Arthritis is defined as inflammation of a joint. Joints are the structures that joint two or more bones together. Osteoarthritis is a variant of arthritis in which the bones of the joint have become inflamed as well. Joints are created by a strong fibrous tissue “joint capsule” and ligaments (bands of tissue) that hold the joint together and limit its range of motion. The inside of joints is filled with a lubricating “joint fluid” created by the cells lining the joint (synovial cells). This fluid lubricates and nourishes the cartilage, which makes up the gliding surfaces of the bones.
Inflammation is a reaction of the body in response to a noxious stimulus that results in swelling, pain, heat and redness. The noxious stimulus can be mechanical trauma (overextension, hyper flexion, rupture of ligaments, straining of ligaments etc), infectious agents (bacteria and viruses) or immune system related (where the immune system attacks the joints in the body as in Rheumatoid arthritis). Inflammation is caused by various chemicals created by the body that are released into the joint in response to the stimuli listed above. As scientists continue to unravel the mechanism by which the inflammatory response is caused, they have been able to develop new drugs to help combat it.
How do we diagnose Arthritis?
When we are presented with a pet in Rancho Cucamonga that is exhibiting pain related to a joint (lameness) we first try to isolate the location of the pain through a thorough physical examination including palpation of all the joints on the affected limb. Frequently, this may require mild to heavy sedation because the painful pet may resist palpation and make it difficult to isolate the problem.
Once we have found the affected area(s), then we will generally take radiographs (x-rays) of the affected joints. Most often taking radiographs will require heavy sedation or general anesthesia. This is due to the fact that the joints must be held very still in awkward positions to get diagnostic films. Most pets will resist this positioning due to the pain and thus thwart our ability to gain a diagnosis.
Radiographs will tell us if there has been any damage to the bones in the joint such as fractures or chips off of the bone as well as if any of the bones are misaligned (luxated or sub-luxated). They will help us determine how long the inflammation has been going on and whether the bones have been affected by the inflammatory process. Finally, they can help us determine if there is an infectious or cancerous condition causing the problem. This information is vital in helping us determine a treatment strategy and determining the prognosis for recovery.
In many cases, we may need to take a sample of the joint fluid for analysis to help determine what is causing the arthritis. These samples are generally obtained by withdrawing joint fluid with a needle while the pet is anesthetized. The fluid is sent to the laboratory where the types of cells are analyzed and the fluid is cultured to check for bacterial agents. If immune mediated arthritis is suspected, a variety of blood tests may be run to help verify the diagnosis.
How do we treat arthritis?
Treatment of arthritis depends on the cause of arthritis. If there has been damage to the bones, ligaments or joint capsule, the joint becomes unstable. As long as the joint is unstable, the inflammation will not stop. Therefore, we may need to perform surgery to correct the problem causing the instability. If the problem is caused by an infectious agent (bacteria, fungus or viral) we will need to treat with an appropriate antibiotic, anti fungal or antiviral agent. If the arthritis is severe, we may need to surgically drain the joint and flush it out to help get rid of the toxins. Drug therapy for infected joints usually lasts 6 to 12 weeks at a minimum. Immune mediated arthritis is treated with a variety of drugs aimed at suppressing the immune system. These drugs can have many side effects and the patient must be monitored closely throughout the therapy.
Regardless of the cause of the arthritis, we usually will add drugs to the regimen to help relieve the pain and inflammation for the comfort of the pet. These drugs fall into the categories of non-steroidal anti-inflammatory drugs (NSAIDS), steroid drugs, narcotic analogues and chondro-protectants (cartilage protectors).
NSAIDS (non-steroidal anti-inflammatory drugs) include human drugs like aspirin, ibuprophen, naproxen and many others. Most of the drugs used for humans tend to cause severe side effects in pets (bleeding ulcers and kidney failure) and should never be given without direct supervision of your veterinarian. Fortunately, in recent years a number of newer drugs have become available for pets that minimize the side effects while providing the desired benefits. Previcox and Meloxicam are two such drugs and has been very successful in our hands. It, like all drugs has some risks, which will need to be discussed before prescribing it.
Chondro-protectants are drugs that help to protect the cartilage in the joint from the effects of inflammation. They also increase the “slipperiness” of the joint fluid (viscosity) to improve the lubricating properties in the joint. Adequan is an injectable version of this drug type. It is generally administered by a series of injections over a number of weeks to build up the drug levels in the joints. Then, many pets can be switched to an oral powder (Dasequin) that will be given daily on the food. These drugs have the least side effects of any of our anti-arthritis drugs and play an important role in the management of chronic arthritis.
Steroid drugs are derivatives of cortisone, which is a naturally occurring hormone in the body. Steroids are the most potent anti-inflammatory agents available. They can work wonders for an arthritic pet. Unfortunately, long-term use of steroids may actually make certain types of arthritis worse. In addition, there are many systemic side effects from these drugs and so they are not generally used until other options have been exhausted.
In all cases of arthritis, rest is essential to allow the body to heal. Generally 2-3 weeks of enforced rest is requires. In, sudden onset arthritis caused by strain or sprain an external splint may be applied during this period allow the soft tissues to heal without pressure. In the same vein, weight control is equally important to reduce the strain on the affected joint(s). Frequently, we may prescribe strict weight loss regimens for overweight arthritis sufferers.
Stem Cell Therapy: A cutting edge therapy is now available for the treatment of chronic arthritis using the patient’s own stem cells to help improve the affected joints. Click here for more information.
Therapeutic Laser Application: Often times arthritis and its associated pain can be substantially improved with the use of a therapeutic laser. These lasers reduce inflammation, reduce pain and improve bloodflow to the affected area. Generally a series of 6 to 10 treatments are prescribed over a 2 to 3 week period with follow up applications as needed.
What is the prognosis for arthritis?
The prognosis for arthritis varies with many factors. Sudden onset arthritis in which no ligaments have been ruptured, no bones have luxated (as in a sprain or strain) may have a very good prognosis provided it is treated quickly and appropriately. Infectious and immune mediated arthritis have variable outcomes and always carry a guarded prognosis. The longer a lameness goes undiagnosed and untreated, the worse the prognosis becomes. Once the bone becomes involved the joint surfaces become roughened and irregular, the prognosis gets significantly worse. The reason for this is that it is nearly impossible to reverse those bony changes once they have developed. Most pets that have arthritis that has involved the bone will require drug therapy for life. Frequently drugs may lose their effectiveness and various “salvage” surgical procedures may need to be performed. These include joint fixation (arthrodesis), joint replacement and other surgical procedures, which aim to reduce the pain and improve the quality of life of your pet.
Given this information, you can see how important it is to bring your pet into the veterinarian for evaluation at the first sign of lameness. Early intervention may help your pet avoid years of chronic pain and suffering.
At Alta Rancho Pet Hospital, we have successfully treated thousands of pets in Rancho Cucamonga, Claremont and the Inland Empire for arthritis and orthopedic problems. If your pet is suffering from lameness of any kind, we encourage you to bring him/her in for evaluation.