Osteoarthritis (OA) affects an estimated 25 percent of dogs (1), and while figures differ depending on population studies, recent reports suggest this number could be even higher. This figure is staggering, especially in light of knowledge that osteoarthritis is a common consideration in quality of life decisions. Starting the discussion about canine OA early can help patients live with OA.
Early Detection of Osteoarthritis in Dogs: Why It Matters
It’s important to identify dogs who are at increased risk of developing OA so that risk factors can be controlled and so that the dogs can be proactively monitored for the development of clinical signs. With proper education, pet owners can play an integral role in this process. Early detection of OA enables timely initiation of a management plan aimed at controlling pain and inflammation, building muscle strength, and maximizing range of motion and mobility. However, we know that it can be difficult for pet owners to recognize the early signs of OA, meaning that joint degeneration can continue unnoticed. Delays in the spontaneous reporting of symptoms can make it more challenging to control pain and adequately restore function. Once dogs are presented in the moderate to severe stages of arthritis, their degree of discomfort can range from moderate to unbearable.
The initiation of OA sets in motion a vicious cycle of deterioration. Joint degeneration leads to joint pain, decreased use of the limb, weakening of periarticular structures and disuse muscle atrophy, further joint misalignment, compensatory gait changes and pain in other regions, a further reduction in mobility and exercise ability, and so on. Weight control becomes more challenging, placing extra stresses on the joints and a reduction in mobility/range of motion is detrimental to joint health. If pain is uncontrolled, it can lead to pain sensitization and maladaptive pain, which is more difficult to manage. It is also more challenging to rebuild periarticular strength and support when pain and structural changes are more advanced. When OA and OA risk factors are picked up early, it is possible to intervene sooner with an OA management plan that can delay the severity of the disease (2). Starting from a less advanced point means that the care plan is built on a stronger foundation, because not as much deterioration in the joint, periarticular and muscular structures has taken place.
Once clinical OA is confirmed, drug and non-drug therapies are part of a balanced multimodal approach. NSAIDs such as Galliprant® (grapiprant tablets) are often considered to be a cornerstone of canine OA treatment because pain control is not only important for the welfare and comfort of the animal but also facilitates other elements of their OA management plan. For example, pain relief is required to help dogs get the maximum benefit out of their exercise program. Important non-pharmacological modalities include weight control, canine exercise and physical rehabilitation programs, therapeutic joint support diets and empirically evaluated joint supplements. Nutritional and nutraceutical intervention have a protracted time course for efficacy, however, so immediate changes should not be expected.
Signs of Canine Osteoarthritis
Canine osteoarthritis signs are just as diverse as dogs themselves. From slowing down on walks to subtle changes in posture and motion, signs of early OA can be difficult to detect for both pet owners and veterinarians: Pet owners may struggle to see subtle changes in their dog’s behaviour or mobility and if a dog doesn’t present at the clinic for a problem, then the veterinarian has limited opportunity for evaluation. Helping owners to understand and recognize the signs of canine OA is a key step in detecting the disease early.
A proportion of dogs without clinical signs of OA have an increased risk of developing OA due to breed predisposition, joint injury, obesity, intense activity and/or radiographic signs of dysplasia or joint trauma. Pet owners who are engaged and aware of OA risks can proactively monitor their dogs at home and remove or reduce risk factors where possible (e.g., through weight control and appropriate exercise). With both the veterinary team and pet owners keeping an eye on pets, clinical changes can be spotted earlier and veterinarians can respond and treat patients sooner.
Owner reporting is an important part of the early detection of OA and may be facilitated by directed questionnaires. Validated clinical metrology instruments (CMIs), such as the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire, can be easily integrated into clinical history gathering. Based on 13 specific questions, evaluating various aspects of canine mobility, LOAD is designed to help identify and monitor dogs with OA and provide an indicator of disease severity.
The orthopedic examination is an essential step in assessing dogs for signs of OA, providing a professional evaluation of aspects such as posture, gait, pain upon manipulation and range of joint motion. Even subtle or mildly abnormal changes, such as a slight shift in static body weight distribution, slight lameness and/or stiffness in gait, a minimally reduced range of motion or slight joint thickening, should trigger a discussion of OA regardless of patient age. Many pet owners are able to capture videos on their mobile phones, providing useful insights into their dog’s behavior and activity at home or outside.
As OA progresses, owners may report that their dog is reluctant to engage in a wide variety of activities. Some owners notice and report that their dog no longer greets them in the morning or no longer jumps onto the couch. They often explain away these changes as their dog “is just getting old” or slowing down. They may not realize that age is not a disease, and that this slowing down could be related to moderate to severe OA. Symptoms of moderate OA include obvious abnormalities in limb loading and/or static body weight distribution, stiffness or other consistent abnormalities in motion at all gaits, an obvious reduction in use of the affected limb, and some difficulty in rising. Signs of severe OA in dogs include a general reluctance to move, severe lameness and weight shift, and marked difficulty when getting up.
Educating clients and helping them understand the importance of addressing signs of canine OA can be challenging and time consuming. By starting the discussions with pet owners early in their dog’s life, information can be transferred gradually, building understanding and maintaining engagement in a very organic way. Taking advantage of all the tools at our disposal can also make it easier to identify risk factors and the early signs of OA.
5 Ways to Help Identify Early Canine Osteoarthritis
#1 A Standardized Approach Like COAST
The Canine Osteoarthritis Staging Tool (COAST) is a way of providing a standardized approach to evaluate and monitor dogs either “at risk of” or with clinical signs of OA. It enables veterinarians to stage dogs according to disease severity. Developed by a consortium of international experts in veterinary surgery and pain management, it includes assessment of the joints as well as an overall evaluation of the impact of the disease on the dog as a whole. COAST can be useful in monitoring for changes compared to a prior visit (e.g., at an annual interval or more frequently if required). The report can also serve as a visual aid to help owners understand your findings and compel them to take action. When results are presented in a simple documented format, it can help explain what is being monitored to owners and help them visualize any changes.
The COAST stages track from 0 (clinically normal, no risk factors) through 4 (clinical OA, severe). The staging incorporates pet owner input from any appropriate CMI (such as LOAD), as well as a full veterinary assessment. COAST includes additional web-based materials for extended client education.
#2 Pet Owner Input
Giving a pet owner something to do in the clinic while they wait for their appointment can both improve client experience and help provide us with valuable information about their pet. The LOAD questionnaire is designed, tested, and validated for evaluation of canine OA. Completed by the owner, it is easily compiled and stored as part of a patient’s record. In addition to the answers provided and the total score generated, LOAD also encourages owners to think about their pet’s activity and lifestyle and can improve the quality of the history they provide. In addition to providing useful information at a first visit, the LOAD questionnaire can be used to track changes in mobility and monitor patients. LOAD is simple and easy to complete, making it a useful, stand-alone tool for frequent evaluations. It can also be used as a component of the more detailed and complete COAST evaluations.
Obtaining a complete and accurate history is time-consuming, but LOAD is one of the most important tools available for diagnosing diseases that may affect factors like canine mobility and activity, both having a potential impact on the human-animal bond.
#3 Discussion of Risk Factors
When pet owners bring their new puppy to the clinic, the focus is on facilitating the bonding process, and veterinarians are conscious that bringing up health issues and risks common to the breed can be a sensitive subject. However, we are also aware that the first year of life is an important time when it comes to OA and there is a lot to communicate in a short period of time. Owners need to understand the importance of weight management and good nutrition, the need to maintain an appropriate growth rate and how to provide the right level of exercise. The second part of their primary vaccination course can be a useful time to start discussing these important points and begin educating new pet owners about their dog. Breed-related risks can be included in those discussions, along with diet, preventive health care, microchipping, and sterilization. Ideally, separately scheduled visits are set up as a complementary part of the puppy visits, especially if the puppy is an “at-risk” breed. This is another opportunity to further educate and engage pet owners as well as being rewarding work for a multi-disciplinary team.
Recording both body condition score (BCS) and muscle condition score (MCS) is an excellent way to track changes to body composition over time. Appropriate weight and adequate muscling can reduce a dog’s risk and increase age of onset of osteoarthritis. For dogs that are pre-clinical but with increased risk of OA, weight optimization, appropriate exercise, and omega-3 fatty acid supplementation (3) may aid in giving the pet more years of pain-free life. For overweight and obese dogs, a weight loss program is an important part of their OA management plan.
#4 A Quick Orthopedic Exam, Every Visit
Appointments tend to be time pressured but incorporating a quick orthopedic examination at every visit can help us pick up changes quickly. Evaluating a dog’s gait as he gets up and walks into the room can provide a lot of useful information and a quick, yet accurate, orthopedic evaluation can be achieved in just a few minutes. The physical examination can also serve as a first step in education or a useful reminder for pet owners. For example, palpating the stifles of a small-breed puppy predisposed to patellar luxation is a perfect time to mention watching for intermittent lameness or “bunny hopping.” Even if no action needs to be taken, hearing the same warning at each visit will increase the likelihood that owners will notice and report these signs should they develop. For dogs with clinical signs of OA, the orthopedic examination can be an opportunity to help owners relate to the impact of the disease. Seeing how the range of motion differs between elbows or feeling a crunchy joint can help them relate to activity difficulties or understand that a joint is painful.
#5 A Collaborative Approach
Pet owners may occasionally need additional help to identify that early OA is a problem for their dog. Consolidating and discussing all the findings from the above approaches should help, but it can sometimes be difficult for them to understand that even early clinical signs of OA are associated with pain. Repeat video recordings of specific activities over time can also help to show further deterioration, but this has welfare implications. A trial period (e.g., 2 to 4 weeks) of pain control can be an effective way of providing patient comfort while asking owners to watch for any changes in their dog’s activity/behavior during that time. This approach is a plan B and is only undertaken with the collaboration of the pet owner, but it can be an effective way to show positive improvements as a result of pain reduction. The use of LOAD or similar tools during this time can help reduce subjectivity while still keeping the “diagnosis” in the hands of the pet owner.
Osteoarthritis is one of the most common causes of pain in dogs. Through a multimodal approach to management that begins early in life, veterinarians can help reduce this burden. Pain medication is an important piece of the toolkit, alongside weight management, physical rehabilitation, exercise and appropriate nutritional support.
Galliprant® is an NSAID that controls pain and inflammation associated with osteoarthritis in dogs.
Galliprant® Important Safety Information
Not for use in humans. For use in dogs only. Keep this and all medications out of reach of children and pets. Store out of reach of dogs and other pets in a secured location in order to prevent accidental ingestion or overdose. Do not use in dogs that have a hypersensitivity to grapiprant. If Galliprant® is used long term, appropriate monitoring is recommended. Concomitant use of Galliprant® with other anti-inflammatory drugs, such as COX-inhibiting NSAIDs or corticosteroids, should be avoided. Concurrent use with other anti-inflammatory drugs or protein-bound drugs has not been studied. The safe use of Galliprant® has not been evaluated in dogs younger than 9 months of age and less than 8 lbs (3.6 kg), dogs used for breeding, pregnant or lactating dogs, or dogs with cardiac disease. The most common adverse reactions were vomiting, diarrhea, decreased appetite, and lethargy. Click here for full prescribing information.