/// QUARTERLY BEAT / APRIL 2022
QUARTERLY BEAT / APRIL 2022 ///
is pro-inflammatory (e.g., arachidonic acid) and therefore bad. Diets with higher concentrations of omega-3 fatty acids (fish oils, flaxseeds, walnuts) showed significantly improved lameness over dogs fed a conventional diet, 6 so veterinary therapeutic dog food manufacturers strive for a low omega-6/omega-3 ratio. (Table One – BLUE W+M versus Other Mobility Diets). Roughly speaking, the recommended dose of EPA and DHA for dogs with OA is about 1000mg/day for every twenty pounds of body weight, so check the label on over-the-counter fish oil products to make sure they are cost effective and don’t require regular dosing of dozens of stinky capsules. THE TRUTH ABOUT GLUCOSAMINE AND CHONDROITIN SULFATE Both glucosamine and chondroitin sulfate are building blocks for the cartilage matrix and based on in vitro studies, they also appear to suppress proteolytic enzymes and inflammatory cytokines. But do they offer anything beyond a placebo effect for our arthritic dogs? One randomized double-blind study showed arthritic dogs treated with glucosamine and chondroitin sulfate demonstrated significant improvement in weight bearing, pain and severity of lameness some 70 days after starting treatment, but this was based on subjective assessment. 7 And then there’s the question of dosage regimes and bioavailability, with a paucity of information on exactly how much glucosamine and chondroitin sulfate actually finds its way to synovial joint to work their magic. 8 Despite these frustrations, there is enough imperfect evidence to suggest chondroprotective supplements are a worthwhile addition to a treatment plan to offset canine OA, so long as you bear the following in mind. Glucosamine and chondroitin sulfate are better at prevention, so start your patients on these supplements as soon as you make a diagnosis e.g., elbow or hip dysplasia, to try to get ahead of cartilage damage. Both supplements can take eight to twelve weeks before an owner appreciates a clinical benefit, so stress patience, and if cartilage erosion and arthritic change is severe, chances are you’re way too late for these supplements to be helpful. Bottom line, when it comes to canine OA, proactive trumps a reactive approach every time, so work with your clients to find a multi-modal approach that combines a plan to prevent or minimize existing disease through a combination of healthy diet and lifestyle.
References: 1.
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Smith GK, Paster ER, Powers MY, et al. Lifelong diet restriction and radiographical evidence of osteoarthritis of the hip joint in dogs. J Am Vet Med Assoc 2006, 229: 690-693. 2. Marshall WG, Hazewinkel HAW, Mullen D, et al. The effect of weight loss on lameness in obese dogs with osteoarthritis. Vet Res Commun 2010, 34(3): 241-253. 3. Chapman M, Woods GRT, Ladha C, et al. An open-label randomized clinical trial to compare the efficacy of dietary caloric restriction and physical activity for weight loss in overweight pet dogs. Vet J 2019, 243: 65-73. 4. Mlacnik E, Bockstahler BA, Muller M, et al. Effects of calorie restriction and a moderate or intense physiotherapy program for treatment of lameness in overweight dogs with osteoarthritis. J Am Vet Med Assoc 2006, 229(11): 1756-60. 5. Frye CW, Shmalberg JW, Wakshlag JJ. Obesity, Exercise and Orthopedic Disease. Vet Clin Small Anim 46 2016: 831-841. 6. Roush JK, Cross AR, Renberg WC, et al. Evaluation of the effects of dietary supplementation with fish oil omega-3 fatty acids on weight bearing in dogs with osteoarthritis. J Am Vet Med Assoc 2010, 236: 67-73. 7. McCarthy G, O’Donovan J, Jones B, et al. Randomized double- blind, positive controlled trial to assess the efficacy of glucosamine/ chondroitin sulfate for the treatment of dogs with osteoarthritis. Vet J 2007, 174(1): 54-61. 8. Comblain F, Serisier S, Barthelemy N, et al. Review of dietary supplements for the management of osteoarthritis in dogs in studies from 2004 to 2014. J Vet Pharmacol Therap 2015, 39: 1-15.
Strategies to Avoid Surgery for Canine Osteoarthritis
NICK TROUT , MA, VETMB, MRCVS, DIPLOMATE ACVS, DECVS Angell Animal Medical Center, Boston, MA
Whether we are talking about our own health, or our pets, if there’s a decent medical treatment option for a disease, with a good chance of avoiding surgery, we’re going to jump all over it. Osteoarthritis (OA) is one such disease. It remains incurable, and progressive, and when it comes to dogs, reportedly affects twenty percent over one year of age, therefore producing a major negative impact on mobility and quality of life for a huge chunk of our patient population. Be it elbows, hips, knees, or spine, trying to minimize the progression of degenerative changes in synovial joints, for as long as possible, has universal appeal, and there are three major ways to make this happen, long before you are forced to reach for a bottle of anti-inflammatories.
BLUE RUNS NOTMOGUL FIELDS! If you’ve got bad knees but you still want to ski, best to choose the runs that are a little less challenging, a little gentler on your joints. Unfortunately, when it comes to dogs, way too many go black diamond every time, paying the price for days to come. We need to apply our own appreciation of the cost of excessive exercise to our canine friends and impose limitations, starting with a discovery of what constitutes “good” versus “bad” activity. Clients should begin with leash walks, getting longer and longer by five minutes every couple of days, looking for the ‘switch’ between well tolerated walks and those resulting in soreness, stiffness, or other markers of discomfort. If thirty minutes is “good”, but forty minutes means the climb upstairs that evening will be a challenge; stick with thirty minutes. Recommend playing with terrain—grass, asphalt, woodland, beach, inclines, and declines—and how it impacts post-exercise recovery, before working on length and type of exercise off leash, alone in the backyard, or with dogs at a dog park or doggy day care. Often this is easier said than done, but by careful observation and trial and error, over a period of weeks, clients can be closer to finding a healthy level of activity that avoids the cumulative effects of soreness, and deterioration of the affected joints. A DECISION TO TRY While food motivated dogs may not like it, maintaining (or acquiring) a healthy body weight and condition score can have a profound impact on lameness secondary to osteoarthritis (OA). One study took a preventative approach by offering different amounts of food to two groups of eight-week-old Labs; group one was fed ad lib (control), the second group fed twenty-five
percent less (restricted). 1 Followed over a lifetime, the median age of radiographic evidence of hip OA was significantly lower in the control group (six years), compared to those on restriction (twelve years). Arguably a more “real world” study demonstrated how weight loss in obese dogs can have a profound impact on lameness secondary to OA. Subjectively, a 6.1% weight reduction onwards produces a significant decrease in lameness. Objectively, that number increases to 8.85% when using kinetic gait analysis. 2 Either way, modest and doable weight loss can be a game changer both to protect against the progression of OA and improve function and comfort in the face of it. Some owners will ask, if my dog is overweight or obese (body condition score 6-9/9) which approach works best—dietary caloric restriction or increased physical activity? The answer is diet, 3 although adding in some intense physical therapy has proven to enhance osteoarthritic joint mobility while facilitating weight loss. 4 MORE THAN JUST BODYWEIGHT The interplay between OA and obesity is far more complicated than just extra body weight increasing load on synovial joints that exacerbates cartilage damage. In humans, there is a strong correlation between obesity and OA in the hand, despite the hand being a non-weight bearing joint, prompting concerns that obesity may contribute to the inflammatory process through direct cell signaling, and interaction with immune cells. 5 Although the role of inflammatory mediators released from adipose tissue remains unclear, the role of polyunsaturated fatty acids (PUFAs) in the canine diet is well documented. Keeping it simple, where OA is concerned, omega -3 (e.g., eicosapentanoic acid {EPA} and docosahexanimic acid {DHA}) are good, anti-inflammatory, whereas omega-6
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