Arthritis

Arthritis is one of the most common conditions seen in older dogs and cats, affecting about one in five dogs, and slightly less cats. Arthritis will continue to become more significant as our pets continue to live longer and longer.

Our pets most commonly develop osteoarthritis, the wear and tear type. Inflammatory arthritis (like rheumatoid arthritis) and immune mediated arthritis does occur but less frequently.

Osteoarthritis is usually a disease of older animals, but can occur at any age. Younger animals may develop this disease due to developmental problems or accidental joint injuries. Conditions such as hip dysplasia elbow dysplasia, cruciate rupture, and joint injuries can all cause an early onset of osteoarthritis.

Arthritis is a very common cause of chronic pain, and is often not recognised as our pets mask disease very well. In other words they just get on with things & don’t complain. This is particularly so in cats. As a naturally solitary animal, showing pain means you are more likely to get eaten by another predator.

Predisposing factors for osteoarthritis

• Breed - Large or giant breeds have a higher incidence of arthritis
• Age - Arthritis is more common in older dogs
• Weight – Overweight dogs are more prone to arthritis
• Breed inherited traits and conformation – Which cause or lead to arthritis such as hip dysplasia or elbow dysplasia, and chondrodystraphoid breeds
• Stress Activity - Levels of high stress or abnormal activity for long periods of time, such as excess athletic activities or gruelling work
• Joint injuries – injuries to the joint

Signs that your dog may have arthritis:

• Limping
• Difficulty sitting or standing
• Sleeping more
• Seeming to have stiff or sore joints
• Hesitancy to jump, run or climb stairs
• Weight gain
• Decreased activity, or less interest in play
• Attitude or behavioural changes
• Lethargy
• Increased vocalising, particularly cats

How does arthritis happen?

Regardless of the initial cause once established arthritic change leads to more damage.

• The cartilage loses elasticity and may split
• Pieces of cartilage may break off and float around in the synovial (joint) fluid
• The cartilage may break down, leaving the bone exposed and unprotected
• The bone loses shape and thickens at the rims of the joint, producing bony spurs called osteophytes
• The bone beneath the joint surfaces often thins out
• Muscles around the joint may waste away
• Blood supply to the joint may be reduced
• The joint capsule, which surrounds the joint, becomes thickened.
• Joint fluid which lubricates the joint becomes watery

As these things happen, the joint loses its smooth functioning, becoming stiff and painful. In advanced stages of osteoarthritis the joint may be destroyed altogether.

Managing Arthritis

Most of the things we use to manage arthritis, also help prevent it, so that this list can also be used as a guide for helping healthy dogs prior to the onset of this disease.

Weight control
Overweight animals are more prone to arthritis. This occurs for a number of reasons. Obviously overweight animals have more weight on their joints.

However another possible benefit is that joints are totally dependent on glucose as an energy source. Animals that aren’t overweight have more glucose in their circulation compared to other forms of energy like fat. This means they get better joint nutrition than their overweight peers do.

Weight control is the most important step in managing arthritis in your pet. If you are finding weight control hard let us help you devise a diet for your pet. A small number of dogs that can’t lose weight may also have thyroid disease (see the separate data sheet for hypothyroidism for more information).

Exercise

Exercise helps arthritic animals in a number of ways. By increasing muscle tone and mass there is less pressure on joints. Exercise increases blood flow and hence joint nutrition. Exercise also helps weight loss.

Too much exercise however can cause pain, and acceleration of joint damage.

Both the type and amount of exercise are important. Short frequent exercise sessions work the best. If you find your pet is lame after exercise try to decrease the duration, and increase the frequency of exercise periods. Swimming is an ideal exercise for dogs that like it. Lead walking is also good. Dogs like to run but make sure they have ‘warmed up’ with a walk first.

You can encourage cats to exercise by encouraging them to chase toys. Creating multiple feeding spots can also help. Rotate their food bowl through a number of locations in the house, choosing one at random each day. Your cat will then walk around the house checking out the food spots. On average cats with continual access to food will eat 20 times a day. This means your cat may do 20 laps of the house checking out feeding locations.

Environment

Cold exacerbates arthritis. Make sure your pet’s bed is warm, and is raised off the floor. If they do swim dry them off well afterwards.

You may find your pet can’t do things they used to do like climb stairs, or jump in to the car. Cats may find it hard to negotiate cat flaps. You may need to be invented in solving some of these problems for them. Commercially available ramps are now available to help pets with some of these problems.

Treating arthritis

Pentosan polysulphate (Cartrpohen)

This drug is generally given as four injections one week apart. They are given under the skin just like a vaccination. Pentosan polysulphate appears to improve blood flow to joints, whilst decreasing inflammation around the joints, and in the joint capsule. This effect is important as it markedly decreases pain. It is unusual amongst drugs used to treat arthritis in that it can go some way to repairing damaged joints, rather than simply modifying the clinical signs of the disease. Courses repeated on a 6 monthly basis tend to create a better response.

Pentosan polysulphate has been used for over 20 years and has proven very effective with a very low incidence of side effects.

Whilst it can be very useful in treating osteoarthritis, it will have no effect against inflammatory arthritis or immune mediated arthritis.

Non-steroidal Anti-inflammatory drugs (NSAID’s)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are used to control pain and inflammation. NSAIDs work by blocking the production of prostaglandins, the body chemicals that cause inflammation. They are the drugs used most commonly to treat osteoarthritis in dogs & cats. This group of medications are good pain killers, and decrease the inflammation and swelling around joints. Some of them have also be shown to improve the viscosity (stickiness) and hence effectiveness of the joint fluid.

The newer NSAID’s, known as Cox-2 inhibitors are associated with fewer side effects than some of the older style NSAID’s such as aspirin or ibuprofen. COX-2 inhibitors have not experienced the problems in dogs & cats that have been seen with some of these medications in people, and have been in veterinary use for well over a decade. Side effects are rare but do occur.

To minimise the risk of side effects animals being treated with NSAID’s long term are advised to have a blood screen every 6 months. By doing this potential problems can often be detected before they affect your pets health.

Side effects include:

• Vomiting
• Diarrhoea
• Not eating/eating less, and
• Lethargy
• Gastrointestinal bleeding
• Liver and kidney toxicity

If your pet appears unwell whilst using NSAID’s, stop administering the medication and contact us immediately.

Do not administer with other anti-inflammatory drugs, such as other NSAID’s or corticosteroids. Patients at greatest risk for kidney problems are those that are dehydrated, are on diuretic treatment, or have pre-existing kidney, heart, and/or liver problems.

Surgery

Surgery can rarely be used to cure arthritis, for example total hip replacements. More commonly it is used to modify the cause of the disease. For example during surgery for cruciate disease, joints are cleaned of debris, to minimise further damage. The act of stabilizing the knee during these procedures also helps decrease further damage. However unlike joint replacement, arthritis will inevitably develop.

Early intervention for some developmental disease, such as fragmented coronoid process (FCP) in the elbow, and osteochondritis dissecans in the elbow and shoulder, can decrease future arthritic disease.

Stem cells

This is an emerging treatment showing some promise. In this procedure (presently only available for dogs) stem cells are extracted from your own pets fat. These are then purified and injected, under anaesthesia, into the affected joints. Here they implant in to the joint surface where they produce anti-inflammatory proteins. This doesn’t repair the joints as originally hoped, but does have a good local anti-inflammatory affect. At this time Stem cell therapy is expensive. If used and effective, it generally needs to be repeated every 12-18 months.

Glucosamine, Chondroitin, and green lipped mussel

Many naterceuticals and food additives have been advocated for many years in both human and veterinary medicine for the treatment of osteoarthritis. These products are controlled in a very different manner to traditional pharmaceuticals. As such, the evidence for and against these treatments is hard to assess.

Glucosamine and chondroitin are found in joints naturally. Many people thus believe that adding them in to the diet can aid in animals with joint disease.

There are certainly pros and cons for using these suplements, as there is with all the treatments we have discussed. We are more than happy to discuss these as a treatment option for your pet.

Acupuncture

Acupuncture has been used for over 4000 years, and has been used with animals probably for as long as with people. Traditional Chinese medicine describes meridians as channels of “Qi”, or energy, that flow around the body. Acupuncture helps to channel the flow of energy through the meridians of the body. Most acupuncture points are on these meridians and each of these points has a specific action.

Acupuncture is most often carried out using fine needles. They may be left in the acupuncture points from a few minutes up to half an hour. Other methods include the use of laser, pressure, injections and cupping. To the suprise of many people, most animals are extremely tolerant of acupuncture. Once the needles are placed, many become quite relaxed.

Acupuncture has been used successfully in the treatment of many conditions. It is best known for its use in the musculoskeletal system. Degenerative joint disease, spinal conditions and acute inflammation of joints or muscles are some examples. It can also be included in the treatment protocols for conditions such as liver and renal disease, inflammatory bowel disease, infectious diseases to name a few.

REFERENCES

Relating To pentosan polysulphate

Bouck GR, Miller CW and Taves CL (1995). A comparison of surgical and medical treatment of fragmented coronoid process and osteochondritis dissecans of the canine elbow. V.C.O.T. 8: 177-183

Bowman L, et al. (1994) Calcium pentosan polysulphate (CaPPS) stimulates release of superoxide dismutase (SOD) from endothelium in vitro and in vivo. Int. Soc. Free Radical Res., 7th Biennial Meeting 1994

Cullis-Hill D and Ghosh P (1994). Joint Convention of L'Ordre des. Medicins veterinaries du Quebec and the Canadian Veterinary Medical Association, Quebec City, Canada, July 6-9

Francis DJ, Hutadilok N, Kongtawelert P, Ghosh P (1993) Pentosan polysulphate and glycosaminoglycan polysulphate stimulate the synthesis of hyaluronan in vivo. Rheumatol Int 13:61-64

Francis DJ and Read RA (1993). Pentosan polysulphate as a treatment for osteoarthritis (degenerative joint disease) in dogs. Aust. Vet. Practit. 23(2):104-109
Ghosh P and Cheras PA (2001). Vascular mechanisms in osteoarthritis. Best Pract. Res. Clin. Rheumatol. 15(5): 693-710

Read RA, Cullis-Hill D and Jones MP (1996). Systemic use of pentosan polysulfate in the treatment of osteoarthritis. J.Small Anim Pract. 37: 108-114
Rogachefsky RA, Dean DD, Howell DS, Altman RD (1993) Treatment of canine osteoarthritis with insulin-like growth factor-1 (IGF-1) and sodium pentosan polysulfate. Osteoarthritis Cart 1:105-114

Smith JG, Hannon RL, Brunnberg L, Gebski V, Cullis-HiII D (2001) A Randomised double blind comparator clinical study of the efficacy of sodium pentosan Polysulfate injection and carprofen capsules in arthritic dogs, Journal of the Osteoarthritis Research Society International, 9(b):S21-S22

Rerences relating to NSAID’s

Hilary Benton et al , March 1997 “Effect of carprofen on sulfated glycosaminoglycan metabolism, protein synthesis and prostoglandin release by cultured osteorthritic canine chondrocytes” , AJVR, Vol 58 No 3

References relating to stem cell therapy

Webster R, Herbert, B., Blaber, S., and Vesey G. The evaluation of intra-articular injections of adipose derived cells in the treatment of osteoarthritis in twenty-six canines. Data on file

Blaber et al. Adipose derived mesenchymal cell therapy for osteoarthritis: Multiplex cytokine assays correlate with quality of life outcome measures (submitted for publication)

Lalu MM, M. L. P. C. S. D. (2010). Safety of Cell Therapy With Mesenchymal Stromal Cells (MSCs): A Systematic Review. Am J Respir Crit Care Med, 181, 1–1.

Zhu Y, Liu T, Song K, et al. Adipose-derived stem cell: a better stem cell than BMSC. Cell Biochem Funct 2008;26:664-675

Basu, J., Genheimer, C. W., Guthrie, K. I., Sangha, N., Quinlan, S. F., Bruce, A. T., Reavis, B., et al. (2011). Expansion of the human adipose-derived stromal vascular cell fraction yields a population of smooth muscle-like cells with markedly distinct phenotypic and functional properties relative to mesenchymal stem cells Tissue Eng Part C Methods, 17(8), 843–860.

Amariglio N, Hirshberg A, Scheithauer BW, et al. Donor-Derived Brain Tumor Following Neural Stem Cell Transplantation in an Ataxia Telangiectasia Patient - art. no. e1000029. Plos Medicine 2009;6:221-231

Webster R, Herbert, B., Blaber, S., and Vesey G. The evaluation of intra-articular injections of adipose derived cells in the treatment of osteoarthritis in twenty-six canines. Data on file

Black LL, Gaynor J, Gahring D, et al. Effect of adipose-derived mesenchymal stem and regenerative cells on lameness in dogs with chronic osteoarthritis of the coxofemoral joints: A randomized, double-blinded, multicenter, controlled trial. Veterinary Therapeutics 2007;8:272-284

Black LL, Gaynor J, Adams C, et al. Effect of intraarticular injection of autologous adipose-derived mesenchymal stem and regenerative cells on clinical signs of chronic osteoarthritis of the elbow joint in dogs. Vet Ther 2008;9:192-200.

McCarthy G, O'Donovan J, Jones B, et al. Randomised double-blind, positivecontrolled trial to assess the efficacy of glucosamine/chondroitin sulfate for the treatment of dogs with osteoarthritis. Vet J 2007;174:54-61.

Read RA, Cullis-Hill D, Jones MP. Systemic use of pentosan polysulphate in the treatment of osteoarthritis. J Small Anim Pract 1996;37:108-114.

Murphy JM, Fink DJ, Hunziker EB, Barry FP. Stem cell therapy in a caprine model of osteoarthritis. Arthritis and Rheumatism 2003;48:3464-3474.

López-Iglesias, P., Blázquez-Martínez, A., Fernández-Delgado, J., Regadera, J., Nistral, M., & De Miguel, M. P. (2011). Short and long term fate of human AMSC subcutaneously injected in mice. World Journal of Stem Cells, 3(6), 53–62.

Wakitani S, Goto T, Pineda SJ, et al. Mesenchymal cell-based repair of large, fullthickness defects of articular cartilage. J Bone Joint Surg Am 1994;76:579-592.

Murphy JM, Fink DJ, Hunziker EB, Barry FP. Stem cell therapy in a caprine model of osteoarthritis. Arthritis and Rheumatism 2003;48:3464-3474

Toghraie, F. S., Chenari, N., Gholipour, M. A., Faghih, Z., Torabinejad, S., Dehghani, S., & Ghaderi, A. (2011). Treatment of osteoarthritis with infrapatellar fat pad derived mesenchymal stem cells in Rabbit. The Knee, 18(2), 71–75.

Centeno CJ, Busse D, Kisiday J, et al. Regeneration of meniscus cartilage in a knee treated with percutaneously implanted autologous mesenchymal stem cells. Med Hypotheses 2008;71:900-908.

Centeno CJ, Busse D, Kisiday J, et al. Increased knee cartilage volume in degenerative joint disease using percutaneously implanted, autologous mesenchymal stem cells. Pain Physician 2008;11:343-353.

Wu L, Leijten J C H, et al. Trophic effects of mesenchymal stem cells increase chondrocyte proliferation and matrix formation. Tissue Engineering Part A 2011 - accepted for publication.

Yi-Hsin Hsu, Ming-Shium Hsieh, Yu-Chih Liang, et al. Production of the Chemokine Eotaxin-1 in Osteoarthritis and its Role in Cartilage Degradation Journal of Cellular Biochemistry 93:929–939 (2004)

Blaber et al. Adipose derived mesenchymal cell therapy for osteoarthritis: Multiplex cytokine assays correlate with quality of life outcome measures (submitted for publication)