Degenerative joint diseases such as osteoarthritis (OA) are among the most common conditions affecting pets and can significantly impact an animal’s mobility. Although OA is incurable, identifying the condition early and initiating appropriate management strategies can help keep your patients active and improve their quality of life.
Denis Marcellin-Little, DEDV, DACVS, DECVSC, ACVSMR, believes that early client education and clinical diagnosis leads to better management.
“It’s easier to stay lean than lose weight. It’s easier to stay strong than regain your strength. It’s easier to treat acute pain than chronic pain,” said Dr. Marcellin-Little, a professor of orthopedic surgery at the University of California, Davis, School of Veterinary Medicine. “The three main approaches to OA management are simpler when the pet is treated proactively over the long term.”
EDITOR’S NOTE
This article is the second of a three-part series focusing on joint health and client education and is brought to you by clinically proven Rejensa® joint care chews.
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Recognizing OA as early as possible requires a close relationship between the pet owner and the veterinary team. As the pet’s primary caretaker, the owner is the most likely person to notice subtle changes and signs that indicate joint disease. However, many owners do not know which changes to watch for and might overlook the common signs of joint disease.
The veterinary team’s responsibility to educate owners about OA signs is critical to a pet’s long-term well-being. Therefore, address joint disease during every life stage, from puppyhood or kittenhood to the senior years, to help facilitate an early diagnosis. To get your team on board, develop a plan that brings the joint disease conversation into every wellness visit.
Puppy and Kitten Visits
OA is likely not on the radar of new pet owners as they arrive with their puppies and kittens for a wellness visit. However, the appointment is a perfect time to introduce these key points:
- Diet: Counsel owners about the appropriate diet for their pets’ breed and expected adult size. Large-breed dogs, in particular, require controlled calorie and nutrient amounts to modulate growth.
- Body condition: Explain that being overweight increases a pet’s risk of severe OA and that keeping the pet at a healthy body condition can minimize the effects of joint disease.
- At-risk breeds: Clients with high-risk breeds, such as Labrador retrievers and German shepherds, should be on alert for signs that might indicate early joint disease.
- Spay or neuter timing: Joint disease risk should be part of the conversation when determining the best age to spay or neuter large-breed pets.
- OA signs: Make owners aware of common indicators.
Tamara Grubb, DVM, Ph.D., DACVAA, the president-elect of the International Veterinary Academy of Pain Management, emphasizes the importance of talking about OA early and often.
“We are getting better at having educational puppy and kitten visits. It’s not just that first vaccine,” said Dr. Grubb, an adjunct professor of anesthesia and analgesia at the Washington State University College of Veterinary Medicine. “Starting early with puppy and kitten education across the board for all health concerns, training concerns, nutrition concerns — we should be doing that from the beginning. Arthritis should be part of that conversation.”
Adult Wellness Visits
Waiting until 7 years old to bring up joint disease in pets is too late, particularly for high-risk breeds. Instead, use annual wellness visits throughout adulthood as opportunities to remind clients about the development of joint disease. For example, the patient history should always include questions about mobility and pain.
“We need to be asking the right questions,” Dr. Grubb said. “We need to remember to bring those mobility and behavior change questions into the exam. And it’s important to add questions that might identify pain early on.”
Your team can use a standard list of questions or an OA checklist at every visit, comparing the answers to previous visits to detect changes over time. Important risk-reduction strategies, such as weight management and regular controlled exercise, also should be discussed, especially in pets with a higher likelihood of OA development.
Additionally, Dr. Marcellin-Little advocates for regular communication between annual visits.
“Hopefully, we don’t talk to clients only once a year,” he said. “It’s important to set up a communication channel and talk to the owner four times a year about anything related to their pet’s movements and mobility.
“We need to be open to observation visits, reviewing videos and seeing patients regularly as needed, with the idea of de-emphasizing the cost of that communication, because the benefits for the clinic are going to come from having that strong long-term relationship. That way, we can manage OA not after several months but within a week or two after signs appear.”
Senior Pet Visits
By a pet’s senior years, the owners hopefully are accustomed to questions about joint disease and know what to watch for. However, this is the time to ramp up the discussions since most elderly pets likely suffer from some degree of OA. Helping owners understand the difference between normal age-related slowing down and abnormal pain-related behavior changes is critical.
“We need to start this discussion early and teach them that a change in their pets’ mobility can be caused by pain,” Dr. Grubb said. “Owners should be aware that any behavioral change can mean something medical, and it’s very often pain.
“Pain can be eliminated to restore quality of life and the human-animal bond, because a painful pet is not a very good pet. They’re often hiding, biting and don’t want to be around people, and that’s not how we want our pets to be.”
Initiating Management Strategies
Once a joint disease diagnosis is made, your focus should shift to management. Taking a proactive approach can provide a significantly better outcome than waiting until joint issues have progressed. A multimodal treatment plan can help slow OA’s progression and provide years of pain-free mobility, and it might include:
- Weight management: The conversation can be tricky, but clients might be more receptive if you make weight loss part of the treatment plan and emphasize how vital a healthy body condition is for pain control.
- Exercise: Regular, controlled exercise can help keep pets at a healthy weight and maintain their strength, agility and confidence.
- Pain medications: NSAIDs and analgesics will likely be needed at some point to control pain. However, employing other treatment strategies early and aggressively might help delay their initiation.
- Supplements: A number of supplements have been shown to help pets diagnosed with joint disease. Clients are likely to purchase supplements on their own if you do not provide recommendations, so counsel them about which ingredients to look for.
- Rehabilitation: Specific exercises can boost a pet’s strength and balance.
- Adjunctive therapies: Acupuncture and laser therapy can provide non-pharmaceutical pain relief.
- Environmental modification: As OA progresses, household changes, such as non-slip rugs, ramps and supportive bedding, can reduce the need for potentially painful movements and help support pets.
OA shouldn’t be an unexpected diagnosis, especially in high-risk pets. By instituting joint disease conversations early and often, you will prepare the owners to recognize OA signs early in the disease’s course, which can help you promote a longer, more active life for affected patients.
THE RECIPE FOR HEALTHY JOINTS
Given the number of joint supplement products available to pet owners, your clients might purchase the cheapest option at the pet store or one with decent online reviews but without researching the ingredients. To prevent your clients from wasting their money, your team should take the lead in joint supplement discussions. Whether you sell products from your online pharmacy, direct clients to specific supplements or simply recommend certain ingredients, clients should know which nutraceuticals are proven to help maintain joint health and provide pain relief.
GLUCOSAMINE HYDROCHLORIDE
Glucosamine hydrochloride is a natural building block of the cartilage matrix found in joints. It also stimulates cartilage cell growth to boost healing and reduces inflammation in arthritic joints. The ingredient is relatively inexpensive and is found in many different supplement products, such as chews and joint diets. Glucosamine hydrochloride is safe for long-term use and would be a good recommendation for pets who are predisposed to OA, as well as those with existing joint disease.
CHONDROITIN SULFATE
Chondroitin sulfate inhibits enzymes that damage and destroy cartilage and has a synergistic effect when given with glucosamine hydrochloride. It also has been shown to reduce inflammation when given before a joint injury in dogs. Many joint products contain a combination of glucosamine hydrochloride and chondroitin sulfate, and these supplements can be used as part of an early management plan.
OMEGA-3 FATTY ACIDS
Omega-3 fatty acids such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) partially displace arachidonic acid (ARA) — an integral part of the inflammatory pathway — from cell membranes. Omega-3 fatty acids inhibit ARA metabolism to inflammatory mediators such as leukotrienes and prostaglandins, thereby reducing joint inflammation. Fish oil contains high concentrations of DHA and EPA and is used in many joint health products.
GREEN-LIPPED MUSSEL
Powdered extracts from New Zealand-harvested green-lipped mussels (GLM) contain a combination of omega-3 fatty acids, other beneficial lipids, vitamins, minerals, antioxidants and glycosaminoglycans. GLM has been shown to reduce joint pain and swelling and improve mobility and activity in dogs. Product quality can vary greatly based on the harvesting location and timing, extract processing, and quality analysis, so care should be taken to recommend reputable, proven products.
N-BUTYRYL GLUCOSAMINE
New and improved forms of glucosamine products are in the market. For example, N-butyryl glucosamine (GlcNBu) is a breakthrough analog of glucosamine developed as an improved form to provide clinical benefits. Stay informed of new research.