Editor's Note: Ronald McLaughlin, DVM, DVSc, Dipl. ACVS, is a professor and chief of Small Animal Surgery at the College of Veterinary Medicine, Mississippi State University. He also is chief of staff at Mississippi State University's Animal Health Center and head of the Department of Clinical Sciences.
DVM: Do you see patients in a clinical setting, or do you devote your time to research and teaching only?
DVM: You've done a lot of research on osteoarthritis treatments. Tell us about your conclusions.
McLaughlin: Most of my research in this area has been on the management of osteoarthritis, not necessarily in geriatric patients, but in all ages. We've done clinical evaluations of new and existing nonsteroidal anti-inflammatory drugs (NSAIDs), nutraceuticals and other agents. We look to see if certain agents or newer drugs are more effective than what currently is being offered, if patients are more comfortable and whether these drugs should be part of the overall treatment for patients.
There's increasing evidence—in fact, a substantial body of knowledge now—that NSAIDs and nutraceuticals do help control inflammation and reduce the signs of osteoarthritis and, as such, are valuable treatments. However, there are still questions to be answered about which treatments are best and what new treatments might help improve patients' quality of life.
DVM: For veterinarians in clinical practice, what would you recommend as the most effective ways for them to relieve the signs of this condition in older canines?
McLaughlin: The ideal approach is a multimodal one. One treatment alone is unlikely to be fully effective. Rather, a combination of treatments helps make patients more comfortable and relieves signs. A good multimodal approach would entail NSAIDs for anti-inflammatory properties; analgesics for pain; nutraceuticals for comfort and to preserve cartilage; proper nutrition, for example, an omega-3-based diet; weight control or weight loss and physical therapy.
DVM: Are certain breeds most at risk?
McLaughlin: We see osteoarthritis in all breeds of both dogs and cats. That said, we do tend to see older, large-breed, athletic and working dogs with this condition. For the latter two, it may be that their signs are more obvious because the osteoarthritis affects their work.
DVM: What medications would you recommend? Any common contraindications or side effects veterinarians should watch for?
McLaughlin: Long-term use of NSAIDS can cause renal and gastrointestinal problems, especially in geriatric dogs. Veterinarians should watch for clinical signs of those complications and regularly get blood work done on such dogs. Also, veterinarians should never give an animal two NSAIDs at the same time.
A multimodal approach as I described earlier can enable veterinarians to lower the dosage or reduce the frequency of NSAID treatments, which is especially important in dogs that must be on NSAIDs for a long time.
DVM: Other than medications, what treatments, if any, have demonstrated relief in dogs? For example, physical and exercise therapy, massage, acupuncture or any other alternative medicine treatments?
McLaughlin: A lot of work has been done in alternative therapies to see if they reduce osteoarthritis signs. For example, physical therapy is becoming more common in veterinary medicine. With the right protocols and physical therapy modalities, patients have improved.
There's also been recent research that looked at laser therapy, electrostimulation and therapeutic ultrasonography that have shown some benefits, but more work is needed in these areas. The body of knowledge around nutraceuticals certainly has increased and does show some positive effects, though some seem more effective than others, based on the research.
DVM: Are there any new and promising treatments down the road for this condition?
McLaughlin: Yes, some newer NSAIDs are in the pipeline, and some are very effective and have fewer side effects than current options. Also, we're seeing some newer rehabilitation techniques and even gene therapy that look promising. And in the surgical field, some cartilage replacement and resurfacing techniques have shown early promise.
DVM: Speaking of surgery, when should a veterinarian recommend surgery for arthritic patients, and what types of surgery tend to work best?
McLaughlin: In those osteoarthritis cases in which the medical therapy is ineffective or there are complications—or in athletic or working dogs—we're more likely to move to surgery more quickly that in other cases. Also, if we see the condition in younger dogs, we may suggest treating the joint injury earlier rather than later.
Much of the surgery done on these dogs includes corrective surgery for osteoarthritic hips and joints with ligament ruptures. At the end, for patients with severe osteoarthritis, we use palliative measures to relieve the pain. These include arthrodesing painful joints and even joint replacement. Hip joints are commonly replaced to restore function, and elbow and knee replacements are showing early potential in dogs.
DVM: Are there any popular misconceptions in the veterinary community about osteoarthritis treatment that you would like to dispel?
McLaughlin: NSAIDs alone won't solve this problem. They're not an ideal long-term treatment. Sometimes, a veterinarian may have to try different NSAIDs in different patients, but never two at the same time, as that increases the risk for complications substantially.
DVM: What should dog owners do to reduce their aging dogs' risks for arthritis? That is, what advice should veterinarians give their clients?
McLaughlin: Clients should be reminded of the clinical signs of osteoarthritis and should look for them in their dogs, especially older dogs. Once the disease becomes severe, it's much more difficult to treat. The earlier we catch this disease, the more effective the treatments will be, and the more comfortable the dog will be.
DVM: And the signs clients should watch for?
McLaughlin: If their dogs are starting to slow down and be less active. Clients tend to think, "Well, the dog is just getting older." But if the dog isn't running, playing or catching a ball like it used it, it could be because the animal's joints are uncomfortable and the dog is in pain. It's best to get the dog checked out. Again, the earlier we can catch this condition, the easier it is to treat. With early detection, our success rate is much higher.
Loyle is a freelance medical editor and writer in Philadelphia and the former primary editor of the North American Veterinary Licensing Examination.