Page 1595 - Clinical Small Animal Internal Medicine

173 Osteoarthritis in Small Animals 1533

warrant a complete minimum database (complete blood
VetBooks.ir Rx/N-Rx count [CBC], serum chemistry profile, urinalysis [UA])
to rule out metabolic disease or endocrinopathies.
Weight reduction can be obtained in healthy patients
by four methods.
Exercise
Modification ● Reducing current caloric intakes, using reductions by
33–50% of the “normal” volume of the regular diet.
Calculating caloric content of regular diet and caloric
●
needs based on basal metabolic rates.
Weight Control
● Using specially formulated commercial diets with
recommended intake volumes per the manufacturer.
Figure 173.5 Multimodal approach to treating osteoarthritis. ● Pharmacologic management (e.g., dilotapide).
Three basic components of the multimodal strategy for the Appropriate caloric restriction should result in the loss
management of the clinical signs of osteoarthritis. The size of the
area of each component within the pyramid reflects the of 1–2% of body weight per week.
importance of that component for successful management of All weight reduction/control programs must include
the patient. an exercise element to ensure constant weight loss and
eventual body weight maintenance. To encourage activ-
effects of OA. Recently, research shows the same is true ity in the debilitated OA patient, regular pharmacologic
for other animals. A clinical study investigating the treatment may be required for a short period until the
effects of obesity in dogs with hip dysplasia concluded patient becomes more ambulatory and physiologically
that overweight dogs that achieved an 11–18% body acclimated to the new level of physical activity.
weight reduction were significantly less lame compared
to their preweight reduction lameness scores. Exercise and Activity Modification
Weight control can be one of the most challenging
aspects of the medical management of OA in dogs for Exercise is very important in people for maintaining
several reasons. strength, stamina, and joint range of motion; there is also
less dependency on medication when OA patients are
● A patient that is clinically inhibited by moving an OA allowed to exercise. It is assumed that the same is true in
joint(s) will not be able to utilize consumed or stored other animals as well and this is supported by a study in
body energy efficiently and will instead increase body hamsters. Therefore, an important aspect in the man-
stores of energy (fat) when given a constant caloric agement of OA in animals should be controlled exercise.
intake. Depending on the animal’s activity history, it may be
● Dogs with underlying endocrine disease (e.g., hyper- necessary to modify a patient’s regular level and type of
adrenocorticism, hypothyroidism) will have the meta- activity.
bolic propensity to maintain body fat stores even in the It may seem intuitive that an OA animal should not be
face of a reducing diet. allowed to have hard‐impact, prolonged exercise activity,
● Dogs in a multipet household (e.g., other dogs and but controlled clinical studies have not been performed
cats) are more prone to consume greater volumes of to evaluate this recommendation. However, from clinical
food than dogs in single‐pet households. experience, practitioners are used to hearing the usual

● An inaccurate estimation of the animal’s ideal body owner’s report of greater clinical signs in OA patients
weight. after hard, prolonged activity. It is known from kinetic
● An inaccurate estimation of the animal’s energy and kinematic gait analysis that dogs with OA will modify
requirements. their gait to reduce the load of weight bearing and motion
● The owner’s lack of willingness to be proactive in of the affected joint. It is therefore safe to assume that
trying to reduce their pet’s body weight. prolonged “overactivity” should result in greater modifi-
Any one or a combination of the above factors will cation of gait due to exacerbation of the discomfort asso-
maintain the obese patient indefinitely. ciated with an OA joint. Some recommendations for the
Prior to starting a weight‐reducing program, a com- duration of certain activities in dogs have been made but
plete physical exam should be performed. The clinical recommendations for activity duration can also be based
history (attempted weight reduction in the past with poor on common sense and owner observations of their pet’s
results, lethargy, “heat seeking,” polyuria/polydipsia, apparent gait response/comfort level to an activity period.
etc.) and physical exam findings (pendulous abdomen, Just as important as duration of activity is the type
symmetric alopecia, recurrent dermatopathy, etc.) may of activity undertaken in the animal’s daily lifestyle.