a radiograph is a bone tumor. This one is on the femur (thigh bone).


The other important differential on radiograph is a bone infection, called osteomyelitis. The fuzzy or roughened edges at the arrows is the infection.


Treatment

Treatment of OA initially includes correction of any underlying primary diseases such as surgical correction of a torn ligament or arthroscopy to remove a cartilage flap. Once any primary disease has been addressed, the goal of treatment is to slow the progression of OA and to keep your pet comfortable. It's important to realize that there is no cure for OA.

Most pets with OA will require some adjustment in their lifestyle. Weight management is most important, since obese pets put unnecessary strain on joints, leading to a more rapid progression of the disease. Excessive exercise that leads to pain or discomfort should be avoided, but moderate exercise is recommended. Swimming is an excellent exercise for pets that have OA and aren't fearful of water. Most pets do best with several short, exercise periods per day rather than fewer extended periods. Each patient will have their own unique program of weight management and exercise, and we can help you individualize one for you and your pet.

Drugs play an important part in the management of OA, and should be used in combination with lifestyle adjustments. Many dogs, especially large breeds can be stoic when it comes to pain. This means that these dogs are feeling pain, but their outward appearance appears normal. This type of pain is easily overlooked, and has lead to inadequate pain relief in the past. With the advent of modern drugs to treat OA there is no longer any excuse for these dogs to feel pain.


Chondroprotective Agents

These products typically contain precursors of cartilage and joint fluid synthesis. They are administered orally or through injections. Much controversy surrounds the use of chondroprotective (cartilage protecting) agents. Little clinical research has been done to substantiate the claims that these products have a positive effect on cartilage matrix synthesis and that they have an inhibitory effect on the enzymes that break cartilage down. These medications require up to 6 weeks of use before OA symptoms are diminished.

We like to use these medications first since there are negligible side effects and they can be an aid in preventing further deterioration of the cartilage.

Adequan

Adequan (polysulfated glycosaminoglycan) is an injectable chondroprotective agent. Adequan incorporates into joint cartilage and inhibits several enzymes that break down cartilage. No studies have been done in animals other than horses and dogs, but it appears to be safe and effective in other species including cats, rabbits, ferrets, and birds. We use it first because of its ability to rapidly help a painful pet.


The intramuscular injections are initially given twice weekly (every 3-4 days) for a month, then given monthly as needed. adequan seems to be most effective when given in the early stages of OA, but is beneficial in all stages of the disease. Side effects of adequan are much less common than with NSAID's. If adequan works well after several months we will try an oral chondroprotective agent called Cosequin.

Cosequin

Unlike the injectable adequan, Cosequin and other oral joint supplements are considered nutraceuticals, or nutritional supplements, and do not require FDA approval. Cosequin contains glucosamine and chondroitin sulfate, agents proven to be effective at supporting and protecting joint cartilage. Currently, Cosequin is the only veterinary product that contains highly purified glucosamine hydrochloride and chondroitin sulfate mixed in a specific ratio clinically proven to decrease the severity of OA. Cosequin is given orally at an initial loading dose for six weeks, then decreased to a maintenance dose that must be given continually. The rare side effect that occurs is usually related to intestinal upset.


Synovi G3

One of the newer products we have to treat arthritis has been very effective in in both dogs and cats. In addition to glucosamine and chondroitin sulfate, it contains Omega-3 fatty acids, antioxidants, Vitamin E, and MSM to name a few.


NSAID'S

The non-steroidal anti-inflammatories (NSAID'S) are the most commonly used drugs in treating OA in dogs. NSAID'S work by inhibiting an enzyme in the inflammatory pathway, thereby providing analgesia (pain relief), antipyrexia (decreased fever) and reduced tissue swelling.The enzyme that is inhibited is called cyclooxygenase (abbreviated COX). This enzyme causes an inflammatory reaction in the joint fluid that surrounds the joint.

These side effects can be minimized by using the lowest dosage and frequency possible for your pet. Before we start your pet on NSAID'S we perform an examination and run a baseline blood sample. Every 6 months we will examine your pet and recheck the blood to look for any potential side effects. This will make sure kidney and liver function is adequate.

Using NSAID'S alone is not recommended since the signs of arthritis are masked, leading to a more active dog and a quicker progression of disease. NSAID'S, in combination with chondroprotective agents, provide cartilage building blocks in addition to pain relief, and may slow the progression of OA.

Many OTC NSAID'S can be used to treat OA. These products are readily available and relatively inexpensive. Some of the more commonly used formulations contain aspirin, acetaminophen, or ibuprofen. Each product has different anti-inflammatory and antipyretic properties, and each has a different margin of safety with respect to dosing. It is very important to consult a veterinarian before using any OTC drug on any pet, since it is estimated that these drugs accounted for approximately 1/3 of all fatal animal poisonings. In general, we do not recommend Tylenol or Ibuprofen in dogs because of the potential for side effects.

All NSAID'S carry a small risk of side effects, so careful observation of your pet while on one of these medications is important. If they occur, the most common side effects are vomiting and diarrhea. There might also be kidney and liver problems, and even bleeding.

Baby aspirin can be used in cats when administered under a veterinarians supervision. Cats are much more sensitive to the side effects of NSAID'S and should not be used without a veterinarian's prescription. Tylenol is never used in cats because of its toxic effects.

Rimadyl and Etogesic

Both Rimadyl (carprofen) and Etogesic (etodolac) are potent NSAID'S approved for use in dogs. These products selectively inhibit the cox-2 enzyme and therefore provide a greater inhibition of the inflammatory pathway with fewer intestinal and kidney side effects. Both are given orally, twice daily for Rimadyl, and once per day for Etogesic. Side effects are uncommon, although sensitive individuals may experience mild intestinal upset. Rarely, more serious liver, kidney, and intestinal side effects have been reported. Labradors are reported to be more sensitive to Rimadyl than other breeds, so the use of NSAID's in this breed should be carefully monitored. In Labradors a blood panel should be checked to ensure proper liver function, and should be monitored every 6 months while on this medication.

Steroids

Steroids are broken down into 2 main classes. The first, known as corticosteroids or cortisone (Prednisone, DepoMedrol), are very potent anti-inflammatory drugs that we use on a daily basis for many disease processes. They are not our first choice in treating OA in dogs since they are thought to actually speed the process of cartilage destruction. The other type of steroids are called anabolic steroids (Winstrol, Deca-Durabolin), which have an opposite effect to corticosteroids.

Steroid therapy in dogs is usually reserved for cases that have become refractory to other treatments. It is also used in severe end stage OA where a pet is suffering considerably and quality of life becomes an issue. These pets get substantial relief from pain when we give one injection of DepoMedrol with weekly injections of Winstrol. If there is a response we can even use the oral version of Winstrol given on a daily basis. If there is no response we will use Deca-Durabolin.

In cats, steroids are much safer to use than NSAID'S and are frequently used in conjunction with chondroprotective agents to treat OA. Cats also seem much less prone than dogs to the side effects of steroids. Like any medication that is being used long term, monitoring blood parameters is recommended.

Baby aspirin is also used in cats with arthritis. It must be used only under the direction of your veterinarian.

Veterinary Orthopedic Manipulation (VOM)

An additional treatment modality that has yielded great succes is called VOM. It is a non-invasive and non-painful way to stimulate the nervous system to help correct the problem. Through the use of VOM we can decrease the use of the above medication in almost all cases. By decreasing the use of these medications we help your pet live a longer and healthier life, while decreasing you medication costs over the life of your pet.

Return to top of page

Disease Search


Google
 

Our online store can provide you with pet products and prescriptions that are competetive with any online organization, along with the added convenience of pre-approval by our doctors and products that are safe and effective, backed by the manufacturer's guarantee.

Vet Online Store

 

 

 

Home | Staff | Clients | Medical | Boarding | Wildlife | Diagnosis | E-Mail

© 1998-2007 CP LTD. all rights reserved.