Page 1424 - Cote clinical veterinary advisor dogs and cats 4th

722 Osteoarthritis

Advanced or Confirmatory Testing (e.g., tramadol 2-5 mg/kg PO q 8-12h) if • Scoring systems have been developed for
necessary to decrease pain
• Arthrocentesis (p. 1059) and synovial fluid • N-methyl-D-aspartate (NMDA) receptor repeated owner assessment of severity of
VetBooks.ir rule out other forms of arthritis (e.g., septic, antagonist: amantadine 3-5 mg/kg PO q PROGNOSIS & OUTCOME
analysis (p. 1384): rarely necessary but can
signs.
24h (dog or cat) given along with an NSAID
immune-mediated)
○ Total cell count < 5,000 nucleated cells/
mcL; mononuclear cells/macrophages Chronic Treatment • Osteoarthritis is typically an irreversible,
predominate; < 10% polymorphonuclear • NSAIDs slowly progressive disease.
cells. Fluid is clear, hazy, or pale yellow • Oral omega-3 fatty acids • Medical and/or surgical treatment often
with normal to decreased viscosity. • Disease-modifying agents permits a good quality of life.
• Other tests used on rare occasions • Intraarticular injection of platelet rich plasma
○ Arthroscopy: view articular cartilage or mesenchymal stem cell products PEARLS & CONSIDERATIONS
○ CT: confirm joint incongruity • Arthroplasty of severely affected hip, stifle,
○ MRI (p. 1132): morphologic change of and elbow joints Comments
articular cartilage • Arthrodesis of severely affected joints • Radiographic signs of osteoarthritis may
○ Nuclear scintigraphy: localize osteoarthritis • Excision arthroplasty (hip, shoulder, meta- not correlate with clinical signs. Treatment
or inflammation to specific joint carpo-/metatarsophalangeal joints) decisions cannot be made on the basis of
• Acupuncture (p. 1056) radiographic findings alone.
TREATMENT • Efficacy of cartilage modifiers is not as well
Nutrition/Diet documented as efficacy of NSAIDs.
Treatment Overview • Weight control to maintain a lean body • Comparative efficacy of various NSAIDs is
The goal of treatment is to alleviate pain, condition score (p. 1077) debatable.
improve function, limit disease progression, • Diets high in omega-3 fatty acids (e.g., Hill’s • Use of glucocorticoids in place of NSAIDs
and facilitate joint reparative processes. Treat- j/d, Purina JM) is controversial; using both together is
ment may include surgical correction of the contraindicated because of severe, potentially
primary cause of osteoarthritis (correction of Behavior/Exercise life-threatening gastrointestinal ulceration.
malalignment or instability), joint replacement • Encourage low-impact activity such as leash • In cats, low-dose regimens of ketoprofen,
or excision, or arthrodesis if other treatments walks and swimming rather than high-impact meloxicam, robenacoxib, or butorphanol and
are not possible. Nonsurgical management activity such as unrestricted off-leash activity treatment with tramadol and omega-3 fatty
includes analgesics/antiinflammatories, exercise and jumping. acids have been described (see Additional
modification, and weight management. • Physical activity/therapy can help strengthen Suggested Readings, Lascelles).
muscle mass and improve function.
Acute General Treatment • Nonslip surfaces or products to increase Prevention
• Surgical treatment for cause of joint degenera- traction (e.g., PawFriction) can be helpful Prompt recognition and early intervention may
tion: repair of an articular fracture, removal for some dogs. delay progression of disease.
of osteochondral lesion, stabilization of an
unstable joint, as necessary Drug Interactions Technician Tips
• Nonsteroidal antiinflammatory drugs • Gastrointestinal irritation, hemorrhage, Nonslick floors and slow leash walks with slings
(NSAIDs) to reduce inflammatory mediators gastric ulceration, and perforation with to support body weight (especially during rising)
and pain; give one of the following (dosages NSAIDs may improve dogs’ comfort.
are for dogs unless stated otherwise): • NSAID-induced nephrotoxicity possible with
○ Carprofen 2.2 mg/kg PO q 12h hypovolemia or pre-existing renal disease Client Education
○ Deracoxib 1-2 mg/kg PO q 24h (may use • Hepatotoxicity with carprofen (idiosyncratic) • Treatment is palliative (no magic bullet), and
3-4 mg/kg PO q 24h for first 7 days only) • Decreased platelet aggregation with NSAID disease will likely progress.
○ Etodolac 10-15 mg/kg PO q 24h therapy (especially aspirin) • Client participation is necessary for long-term
○ Firocoxib 5 mg/kg PO q 24h • Do not give NSAID drugs to animals receiv- management.
○ Meloxicam 0.1 mg/kg PO q 24h; for cats, ing glucocorticoids for any cause. • Animals in pain are more likely to bite; use
0.1 mg/kg PO on day 1, then 0.05 mg/kg caution in handling.
PO q 24h for 4 days, then 0.05 mg/kg Possible Complications • Be sure that cats with OA can comfortably
every other day thereafter Polysulfated glycosaminoglycan is a heparin access food, water, and litter box.
○ Robenacoxib 1-2 mg/kg PO q 24h; for analog; caution if given with NSAIDs to an • Educate clients regarding potential adverse
cats, 1 mg/kg q 24h for 3 days animal with a bleeding disorder. effects of NSAID use (e.g., monitor appetite,
• Non–cyclooxygenase (COX)-inhibiting watch for signs of melena in stools).
prostaglandin receptor antagonist: grapiprant Recommended Monitoring
2 mg/kg PO q 24h • Palpate for joint effusion and/or periarticular SUGGESTED READING
• Disease-modifying agents fibrosis. Sanderson RO, et al: Systematic review of the
○ Polysulfated glycosaminoglycan 5 mg/kg • Quantify muscle mass with palpation and management of canine osteoarthritis. Vet Rec
IM once weekly for 4-6 weeks (dogs) tape measure. 164(14):418-424, 2009.
○ Pentosan polysulfate 3 mg/kg SQ or IM • Measure range of motion with a goniometer
once weekly (dogs or cats) during exam. AUTHORS: Desiree D. Rosselli, DVM, DACVS; Spencer
A. Johnston, VMD, DACVS
○ Oral formulations (omega-3 fatty acids, • Monitor joint pain and gait during exam or EDITOR: Kathleen Linn, DVM, MS, DACVS
glucosamine, chondroitin, avocado-soy with force plate analysis.
unsaponifiables): according to formulation/ • Assess serial radiographs.
labeled instructions • Assess animal’s attitude, appetite, body
• Opioids (e.g., fentanyl patch 2-4 mcg/kg/h condition score, body weight, and activity
for 3-5 days) or synthetic opiate agonists level.

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