Educating Clients about Arthritis in Pets
A recent Google search of “arthritis in pets” produced nearly 13 million results in less than half a second. Estimates of the prevalence of osteoarthritis (OA) or degenerative joint disease (DJD) range from 20% to 25% in dogs to as high as 90% in senior cats.1 The actual number of pets suffering from DJD is unknown because many cases go undetected and undiagnosed. All these statistics boil down to one fact: Veterinarians should consider arthritis as a clinical condition in nearly one-third of their patients.
Changing the Arthritis Conversation
Oh, he’s just getting older.
What many clients consider a general slowing-down and aging in pets may actually indicate the animal is in pain. Thus, by focusing the discussion on pain rather than simple aging as a possible cause of a pet’s clinical signs (eg, limping), the direction of the discussion is changed.
No one expects a pet to live forever, but caring owners want to keep their pet from suffering. When the conversation is focused on pain and discomfort rather than the inevitability of old age, clients are much more willing to intervene.
(See the client handout Arthritis Pain & Your Pet.)
When the conversation is focused on pain and discomfort rather than the inevitability of old age, clients are much more willing to intervene.
Diagnosing Arthritis
Radiography is the best tool to accurately assess DJD in dogs.
However, in cats, there appears to be a mismatch between radiographic findings and clinical signs (pain response), so radiography should not be the sole assessment tool. The main features of feline DJD are changes in behavior and lifestyle that develop gradually, which owners tend to interpret as effects of old age.2,3
Palpation for joint range of motion and pain level in dogs and cats should be performed with the client present. “Seeing is believing,” so if you want clients to believe, let them see.
A drug trial is helpful when there is uncertainty whether an animal is suffering from DJD. A trial of an NSAID in dogs, or a short course of prednisolone in cats, followed by a recheck one week later can be useful. Generally, in cases of DJD, the author has noticed a clear benefit that clients can readily appreciate.
Treatment Options
The last decade has seen a dramatic increase in medications and supplements for arthritic pets. The internet is replete with information, both good and bad, and clients will come armed with questions. Be familiar with all the available treatment options, and be prepared to educate clients about these broad categories:
Analgesics. These can make a great difference in quality of life. Arthritis means pain, so treat the pain, and you treat the arthritis. Be sure this is clear to clients. Options include tramadol, gabapentin, and amantadine.
Antiinflammatory drugs. Choose 2 or 3 to carry in the practice; run regular panels in intervals of 6 months or fewer to monitor changes to kidney and liver function.
Exercise programs. Explain to clients that regular moderate exercise is preferable to “weekend warrior syndrome.”
Intraarticular injections. These treatments include stem cells, platelet-enriched plasma, hyaluronic acid, and steroid injections. However, there is limited research to support the use of these agents; most data at this point are anecdotal.
Low-level laser therapy & acupuncture. These alternative treatments are a growing trend, and research exists in the literature both “for” and “against.”
Nutraceuticals & therapeutic foods. Omega 3s, chondroitin, glucosamine, and methylsulfonylmethane (MSM) are common options. Therapeutic foods for dogs and cats with mobility issues are often helpful.
Physical Rehabilitation. This is a growing field, and clients are familiar with the benefits of physical therapy for humans. Much information is available online for basic exercises clients can perform with their pets.4
Surgical management. In some cases, pets benefit from procedures such as total hip replacement, femoral head ostectomy, or arthroscopy.
Weight management. Avoiding weight gain is critical to managing arthritis symptoms. Be sure your practice has an active weight management program in place.5
Client Discussions
Veterinarians and their clients have differing levels of comfort with treatments, both traditional and nontraditional. Starting an open-ended conversation is one way to approach a client. Once the client’s comfort zone becomes clear, treatment recommendations can be tailored for the patient. The following questions can help get the conversation started:
On a scale of 1 to 10 (with 1 being the least aggressive and 10 being the most), how aggressive a treatment regimen would you like to pursue for your pet? This tactic is good for determining a client’s philosophy.
Would you prefer to use drugs with a stronger effect that may require more monitoring, or would you prefer a natural, drug-free approach?
Many clients believe little can be done for “age.” Some clients choose to treat at home and default to over-the-counter medications, which are potentially damaging and even toxic. A proactive approach to client education about aging can help expand your practice and improve your patients’ quality of life, which will, in turn, improve longevity.