Osteoarthritis in the geriatric canine
Steven Budsberg, DVM, MS, Dipl. ACVS, is the director of clinical research at the University of Georgia College of Veterinary Medicine and professor of orthopedic surgery, with extensive research experience in OA in animals. He spoke with DVM Newsmagazine about the challenges of treating OA, especially in the older dog.
DVM: What is it about a diagnosis of OA that makes it such a challenge?Budsberg: When you see a geriatric patient with OA, the first thing in your mind is what caused it. I think it's a very important point that dogs don't just get OA. There is usually a causative situation, a problem with that joint at some point in its life. The classic example is the overweight Labrador who's about 6 years old with significant degeneration in the elbows. This OA is a sequela of a problem in the elbows the dog probably had at 6 months. So now that the dog is older and overweight, clinical signs of OA begin to manifest.
DVM: What signs should veterinarians be looking for?
Budsberg: Dogs start not doing things they used to do, and it's usually the owner who will pick up on it.
You might hear comments like: "My dog is slowing down." "He's limping a little bit." Or even, "He's just getting old." During the annual check-up, the veterinarian is able to say, "You know, the dog really does hurt in his elbows, his knees, his hips. Have you noticed anything?" If they haven't, it is within the veterinarian's purview to say, "We need to really look at this."
It can be a hard thing to tell the owner, "Your animal does hurt and you just don't know it," but often you have to step in and actually do that.
DVM: When an animal presents in acute distress, what are the first things that the veterinarian should consider when initiating treatment?
Budsberg: Many times animals are brought in for what's called the OA flare. In other words, the dog has had OA for years, but it comes in one day limping acutely. The dog is lame, and it hurts. We need to be aggressive to get that acute flare under control — the two-, three- or four-day pain that really hurts needs to be managed with rest and pharmaceutical therapy.
For us the acute flare is managed with non-steroidal anti-inflammatory drugs (NSAIDS). It is very important to use an FDA-approved drug since we have so many to choose from. These drugs have gone through extensive efficacy and safety testing at the recommended dosage regimens.
If the animal is in extreme pain, we can use narcotics such as fentanyl patches or injectable products. There's a lot we can use in this acute period. Once you get the flare under control, then you need to address its chronic problem.