Treating Chronic Canine Arthritis

The District Vet

Last month we discussed the role of supplements, such as glucosamine/chondroitin and Adequan, in the treatment of canine arthritis. Recall that treatment of arthritis is multimodal, meaning that the best therapy plan uses several different types of treatment. A number of medications and therapies can be used in combination with nutritional support to achieve maximal comfort and mobility for your dog. 

With any medication it is important to follow your veterinarian’s directions carefully. Many medications are safe to administer but have specific dosing amounts and are not safe to be combined with other medications. You should also never increase the dose or frequency of administration of medications without consultation with your veterinarian. In addition many of the arthritis medications are flavored and should be kept in a cabinet, far out of the reach of dogs and children. This is especially true of NSAIDs (discussed below). 

The most common medications used to treat chronic arthritis are nonsteroidal anti-inflammatory drug (NSAIDs). These medications work by inhibiting the production of cyclooxygenase, an enzyme which stimulates cells to produce prostaglandins, a group of chemicals that cause inflammation. Prostaglandins contribute to pain, inflammation, joint damage, and fever. The inflammation further damages the dog’s joints, leading to more discomfort. Prostaglandins are important for other bodily functions, including supporting platelets and blood clotting, stomach lining protection, and blood flow to the kidneys, therefore NSAIDs must be used carefully. 

When used under the direction of a veterinarian, with routine monitoring, NSAIDs provide the most reliable and effective pain management for arthritis. Many dogs with severe pain will have remarkable responses to NSAIDs. The most common veterinary approved NSAIDs include Rimadyl (carprofen), Deramaxx (deracoxib), Previcox (firocoxib), and Metacam (meloxicam). 

NSAIDs should be used with caution in any dog with kidney, liver, heart, endocrine, or intestinal disorders. Never give your dog another NSAID or corticosteroid unless specifically directed by your veterinarian.

While NSAIDs control inflammation and to a lesser degree pain, there are several medications commonly used to control pain itself. Remember, arthritis is painful and this is why dogs are lame when walking. Tramadol works directly upon pain pathways, making dogs more comfortable quickly. It may be used alone or in combination with NSAIDs, as they have very different mechanisms of action. Tramadol works similar to morphine: it blocks opioid receptors in the brain, leading to less sensation of pain. The effects of the medication can last 6-12 hours, depending upon the dog, but the medication is generally given twice daily. Use with caution in dogs with seizures and those on antidepressants or other medications. The main side effect we have seen is mild sedation, but it can also cause constipation or insomnia. 

Gabapentin has recently gained favor in the treatment of chronic arthritis in dogs. It works via mimicking the activity of GABA, a chemical in the brain which helps calm nerve activity. Traditionally gabapentin has been used to treat seizures, but at a different dose it helps address chronic pain too. The medication is considered quite safe to use, with the most common problems including sedation and wobbling when walking. Adjusting the dose usually takes care of these issues. Gabapentin may be used in combination with several other arthritis medications. 

Other therapies aside from nutritional support and medications may also be employed to control arthritis pain and discomfort. Cold laser therapy (CLT) has been gaining in popularity and use over the past few years. CLT works through shining a beam of light at a certain frequency, which gently warms tissues, many times resulting in pain relief, decreased inflammation, increased blood flow, enhancement of immune cells to combat pathogens, and tissue regeneration. The therapy is given over a number of sessions, generally twice per week for a month, and does not require sedation or have side effects. It is particularly useful post-injury and may be combined with any other form of arthritis treatment. 

Rehabilitation therapy is integrative to many arthritis and post-injury protocols. As in humans, rehab for dogs helps increase mobility, decrease pain, and strengthen muscles and bones. There are many modalities in rehab, from using an underwater treadmill (allowing dogs to use their legs more freely with less pressure), to manual flexion/extension/massage of joints, to chiropractics and acupuncture. Rehabilitation therapies will require their own article in the near future. 

Please remember that the above content is only for informational purposes. Never treat your pet without being under the direct supervision of your veterinarian. And as always, feel free to contact one of us at District Vet if you have questions or concerns about your dog. 

Dan Teich, DVM, is at District Veterinary Hospital, 3748 10th St. NE, Washington, DC 20017; 202-827-1230 and desk@districtvet.com.