Degenerative joint disease is
the number one cause of chronic pain in the dog and cat. The condition itself
is the result of long term stresses and instability of a joint either as a
result of old injury or of natural development of the joint in that individual.
While surgery may be able to help in some situations, most of the time the
degeneration of the joint cannot be reversed and treatment focuses on preventing
progression of damage. Numerous products are available on the market; some
are best combined with others and some cannot be combined. The following is
a summary of options:
ASPIRIN
Aspirin is a non-steroidal anti-inflammatory drug or NSAID. It is effective
in relieving pain due to inflammation as is occurring within the arthritic
joint. It has the advantage of being readily available and inexpensive. It
also has a relatively fast onset of action (other medications require at least
one month of use to build up adequate levels in the joint). In some animals,
however, it is simply not strong enough or it causes unpleasant side effects
such as upset stomach or even intestinal bleeding. Aspirin also deactivates
platelets (the blood cell responsible for clotting) and thus can promote
bleeding should surgery or trauma occur.
Cats metabolize aspirin extremely slowly and require a very low dose and
a typical dosing schedule of twice a week usage. Dogs can use aspirin up to
three times daily.
Because this medication is available in almost every pet-owning household,
there may be a temptation to guess a dose based on the human dose. Do not
be tempted to do this. Do not use aspirin or any other medication in your
pet without veterinary guidance.
Enteric coating of aspirin has become popular in human products. This coating
is a problem in animals and creates unpredictable absorption. This becomes
dangerous when enteric coated aspirin tablets do not digest in the stomach
and instead collect in the stomach until a toxic dose is reached. To avoid
this disaster, use either aspirin made specifically for pets or aspirin with
a powdery covering rather than the "hard candy" type enteric coating.
RIMADYL AND ETOGESIC
These medications are also NSAIDs. They were developed as an improvement
upon aspirin and other NSAIDs developed for humans for which side effects
have been problematic in animals. Rimadyl and Etogesic are both designed for
indefinite use in dogs with minimal side effect potential. Rimadyl is given
twice daily and Etogesic is given once daily.
Typically a short trial of one of these is prescribed to see if the
effect is worth continuing; as with people, some individuals respond better
to different NSAIDs. If the effect is good, then the medication can be continued.
Some blood testing is recommended prior to long term use and every 6 months
thereafter.
Approximately one dog in 5000 will have a serious liver reaction to Rimadyl.
Animals with histories of elevated liver enzymes, pre-existing liver disease,
Cushing's disease, or phenobarbital use should probably not take this medication.
Neither of these medications should be used in cats.
GLUCOSAMINE AND CHONDROITIN SULFATE
These products are cartilage components harvested chiefly from sea mollusks
(i.e., cartilage is made up of glucosamine and chondroitin sulfate). By taking
these components orally, the patient is able to have plenty of the necessary
building blocks needed to repair damaged cartilage. It is also felt that these
products may have some anti-inflammatory properties separate from their structural
uses. Unlike NSAIDs, these products do not produce rapid results; one to
two months are needed for them to build up to adequate amounts. There are
numerous products available combining glucosamine, chondroitin sulfate, assorted
vitamins, creatine (a muscle building block), omega 3 fatty acids, and more.
Because these substances are classified by the FDA as nutriceuticals (i.e.,
nutrients with medicinal properties) rather than as drugs. The usual rigorous
testing for efficacy has not been required. As a result, the optimal dosage
has not been determined and almost every product has a different dose recommendation.
Some experimentation may be necessary.
These products are not likely to be helpful for spinal arthritis as the
joint composition of an intervertebral disc (the joint of the spine) is totally
different from those of other bones.
These products can be used in both dogs and cats.
These products often complement treatment with NSAIDs.
ADEQUAN® INJECTIONS
Adequan® is a polysulfated glycosaminoglycan, which is also a cartilage
component but instead of coming from sea mollusks, adequan is derived from
the windpipe cartilage of cattle. Adequan has numerous beneficial effects
for the arthritis patient including the inhibition of harmful enzymes involving
joint cartilage destruction, stimulation of cartilage repair, and increasing
joint lubrication.
Adequan is given as an injection and so is able to reach all joints but
it seems to have a special affinity for damaged joints.
Adequan should be avoided in patients with blood clotting abnormalities
as a matter of caution. (At excessive doses tested in normal patients, abnormal
clotting resulted so it is best not to take a chance in an abnormal patient.)
Adequan is best given as a series of injections, twice a week or so until
a response is seen but not exceeding eight injections. After an effect is
seen, Adequan injections are given on an as needed basis.
Adequan is formally approved for use in dogs and horses but may also be
used in cats with good results.
Adequan may be combined with NSAIDs and with glucosamine and chondroitin
sulfate.
OMEGA 3 FATTY ACIDS
Certain fats have been found to have anti-inflammatory properties. While
this finding has primarily been utilized in the treatment of itchy skin, many
arthritic dogs and cats have also benefited from supplementation. While there
are no toxic issues to be concerned with, these products require at least
one month to build up to adequate amounts. Effects are not usually dramatic
but can be helpful.
Omega 3 fatty acids can be used in dogs and cats.
Omega 3 fatty acids can be combined with any of the above treatments.
MSM
MSM stands for methyl sulfonyl methane and represents another nutriceutical
anti-inflammatory agent. MSM is present in most plant and animal tissues and
is a natural source of sulfur; however, for commercial sale MSM is derived
from DMSO (dimethylsulfoxide), a solvent that comes in both medical grade
or industrial grade. Because it is a nutriceutical and thus not required by
the FDA to be subjected to tests of safety or efficacy, its effectiveness
is still up in the air. There is a tremendous human market for this product,
thus little motivation for manufacturers to finance expensive testing of this
nature.
MSM can be used in dogs and cats.
MSM can be combined with any of the above products.
SUPEROXIDE DISMUTASE (SOD)
The usual veterinary product for SOD is called Comfort Tabs. (There is also
an injectable product called palosein.) This product is what is called an
anti-oxidant, or free radical scavenger. Free radicals are molecule fragments
that are unstable due to the presence of an electron that should be matched
with electron as a pair. The free radical will attract electrons from other
molecules thus creating biochemical chain reactions as free radical molecules
steal electrons from one another. This transfer of electrons, called oxidation,
is very damaging to cells and can increase the risk of cancer. The inflammatory
activity in an arthritic joint is one of many sources of free radicals in
the body. The body has natural anti-oxidants to curtail free radical activity
but there is a great deal of thought that taking these agents as medication
could be helpful in an assortment of situations (from slowing the aging process
to the prevention of cancer). While proof is somewhat lacking, SOD does not
appear to be harmful and should be able to combine with any of the other products
listed above.
PREDNISONE AND OTHER STEROIDS
This discussion would not be complete without mention of the steroid class
of drugs. These agents are strong anti-inflammatory agents but with chronic
use, can lead to suppression of the immune system, excessive weight gain,
and impaired cartilage healing. These are considered a last resort in most
cases. See more information on prednisone.
Proper exercise is excellent physical therapy for the arthritic pet as it
is crucial to maintain as much muscle mass as possible to support the abnormal
joint. Massage and gentle flexion/extension of the joint may also help. Remember,
treatment for joint disease is likely to involve a combination of medications
in addition to physical activities.
Copyright
2001 - 2007 by the Veterinary Information Network, Inc. All rights reserved.
This work was originally
published by Veterinary Information
Network, Inc. (VIN)
and is republished with VIN's permission
The above information is simply informational. It's intent is not
to replace the advice of a veterinarian nor to assist you in making a diagnosis
of your pet. Please consult with your own veterinarian for confirmation of
any diagnosis. Your pets life may depend on it.
