Kristin Shaw, DVM

Are you diagnosing and managing canine osteoarthritis the same way you were taught in vet school? Depending on when you graduated, chances are the techniques and treatments you learned may be due for a refresh. This article will offer tips for ensuring you are practicing the best medicine you can for your canine patients while following the principles of Fear Free practice.

Diagnosing OA: You don’t have to cause pain to find pain

If you were ever taught that you had to “push harder” to find the pain—forget that! Instead, there is a very good chance you can diagnose OA pain without even putting your hands on a dog (though that is still important!). Dogs show chronic, OA pain through changes in their mobility, posture, function, mood and behavior.¹ Additionally, joint pain leads to compensatory pain in other parts of the body, including muscles. There are a number of ways we can identify OA pain without trying to make the dog cry out with our palpation.

• Use a screening checklist: A recent study found that using an owner checklist that asks questions about a dog’s mobility at home can increase the rate of identifying dogs with OA.² See here for the checklist that was used in this study and is available for you to implement in practice.
• Observation is key: Dogs with OA may hide an obvious lameness during a traditional gait evaluation. While it is still recommended to watch how dogs walk on a leash, more rewarding information is often gleaned observing a dog’s posture and from watching how a dog moves through transitions (rising from a down position, moving into a seated or down position).³ When standing, if the spine is not neutral, and/or if limbs are held in abnormal or asymmetric positions, and/ or if weight is shifted off of a limb or body segment, these are all indications of likely joint pain. If any slowness or asymmetry to movement through transitions is seen, there is a good chance the dog has musculoskeletal pain.
• Sedate for radiographs! Imagine being pinned to a cold table in a dark room and having your painful limbs manipulated. You would at the very least squirm too! Sedation and analgesia are musts for obtaining high quality, diagnostic radiographs while minimizing stress and discomfort. Also remember to take orthogonal views, centered on the joint of interest, and take both sides for comparison.

Treating OA: Unmanaged OA pain is a life-threatening condition

We care about OA because it causes pain. And not just pain in the arthritic joint, but over time, whole-body pain develops. Additionally, chronic/maladaptive pain is progressive and usually worsens, often drastically, without treatment.⁴ Multimodal, proactive, and continuous pain management is essential to reduce the devastating consequences of unmanaged OA.³

• Multimodal is built on effective analgesia: According to the 2022 AAHA guidelines, the first line of analgesia for canine OA should be either NSAIDs or the anti-NGF monoclonal antibodies (mAbs).³ Both of these classes of drugs have proven efficacy and safety in dogs with OA. There are additional benefits of anti-NGF mAbs that may make it a better option for many dogs. Anti-NGF mAbs are administered by a veterinary professional, in the clinic, so take away the caregiver burden of an oral medication, improving owner compliance. Additionally, anti-NGF mAbs directly target a key player of chronic pain, sensitization, and neurogenic inflammation and have an encouraging safety profile. Maintenance of a lean body condition and regular exercise are also required as part of an effective OA plan. Other supplemental therapies may be considered as needed.
• Proactive pain relief is standard of care: Canine OA is predictable- it typically develops secondary to developmental orthopedic disease (dysplasia, OCD) or joint trauma. Therefore, as soon as a dog is diagnosed with a joint disorder, which in the case of developmental disease generally occurs in the first few years of life, a proactive OA plan should be put in place. Clients should be educated on OA, the consequences of unmanaged pain, and how to monitor for pain at home. Analgesics should be started when pain is mild rather than waiting until it becomes severe.
• Don’t let the pain break through: It is tempting to suggest to pet owners that they give analgesics on an as-needed basis. However, this can become problematic if they don’t recognize the early signs of pain. Chronic pain signaling leads to physical changes in the spinal cord that ultimately result in severe, neuropathic pain.⁴ A study that evaluated maintaining dogs at the NSAID label dosage vs. gradually reducing the dosage of the NSAID overtime, found that the dogs maintained at the label dosage, had the best outcome.⁵  Furthermore, continuous pain management through daily NSAIDs has been shown to improve signs of OA in dogs.⁶ Once a month anti-NGF mAb is given as a monthly SQ injection and controls pain for up to 4 weeks, which may be an optimal alternative to asking pet owners to give a daily medication. Remember to ensure a pleasant and enjoyable visit utilizing Fear Free techniques whenever dogs are coming in for any type of appointment, including monthly injections.

References

1. Roberts C, Armson B, Bartram D, et al. Construction of a conceptual framework for assessment of health-related quality of life in dogs with osteoarthritis. Frontiers in Vet Sci. 2021.
2. Wright A, Amodie DM, Cernicchiaro N, et al. Identification of canine osteoarthritis using an owner-reported questionnaire and treatment monitoring using functional mobility tests. JSAP 1-10, 2022.
3. Gruen ME, Lascelles BDX, Colleran E, et al. 2022 AAHA Pain management guidelines for dogs and cats. JAAHA 58:55-76, 2022.
4. Malfait AM, Miller RE, Miller RJ. Basic Mechanisms of Pain in OA: Experimental observations and new perspectives. Rheum Dis Clin N Am 47:165-180 (2021).
5. Wernham BGJ, Trumpatori B, Hash J, et al. Dose Reduction of Meloxicam in Dogs with Osteoarthritis-Associated Pain and Impaired Mobility. ,J Vet Intern Med 25:1298–1305, 2011.
6. Innes JF, Clayton J, Lascelles BDX. Review of the safety and efficacy of long-term NSAID use in the treatment of canine osteoarthritis. Vet Record 166:226-230, 2010.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

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