The Power of Three: Treating Osteoarthritis in Cats and Dogs
When your older cat or dog has painful joints, you’ll probably go first to your family veterinarian. That’s great! What you shouldn’t do is shrug off pain in your older pet, thinking, “Oh, my pet’s just getting older and slowing down.” Or, “Well, they don’t cry out, so they must not be in pain.”
It’s important to put ourselves in our pet’s shoes (paws!). Most of us, as we get older, experiences aches, pains and stiffness, and we’re not as limber and comfortable as we were in our 20s. Most of our older dogs and cats are the same, but we can often do lots about it to improve quality of life and slow down the progressive damage of osteoarthritis: the aging and degeneration of a joint that results in chronic inflammation and pain.
What are common signs of osteoarthritis and joint pain in cats or dogs?
Relying on your pet vocalizing and making noise is not an effective way to figure out whether your cat or dog is uncomfortable. Many pets hide pain well, they don’t vocalize with chronic pain, and they make noises for all kinds of reasons (communicating with you and other animals, for instance).
Identifying signs of osteoarthritis is about identifying changes in behavior. Pets experiencing chronic pain are less interactive with you, enjoy play less and show other, even more subtle behavioral signs. Think of them as distracted by the pain and trying hard to hide it or work around it. For example, your big Labrador may start to hesitate before going up and down stairs, or not want to play fetch much anymore. Maybe your cat is a little slower these days and avoids jumping up on the windowsill to get to the sun anymore, even though he enjoys it when you lift him up and place him there. Cats may also struggle to get in and out of the litter box and start having accidents on the floor.
If you’re wondering about your pet’s behavior and signs of discomfort, take a look at this guide on how to detect if your pet is in pain.
It’s so important to remember that chronic pain can be caused by many conditions, ranging from intervertebral disc disease in a pet’s back to chronic ear infections or even severe dental disease. So much of these same issues can show up in medical issues other than osteoarthritis.
How do we diagnose osteoarthritis in cats and dogs?
A complete physical exam for orthopedic and neurological issues is a good start, along with radiographs (X-rays) to better define what areas have injury or arthritis. Those views often include the knees, the hips, the elbows, and potentially even the spine. In some cases, a CAT scan or MRI may also be necessary.
To rule out other conditions and assess for comorbidities—other diseases and medical issues happening at the same time—most older pets can benefit from basic blood work and urinalysis. Those tests may also be helpful to evaluate for liver and kidney health prior to starting different treatments that occasionally affect those organs.
How do we treat osteoarthritis in cats and dogs?
Unfortunately, it’s difficult to reverse osteoarthritis or joint injury once it has begun. For this reason, my main goals for treating osteoarthritis include maintaining future joint health and improving pain control so that a pet maintains a great quality of life.
The best approach in my experience is a multimodal one. That means we add a treatment from each point of the osteoarthritis treatment triangle:
- Lifestyle modifications
- Nutraceuticals and other adjunct therapies
- Prescription medications
One mistake many veterinarians or pet owners may fall into is utilizing only one of those approaches at a time without including the other two. I start patients on three treatments (one from each category) right from the start rather simply starting with one therapy and waiting for it to fail. You get the best bang for your buck and the best chance for success by using a therapy from each category simultaneously.
Small adjustments that go far: Lifestyle modifications
While we can tackle a pet’s joint health and pain with prescription medication, nutraceuticals and adjunctive therapies (see below), we first want to think about how the pet’s environment and lifestyle play a role in their condition. Here are things we can try:
- Cutting weight. Probably the first and arguably easiest thing to change about a pet’s joint pain is gradual weight loss. We recommend feeding a little less food or different food if a pet is overweight or obese. The latest body condition scoring that veterinarians use to assess weight in a cat or dog runs from 1 to 9. We aim for a healthy 4 out of 9. Even a small weight loss can have a big patient impact.
- Getting (easy-going) exercise. We want to ensure a pet with osteoarthritis (and, really, all pets) get regular mild- to moderate-intensity exercise. That could be playing with cats indoors, walking more with dogs, or even underwater treadmills or physical therapy for pets who are already experiencing joint pain that keeps them from comfortably exercising at home. Where pet owners especially get their dogs into trouble is taking it easy all week, then going for a 5-mile walk or run on a beautiful Saturday morning and finding out their dog struggles to walk the next day. Exercise regularly, but take it easy on pets with joint pain.
- Trying out harnesses and other mobility aids. If a pet struggles getting around, getting up and down steps, or getting in and out of cars, consider a harness like the Help ‘Em Up (Blue Dog Designs). If a harness doesn’t cut it, consider any and all mobility aids: steps or ramps to the bed or couch, steps or ramps into the car, cat litter boxes that are easier to climb in and out of, and beds that are extra-cushiony (would you want to sleep on the hard floor as you get older?).
- Getting creative. You can see what your cat or dog is struggling with: Where do they need to go? Where do they want to go, but struggle to get? For example, owners of dogs with soreness in their elbows saw how leaning down to eat might be painful. So they raise food and water bowls high enough so dogs don’t need to put pressure on their front legs bending down to crouch anymore.
Christopher Norkus, DVM, DACVAA, CVPP, DACVECC
Supplements to your pet’s medication: Nutraceuticals and adjunctive therapies
While there isn’t always as much research proving the effectiveness of nutraceuticals and other over-the-counter supplements, some of them have been shown to be effective for osteoarthritis in pets.
Some products that your veterinarian might recommend that have shown benefit may include ingredients like methylsulfonylmethane (MSM), elk velvet antler, CBD, fish oil, and avocado or soybean unsaponifiables (ASU). Other options that your veterinarian might recommend could include acupuncture, laser therapy, Assisi loop therapy, or even stem cell treatments. Believe it or not, glucosamine and chondroitin sulfate products, for instance, have not really been shown to beneficial for humans or animals.
Be aware that a lot of these nutraceuticals mix and match ingredients, so it can be hard to say which ingredient, or which mix, is working.
In all cases, I love to see pets earlier rather than later. I want a dog at age 7, not 12, to start taking supplements to slow the progression of joint injury. And I don’t recommend a single supplement and tell pet owners to come back next year and see where we’re at. I want to move quickly to add in additional options if the first choice isn’t working. The key is, don’t pick one thing and expect to see miracles.
The power of drugs: Prescribed medications
Last but not least are the animal-specific medications that a veterinarian can prescribe. The most effective drug class for treating osteoarthritis in dogs and cats are nonsteroidal anti-inflammatory drugs (NSAIDs) like carprofen, meloxicam, grapiprant or robenacoxib. We often add on other agents, such as amantadine, amitriptyline, naltrexone or gabapentin to help enhance the effect of the NSAID in treating chronic pain. Newer therapies, such as anti-nerve growth factor antibody injection, are also coming onto the market and are available for regular injections at the veterinary hospital.
Some cat and dog owners are hesitant to use pain relievers such as NSAIDs prescribed by their veterinarians. Remember, in the right doses and with the right checkups, they are very safe for long-term use for the vast majority of pets. Often, veterinarians will recommend baseline testing of liver and kidney function and repeat these tests soon after prescribing the drug to make sure the pet is responding well to the medication. If everything looks good, many veterinarians will check liver and kidney tests every six months or so to make sure there aren’t any negative side effects. Older cats and dogs benefit from these six-month checkups anyway, so these are great times to reassess medications and to see whether different or additional medications are necessary.
Whatever you do, do not be tempted to give your pets NSAIDs prescribed or over-the-counter for humans: No aspirin, ibuprofen, naproxen or acetaminophen. Some of these drugs are ineffective or toxic to cats and dogs. A single human dose of acetaminophen (Tylenol), for instance, is fatal to cats.
The power of three: Helping cats and dogs with osteoarthritis
When you target all three modalities (prescription medication, nutraceuticals/adjunctive therapies, and lifestyle changes), veterinarians and pet owners see the best effects in reducing pain from joint damage and osteoarthritis.
If we ever reach the point where chronic pain cannot be managed, euthanasia is often the kindest therapy we can offer. But my big take-home for all pet owners is, there’s a lot of stuff that veterinarians can do to help aging pets. In some cases, if your family veterinarian is running out of options, a referral to a certified veterinary pain practitioner (CVPP) (https://ivapm.org/) or to a veterinary specialist, such as an anesthesiologist interested in pain management (https://acvaa.org/), should be considered. It’s usually not true that nothing more can be done to improve the quality of life or longevity for an aging pet struggling with joint pain.
Christopher Norkus, DVM, DACVAA, CVPP, DACVECC, is the Medical Director at VCA Veterinary Specialists of Connecticut. Dr. Norkus began his veterinary career more than 20 years ago as a veterinary technician, ultimately obtaining Veterinary Technician Specialist (VTS) status in both emergency-critical care and anesthesia. He is board-certified as a Diplomate of both the American College of Veterinary Anesthesia and Analgesia as well as the American College of Veterinary Emergency and Critical Care, and is also credentialed as a Certified Veterinary Pain Practitioner. Dr. Norkus’ professional interests include toxicology, acute and chronic pain management, and critical care medicine and anesthesia. Dr. Norkus enjoys cooking, Aikido, cars, growing orchids, and eating ice cream (chocolate fudge brownie and butter pecan are his favorites). He also recently adopted a grey and white kitten named Feta.
