Arthritis - a joint approach
The ends of a bone in a joint are covered in smooth cartilage so they can move against each other with minimal friction. The whole area (the joint capsule) is held firmly together by ligaments that run between the bone ends.
Developmental disorders can weaken the structure of the bone ends and their cartilage. In addition, poor conformation and laxity of the joints can also contribute to damage, and even the healthiest dog will suffer some joint damage in old age as a result of wear and tear. The cartilage can become thin and rough, contributing to inflammation, which in turn leads to the joint fluid (the lubricant within the joint) losing viscosity, thickening of the joint capsule and swelling. Fragments of bone can also be deposited around the margins of the joint. These factors can cause further inflammation and stiffness, and a vicious circle of inflammation, and joint damage results. Although resting the affected limb can be good in the short-term, long-term loss of mobility and muscle strength can worsen the situation.
Affected dogs often appear lame and stiff and initially this may ease with exercise. Typically, these dogs are slow to rise and may be particularly stiff after a rest. However with dogs in the early stages of disease or those with a bilateral problem (that affects both opposite limbs) there may be little to observe other than an abnormal gait. For instance, dogs with hip dysplasia may exhibit a low, ‘crouching' hind limb gait, and dogs with elbow arthritis often move with their elbows out from the body, swinging the limb forwards from the shoulder. In more advanced cases owners may notice swelling and thickening of the joint, a reduction in mobility and muscle wastage due to lack of use.
Making a diagnosis
A range of tests can help diagnose arthritic conditions. X-rays are generally the most useful as radiographs can clearly show changes in bone contour and density in the joints. However ultrasound scanning, nuclear scintigraphy (which involves scanning the body for active sites of inflammation) and taking samples of fluid from affected joints can also help. In addition, blood tests can access the dog's general health and can screen dogs for some infectious causes of joint inflammation.
There is an almost infinite number of treatments available, which is testament to the fact that arthritis is a universal condition, affecting large numbers of animals of all species over the thousands of years that have formed medics' knowledge base. However, it is important to realize that some treatments are more effective than others and some are better understood and backed by more scientific evidence.
Surgery may be an option in a minority of cases - but is of no use in most old dogs who have typical wear and tear-related arthritis. It can be used to improve the way the bones fit together within the joint in some cases, therefore reducing any ongoing damage.
Most dogs with arthritis will need anti-inflammatory pain-relieving medication (usually a type of medicine called a non-steroidal anti-inflammatory or NSAID) at least some of the time. These medicines can be used as and when necessary or may be given routinely every day. Although they can cause side effects in the long-term, this is rare and these medicines generally are safe and effective aids to comfort and mobility in affected dogs.
Nutraceuticals such as glucosamine and chondroitin sulphate can also help relieve pain and reduce joint inflammation. Several scientific studies of these products in a range of different species have had varying results, however their use now seems to be fairly well supported. It seems that nutraceuticals are at their most useful in the early stages of disease.
In addition, the quality of products available varies enormously and it is important to use an effective formulation, even though it may be more expensive. It is always a good idea to ask your vet for advice before using these products, especially as several good-quality products are specifically licensed for veterinary use and can be bought from them. Essential fatty acid supplements may help as well.
Acupuncture can also provide pain relief. The treatment involves placing small, sterile needles into sites in the body where they can have an effect on the nervous system to modulate pain. It is generally well-tolerated by dogs but often has to be repeated at intervals and may prove costly.
Physiotherapy can help dogs to keep mobile and maintain their muscle strength and can be used to relieve pain and stiffness too. Swimming can also be helpful as it allows dogs to exercise without their joints having to bear any weight, and massage and other techniques can also be used.
Affected dogs benefit most from several (two or three at least) short periods of exercise a day rather than one long walk and cope best if their exercise levels are consistent. The amount and type of exercise should be appropriate to the dog in question and his current ability and your vet's advice is always advisable.
Other treatments are available, some of which are less well supported by formally recognized evidence. For example there is little scientific evidence about the efficacy of various herbal and homoeopathic remedies, although there seem to be some good anecdotal reports. Magnetic therapy is commonly recommended and it sometimes seems helpful.
There is no known cure for arthritis, although effective treatments aiming to repair affected joints with ‘stem cells' are being developed. Most dogs with arthritis will deteriorate, needing more and more intensive treatment as things worsen. However some dogs, particularly younger ones, may only suffer from brief bouts of lameness and may have years of good exercise tolerance before their arthritis starts to cause them a consistent problem.
Each affected dog is very much an individual and will do best with a tailored (trial and error!) approach to his treatment and exercise regime. With appropriate treatment many affected dogs can continue to lead happy and healthy lives.
- Developmental problems such as hip and elbow dysplasia.
- Poor or distorted joint conformation.
- Old age
Often a combination of:
- Controlled exercise.