Osteoarthritis (OA) is a progressive disease commonly diagnosed in geriatric dogs that results in cartilage loss, synovial inflammation, subchondral bone remodeling, and osteophyte formation and leads to joint stiffness, pain, and loss of mobility. OA can have a significant effect on quality of life.
Diagnosis should be established and other causes of lameness (eg, neoplasia, immune-mediated disease, neurologic disease) ruled out before treatment is implemented. This article highlights evidence-based components, challenges, and tips for optimizing OA management in geriatric dogs.
1. Weight Management
Weight optimization is the most important component of OA management. Maintaining a lean body condition can reduce the frequency of OA across multiple joints, delay onset of chronic disease, and result in an increase in average lifespan of 1.8 years.1 The authors recommend collecting dietary history at intake and tracking data using a body condition scale in addition to body weight (see Suggested Reading). A dietary calculator, like this one created by the authors, can be used to quickly determine ideal body weight, as well as caloric and protein requirements for a weight loss plan.
Dietary Calculator for Weight Loss in Dogs
The calculator will provide recommended energy requirements for weight loss, amount of diet to feed, treat allowances, and amount of protein. Senior dogs, dogs participating in rehabilitation, and dogs needing weight loss may benefit from being fed closer to 2 grams of protein per pound of lean body weight (if there is no evidence of renal insufficiency).
Many over-the-counter and boutique diets are calorie dense and do not provide sufficient protein for weight loss, thus a therapeutic weight-loss diet or consultation with a nutritionist may be considered.
Weight loss can improve mobility in obese dogs with OA, as documented on kinetic analysis2; however, weight management discussions with pet owners may be neglected due to time constraints, perceived disinterest from owners, or fear that conversations may become adversarial.3 The impact of excess weight on life expectancy has been reported to be the most important factor for owners when considering intervention for an overweight or obese dog.4 Directing weight loss conversations toward prolonging life expectancy through improved mobility may thus be helpful.
Talking About Weight Loss
Weight loss conversations can be uncomfortable, but weight loss can be essential for patient health. Try these tips for productive discussions about body weight.
Ask the client for permission to discuss weight. The conversation should feel like a collaboration, not an accusation.
Avoid judgmental or cutesy language. Rather than using terms like chonky or phrases like He’s been getting too much food or too many treats, focus on the issue at hand, which is that excess weight can be detrimental to health, and you’d like to discuss ways to help the patient stay healthy.
Resist the temptation to equate a pet’s weight challenges with human ones. Any human who has dieted knows weight loss can be frustrating and difficult. Focus on the patient and your sincere desire to work with the client as a team to keep their pet healthy.
Create a weight-inclusive environment so clients have no reason to feel self-conscious. Make sure chairs can accommodate a range of body sizes (eg, sturdy chairs without armrests) and posters and other materials in the hospital and examination room avoid judgmental language about weight.
2. Pain Management
NSAID administration is the most effective strategy for managing pain associated with OA; however, owners and clinicians may have concerns regarding long-term use and adverse effects.5 The authors recommend obtaining a baseline CBC and serum chemistry profile before administering NSAIDs because of potential adverse effects in patients with pre-existing liver or kidney disease. Urinalysis may also provide a more complete picture regarding renal health. In patients with no medical contraindications, a traditional NSAID can be used for long-term pain management, with CBC and serum chemistry profile performed every 6 months.
Grapiprant and/or other pain medications (eg, gabapentin, pregabalin, amantadine) can be used in dogs intolerant of NSAIDs or as secondary or tertiary therapy for OA pain. Grapiprant is a nontraditional NSAID that blocks prostaglandin E2 activity downstream of cyclooxygenase (COX) inhibitors,6 providing a better safety profile than COX inhibitors. Anecdotally, clinical improvement has been seen with grapiprant, but studies lack objective data supporting efficacy of this drug.7-9 Conversely, studies of common NSAIDs (eg, carprofen, meloxicam, firocoxib) have used objective measures (eg, accelerometry, force plate analysis) to support efficacy, and these drugs remain mainstays of treatment.6,8,10
Bedinvetmab, an anti–nerve growth factor monoclonal antibody, is FDA-approved for OA pain management in dogs and is administered as a monthly SC injection. A diagnosis of OA should be confirmed prior to starting treatment. Several well-controlled studies have demonstrated improvements in pain scores and lameness in dogs with OA given bedinvetmab.11-13 This medication has not been studied in patients with neurologic disease, so caution is warranted in patients with mobility impairments related to other causes of pain. In addition, the FDA released a notification letter of reported adverse effects suspected to be related to bedinvetmab.14 Potential adverse effects should be discussed with owners prior to administration.
3. Joint Supplements
Many nutraceuticals and supplements to support joint health are available. Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have the strongest evidence to support their anti-inflammatory properties and effects on pain.15 Doses for OA management are higher than for most other conditions that benefit from omega-3 fatty acid supplementation, as shown in the dietary calculator.
A meta-analysis of veterinary joint supplements and enriched diets found some evidence for use of cannabidiol and undenatured collagen type II.15 These supplements showed less effect than omega-3 fatty acids but may be considered as a second-line approach. Glucosamine and chondroitin products were found to have a marked noneffect and are not routinely recommended by the authors.15 Joint supplements can be useful adjuncts but may not provide the same level of efficacy as other (previously mentioned) therapeutics and can be expensive when used long-term.
4. Physical Rehabilitation
OA often affects multiple joints in geriatric patients. Professional physical rehabilitation can help support healthy mobility and provides the opportunity to create individualized treatment plans, build relationships, and perform continual reassessments and therapeutic adjustments. Treatment plans may include therapeutic modalities and manual therapies to treat pain, exercise plans, and use of an underwater treadmill to support mobility and improve muscle strength.
Certified rehabilitation practitioners can be located by state in the United States (see Suggested Reading).
5. Specialist Referral
Many OA treatments are available in the clinic, but referral to a specialist may provide more targeted care and advanced diagnostics. Diagnostic needle arthroscopy can provide detailed assessment of joint health.16 Intra-articular injections, extracorporeal shockwave therapy, and surgery, in some cases, may benefit patients with OA and can be performed by most board-certified surgeons and/or sports medicine and rehabilitation specialists.17,18
Conclusion
OA management in geriatric dogs can be complex and often requires a multimodal approach. Diagnosis is needed before treatment is initiated to rule out other conditions (eg, pain related to neoplastic, neurologic, or systemic disease). Treatment may help improve comfort and quality of life, and each patient and their response to treatment should be considered using tailored protocols rather than a general standardized approach.
Read about the top osteoarthritis treatment options for geriatric cats here.