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Degenerative joint disease
Degenerative Joint Disease and Your Pet
Degenerative joint disease (DJD), also known as arthritis or osteoarthritis, is a progressive
deterioration of joint cartilage resulting in inflammation and irreversible changes in the joints. DJD can affect cats and dogs, males or females of any age or any breed. Two broad classes of DJD are primary and secondary. Primary DJD is believed to be a result of long-term exercise combined with aging and has no known predisposing cause. Secondary DJD is much more common and is the result of some initiating cause such as joint instability, trauma, bone or cartilage defects, or poor joint conformation. Working dogs, athletic dogs, and obese animals are at increased risk for developing DJD because of the increased stress placed on the joints.
The diagnosis of DJD is usually made based on clinical signs found in the history and physical
examination. Pets suffering from DJD often show intermittent lameness that slowly becomes more severe and frequent over time. The clinical signs are often worse after exercise, prolonged periods of recumbency and weather changes. Some pets will walk with a stiff gait, rather than exhibiting obvious lameness. On physical examination pets with DJD may show stiffness in their gait, reduced range of motion in the affected joint(s), crepitus, joint swelling, pain and joint instability. Often radiographs will be taken to assess the degree of change in the affected joint(s), to assess changes over a period of time or to look for fractures, bone infections or tumors. In some cases, the severity of the changes seen on radiographs does not correlate with a pet’s clinical signs. Additionally, other diagnostic tools may be employed to better define the problem in a specific animal. Joint fluid may be collected for analysis. Blood work may be needed to look for underlying metabolic problems, infections or to check the health of the liver and kidneys prior to using various medications.
There are a variety of treatment options available for pets suffering from DJD. These
treatments can be generally classified as drugs to decrease pain, treatments to reduce pain, drugs to protect the joints, diet, surgery, weight loss, rehabilitation and lifestyle changes.
1.) Medical Analgesia
a.) Anti-inflammatory Drugs
i.) NSAIDs - N
rugs include such over the counter
medications as aspirin, ibuprofen, and acetaminophen and such prescription medications as Rimadyl (carprofen), EtoGesic (etodolac), Deramaxx (deracoxib) and Metacam (meloxicam). Over the counter medications are generally less expensive, but may not be as effective as prescription medications. The primary side effects of these medications are gastrointestinal problems, including vomiting, diarrhea and loss of appetite, which may progress to more severe problems such as stomach or small intestinal ulceration. Some of these medications are not recommended for pets with documented bleeding disorders or liver or kidney problems. Also, there has been some research that indicates that aspirin may actually damage cartilage over time. These medications are typically started at an initial recommended dose. The dose is then decreased to the lowest effective level.
ii.) Glucocorticoids or Steroids -
The most common steroid used to treat DJD is
prednisone or prednisolone. Steroids are more potent anti-inflammatory drugs than NSAIDs, but they also can have significant side effects. Most animals on steroids will experience increased drinking and urination and increased appetite. As a result some animals may have urine or stool accidents in the house. Additional side-effects include increased panting, behavioral changes, slowed healing and suppression of the immune system making infections a potential problem. Pets are typically started on an initial dose of steroids to control the inflammation. As with NSAIDs, the steroid dose is then decreased to the lowest level that will keep the pet comfortable.
NSAIDs and steroids should NEVER
be given together as severe gastrointestinal upset
and/or ulceration may occur. Please let us know if your pet is already taking either type of medication.
b.) Tramadol -
a synthetic narcotic drug that produces analgesia and euphoria without the
side-effects of addiction or sedation. Tramadol can be used separately or in combination with steroids,
NSAIDs and chondroprotective agents and can be used in dogs and cats. A reduction in Tramadol
dose may be necessary for those pets with pre-existing liver and/or kidney disease. Side-effects from
Tramadol are rare, but include upset stomach, pupil constriction, decreased heart rate, cough
suppression and constipation. A human product called Ultracet® contains acetaminophen in addition
to Tramadol and should NEVER
be used in cats at any dose and should be used with great caution in
c.) Amantadine –
an NMDA antagonist that is useful as adjunctive treatment for chronic pain
in dogs and cats, particularly in those patients tolerant of opioids. Amantadine is often combined with NSAIDs or opiates. Use with caution in patients with glaucoma, liver disease, renal disease, congestive heart failure or seizure disorders. Side-effects include agitation, loose stools, flatulence and diarrhea.
d.) Gabapentin –
an analgesic drug that is useful as adjunctive treatment for chronic pain in
dogs and cats. A reduction in Gabapentin dose may be necessary for those pets with pre-existing liver
and/or kidney disease. The most common side-effect is sedation. Abrupt discontinuation of the drug
may precipitate seizures in animals prone to them. A human product called Neurontin® contains
xylitol and should NEVER
be used in dogs and with great caution in cats since xylitol can cause
hypoglycemia (low blood sugar) and liver toxicity.
2.) Physical Analgesia
a.) Transcutaneous Electrical Nerve Stimulation (TENS) –
involves the stimulation of
nerves to reduce both acute and chronic pain. A TENS unit is connected to the skin with electrodes and electrical pulses are applied. These electrical pulses vary by pulse width, frequency and intensity.
b.) Laser Therapy –
applies the concept of photobiostimulation to provide pain relief and a
decrease in the inflammatory cycle. Using a veterinary-specific unit, light of a specific wavelength is applied to the affected area(s) for specific periods of time resulting in numerous biologic and physiologic benefits.
c.) Acupuncture –
is intended to correct imbalances in the body’s flow of energy (Qi or Chi)
and involves the insertion of special needles into the skin at specific locations on the body. The needles may be manipulated manually or electrically. Acupuncture has been used to treat a wide variety of conditions including acute and chronic pain in both people and pets.
d.) Myofascial Trigger Point Treatment –
Myofascial trigger points are essentially hard
knots in muscles caused by overuse. These trigger points do not relax and can cause pain. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in other parts of the body. Treatment of trigger points may include massage, dry needling (insertion of needles) and/or injections of local anesthetics and/or steroids into the trigger points.
3.) Chondroprotective Agents.
These agents are intended to maintain and restore the mechanisms
that protect cartilage by encouraging growth of cartilage cells and joint fluid, minimizing
inflammation and preventing or removing blood clots in nearby blood vessels. The most commonly
used agents are glucosamine and chondroitin sulfate. They can be administered orally or by injection.
There are no significant side effects associated with these agents. Typically, pets are maintained on a
consistent dose for long periods of time, often for the life of the pet. It may take six to eight weeks
before clinical improvement is seen when using these agents. These agents are not prescription
products and therefore are not tightly regulated by the FDA. Consequently, the consistency and
quality of ingredients can vary widely between products. We have high quality products available in
Hills has a prescription diet for dogs called Canine j/d
, intended to help manage canine
arthritis. Beneficial nutritional components include: a.) high levels of Eicosapentaenoic Acid (EPA)
which works to turn off the gene that causes cartilage damage, b.) high levels of Omega-3 fatty acids
to help reduce mediators that cause inflammation, c.) glucosamine and chondroitin to provide
building blocks for cartilage repair and d.) L-carnitine to help maintain optimum body weight in dogs.
a.) Orthopedic Surgery -
to support, repair or replace damaged joints. These surgical
procedures can dramatically decrease pain and increase mobility, thereby improving the comfort level of many pets. These procedures are best performed by a board certified veterinary surgeon.
b.) Stem Cell Therapy -
a new area that shows promise in the treatment of DJD in pets. Stem
cells are multipotent cells, meaning they can develop into a wide variety of tissue types, induce repair and stimulate regeneration. First, under local or general anesthesia, a sample of the patient’s own abdominal fat is collected. The fat is then shipped to a special laboratory where the patient’s stem cells are isolated and concentrated from the fat. Finally, the patient’s stem cells are returned to the veterinary clinic where they are injected directly into the site of the injury and/or injected intravenously.
6.) Weight Loss.
Reducing the weight of overweight pets is one of the most important aspects of
effectively treating DJD because it reduces the amount of stress placed on particular joints. For most
animals weight loss involves dietary management (adjusting the amount and/or type of food that is
fed) and exercise. Often prescription diets that are high in fiber and low in calories are recommended
to maximize weight loss. Most treats should be eliminated. Some low calorie treats, either store
bought or homemade, may be permissible. Many dogs enjoy fruits and vegetables and these can be
used as treats without adding significant amounts of calories or fat to the pet‘s diet. Some overweight
dogs suffer from low thyroid levels (hypothyroidism). These dogs will need to have their thyroid
levels medically supplemented in order to increase their metabolism and encourage weight loss.
7.) Physical Rehabilitation -
the treatment of injury or illness to decrease pain and restore function.
Rehab for your pet may include: warm water whirlpool, underwater treadmill, chiropractic
adjustment, TENS therapy, acupuncture, hot and cold therapy, massage, ultrasound treatment and
exercises to stretch, strengthen and increase range of motion.
8.) Lifestyle Changes.
Light to moderate exercise is generally recommended for most animals with
DJD in an effort to control weight and to maintain muscle mass and muscle tone. However, severely
affected animals may need a period of enforced rest. Running, jumping, quick turns and stairs should
be avoided due to the increased stress these activities place on the joints.
With proper management many pets with DJD can be made significantly more comfortable
and their quality of life can be improved. The type of treatment to be used will depend on the individual pet and will be decided between the pet owner and the veterinarian.
If you ever have any questions regarding any of the above information, please do not hesitate
to contact us. Visit us online at www.WhiteBearAnimalHospital.com.
WHITE BEAR ANIMAL HOSPITAL
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