Page 672 - Small Animal Clinical Nutrition 5th Edition

696 Small Animal Clinical Nutrition

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Figure 34-1. Treatment for osteoarthritis includes surgical correc-
tion, nonsteroidal antiinflammatory drugs (NSAIDs), physical rehabili-
tation, therapeutic nutrition and weight control and exercise. Most
patients will benefit from a combination of these treatment options.

aging. Careful evaluation of pets whose owners report changes
typically attributed to aging is warranted. Obtaining a complete
history is important. The use of an owner questionnaire may
facilitate recognition of these subtle changes (Figure 34-2)
(Hielm-Bjorkman et al, 2003).
In dogs, clinical signs of osteoarthritis include reluctance
to walk, run, use stairs, jump or play. Owners may also notice
other signs including difficulty rising from rest, stiffness or
lameness. They may describe their dog as lagging behind on
walks or having decreased mobility that is attributed to age.
Figure 34-2. Osteoarthritis pain assessment questionnaire. Dogs
Generally, signs of lameness are described as intermittent and
with total index scores greater than six are presumed to have chron-
progressive. Typically lameness or stiffness is worse after rest ic pain. (Adapted from Hielm-Björkman AK, Kuusela E, Liman KE, et
and improves with activity. The time it takes for activity to al. Evaluation of methods for assessment of pain associated with
improve lameness or stiffness in affected dogs will frequent- chronic osteoarthritis in dogs. Journal of the American Veterinary
ly increase as the disease progresses. Pain is often difficult to Medical Association 2003; 222(11): 1552-1558.)
assess and owners may be unaware of it unless a dog vocal-
izes (e.g., yelping or whimpering). Personality changes such mobility and flexibility are reduced, cats may be unable to
as withdrawal or aggressive behavior may also be sympto- groom completely and be either unable or unwilling to navigate
matic of pain. stairs to reach the litter box or to enter litter boxes with tall
Clinical signs of osteoarthritis in cats are even more elusive. sides. Stroking or combing over arthritic joints may be painful.
Most cats with osteoarthritis do not exhibit localizing lameness Some cats may resent this type of attention and even demon-
(Clarke and Bennett, 2006). The most common clinical signs strate aggression as a result of pain (Overall et al, 2005). Table
are reduced activity and reluctance and/or inability to jump on 34-1 summarizes common clinical signs for dogs and cats
or off elevated surfaces or travel up and down stairs.The inabil- (Beale, 2004).
ity to perform these activities may be related to the most com- Physical examination should include neurologic assessment
mon sites of osteoarthritis, which include elbows, vertebral col- and a thorough orthopedic examination. Joints, muscles, ten-
umn and hips. Many owners do not recognize decreased activ- dons, ligaments and long bones should be palpated for evidence
ity as problematic. Furthermore, if jumping or using stairs is not of swelling, heat or pain. Joints should be assessed for crepitus,
a normal part of a cat’s daily routine its owners may not appre- range of motion, collateral stress, abduction and adduction
ciate any abnormalities (Roe, 2006). Other behavioral changes (instability). Muscle atrophy, hypertrophy or asymmetry should
that may be related to osteoarthritis include incomplete groom- be noted because these findings may indicate the most clinical-
ing, inappropriate elimination and aggression (Hardie, 1997). If ly affected joint.