August 25, 2011 - Animal Health SmartBrief Special Report: Arthritis, Part II

Animal Health SmartBrief Special Report: Arthritis, Part II

Part II of this Animal Health SmartBrief Special Report on Arthritis looks at treatment options for arthritis, including a Q-and-A with expert James L. Cook, DVM, PhD, DACVS, DACVSMR, professor of orthapaedic surgery and director of the Comparative Orthopaedic Laboratory at the University of Missouri. Part I, published on Tuesday, explored ways to prevent and slow the onset of arthritis. If you don't receive Animal Health SmartBrief daily and find our report useful, sign up for this timely e-newsletter. Animal Health SmartBrief delivers the stories making news in your profession directly to your inbox -- for FREE.

Talking with an Expert

• Looking at arthritis through an expert's lens
  
  
  

  SmartBrief spoke with James L. Cook, DVM, PhD, DACVS, DACVSMR, a professor of orthopaedic surgery and director of the Comparative Orthopaedic Laboratory at the University of Missouri.

  What is the most effective way to treat arthritis?
  There is not a single answer to this question other than to say that the "most effective" way to treat arthritis is to use a comprehensive, patient-based approach based on an accurate diagnosis and complete workup. With arthritis, there are both biomechanical and biologic abnormalities present that contribute to the clinical signs and symptoms. It is important to try to address both of the major components as comprehensively as possible in order to provide the best outcome for the patient. Therefore, the DVM needs to fully assess the patient to determine cause, severity, involvement, and stage and communicate well with the client to determine their goals and abilities in long term management of the arthritis in their pet. Weight management/body conditioning and activity modification are two components of comprehensive management of arthritis that should always be included. Inclusion of the other components, such as medications, nutraceuticals, specific diets, injections and surgery will be dependent on patient and client factors.

  In what situations might treatment beyond pain medications, such as NSAIDs, be necessary?
  When the biomechanical aspects need to be addressed. Many patients can be managed without or with intermittent low levels of NSAIDs, avoiding the cost and potential side effects. NSAIDs should not be just "automatically" used. There are many really good NSAIDs available now for dogs and they can be very effective and helpful and typically will be employed at some point for the vast majority of cases, but DVMs should not just robotically slap dogs on NSAIDs as soon as they diagnose arthritis. [Other approaches may be necessary] when the intended function is not being reached with NSAIDs, when they are no longer effective, when side effects prohibit their use, when other medical issues prohibit their use, and or when clients reject them.

  How effective are pain relievers or other procedures? How much can an animal's quality of life improve?
  Comprehensive management of arthritis is very effective and can improve quality of life tremendously. While there is no cure for arthritis, the currently available treatments are very good and very safe overall. The keys to success are: 1) Comprehensive assessment of the patient, 2) Communication -- listening to the owner and educating the owner about arthritis and the goals of treatment (decreasing pain, improving function, slowing progression), and their roles in management, 3) Comprehensive, patient and owner specific treatment plan, and 4) Consistent monitoring and adjustments as necessary.

  What are the latest treatment options veterinarians and/or pet owners should be aware of?
  There are many, both surgical and nonsurgical. The real push is for minimally invasive surgeries, nutraceuticals, special diets, alternative/holistic therapies, laser, ultrasound and shockwave modalities, platelet-rich biologics and stem cells. Some of these can be and are very effective and helpful in a comprehensive management plan. But, it is critical that DVMs realize that none are a cure, none are effective alone ... none are effective in all cases ... and that they must be proven safe and effective based on high quality evidence before we use them in our patients and charge our clients for them.

  Are there any other promising treatments on the horizon?
  Yes, there are many being developed and evaluated. The major categories of new treatments include pharmaceuticals, such as anti-degradative, anti-inflammatories and analgesics aimed at new targets and drugs that promote tissue healing and repair. 2) Nutrition, including diets, dietary components, and nutraceuticals. 3) Minimally invasive surgical techniques. 4) Biologics, such as systemic and intra-articular cell-based, blood component and molecular therapies aimed at anti-degradative, anti-inflammatory, analgesic, signaling and or anabolic targets and 5) Regenerative medicine, including biologics, pharmaceutical and tissue engineering strategies aimed at a cure, rather than palliation or repair. But, again, it's important that these are proven safe and effective before use.

      

Hill's® Prescription Diet® j/d® Canine Mobility brand pet food is clinically tested to reduce NSAID dosage by 25%. Nutrients in j/d disrupt joint degradation, reduce inflammation, and can help prevent the need for more aggressive treatments later. Learn more.

In the News

• Stem cells from fat emerge as osteoarthritis treatment
  Scientists have made strides in arthritis treatment using a stem-cell therapy that involves injecting an animal's own fat cells into arthritic joints. Unlike other stem cells, fat cells don't transform into different types of tissue; instead, the fat cells secrete anti-inflammatory substances that reduce inflammation and stimulate repairs in injured tissue. The Sydney Morning Herald (Australia) (8/1)     

• Pets are people too when it comes to treating arthritis
  Dogs suffering from arthritis are finding new options at Toronto clinics that model their therapies after physical rehabilitation practices that help humans, including massage, aquatherapy and muscle-strengthening exercises. "Interest in alternative therapies has grown across the health spectrum. (There's) no reason to expect pets to be different," said Martin Fischer of the College of Veterinarians of Ontario. The Toronto Star (7/25)     

• K-lasers help veterinarians treat patients with chronic pain
  Veterinarians are increasingly using a Class-IV laser to treat chronic pain in pets affected by a variety of conditions including hip dysplasia and spondylosis, and to help heal wounds and surgical incisions. The K-laser won FDA approval for human use in 2005 and has been available to veterinarians for more than five years; practitioners are also increasingly using the technology to treat smaller pets such as birds, snakes and turtles. The Warwick Advertiser (N.Y.) (7/21)     

• While arthritis has no cure, medication combinations can treat pain
  Tahlula's pain from arthritis and a dislocated spinal disk was so bad at one point that the Rottweiler's owners wondered whether it might be more humane to euthanize her, but then they hit on the right combination of over-the-counter supplements and prescription medications that made her comfortable. While arthritis isn't curable, owners can work with their veterinarians to ease pets' pain by experimenting with different medications and lifestyle changes until they find a regimen that works, said Oregon veterinarian Wendy Baltzer. The Washington Post/The Associated Press(8/23)     

	Nutrition clinically tested to reduce NSAID dosage by 25% Hill's® Prescription Diet® j/d® Canine Mobility brand pet food contains nutrients that disrupt joint degradation and reduce inflammation. Catching arthritis early and starting patients on a treatment plan including j/d can prevent the need for more aggressive treatments later. Learn more.

Resources

• Caring for arthritic pets
  In this podcast, Dr. Darryl Millis discusses arthritis and offers tips on ways to keep your arthritic pets as pain-free as possible.     

• Veterinary non-steroidal anti-inflammatory drugs (NSAIDs)
  FDA offers information about veterinary non-steroidal anti-inflammatory drugs (NSAIDs). Find out more here.     

• Study looks at in vitro growth factors in normal and osteoarthritic dog joints
  A study published in the American Journal of Veterinary Research assessed in vitro effects of certain growth factors in fibrochondrogensis via synovial membrane cells in both normal and osteoarthritic dog joints.     

• Improving pets' mobility through weight loss
  Arthritic dogs that are also obese and overweight can suffer great pain, making it difficult for them to exercise. In this article from the American Animal Hospital Association, experts offer advice on reducing a pet's weight to ease their pain.     

• AJVR study examines use of robenacoxib for feline pain treatment
  A study published in the American Journal of Veterinary Research examined the effectiveness of orally administered robenacoxib for acute pain and inflammation in casts associated with musculoskeletal disorders. The study, which also assessed the drug's palatability, found that daily-administered tablets were more tolerable than ketoprofen tablets.