The multimodal aspects of treating osteoarthritis mean that it can be complex to manage individual cases. Factors such as staging of osteoarthritis, patient factors, environment and the owner’s ability to comply with veterinary recommendations, together result in a situation where every case can be different and require a custom set of protocols for optimal outcomes.
As part of its Xpertise programme, Vetoquinol has developed a decision tree to help clinicians adopt a structured approach that delivers consistency while also allowing for a bespoke approach to suit the patient.
The Xpertise programme brings together specialists in orthopaedics, neurology and pain management to create a series of consensus documents to guide best practice in arthritis care. The decision tree focuses especially on pain scoring as a basis for staging and designing canine arthritis protocols.
Initial pain assessment
The first step is to evaluate pain based on locomotion, palpation and limitations in function. Owner evaluation is also an important part of this initial assessment and indeed, as part of the re-assessment process to assess the impact of various treatment protocols.
Not all arthritic dogs will be experiencing pain in the early stages, despite the presence of active disease – requiring only monitoring and regular reassessment. Complementary support from supplements, exercise moderation and weight management can be implemented at a very early stage.
Where pain is present, there are a number of options. NSAIDs provide a good option for first line analgesia. If only one or two joints are involved, local intraarticular medication can be administered. If tests indicate that NSAIDs are contraindicated, the consensus document recommends a number of other medical options.
Reassessment of pain – follow up
Reassessment allows the clinician to check for the presence of any side effects and also the level to which pain is controlled. The presence of side effects may initiate a switch to an alternative NSAIDs, steroids or paracetamol.
Pain that is refractory or escalating or where there is additional loss of function, should be addressed. This could involve revisiting the diagnosis or evaluating additional medications to give alongside the current NSAIDs. Introducing additional rehabilitation techniques and aids is also a good option at this stage. This could include the use of laser, shock wave therapy, thermotherapy and active or passive exercise and massage.
Progression of canine osteoarthritis
If subsequent reassessments show that pain is still significant, other options can include surgery or intraarticular products such as platelet rich plasma and mesenchymal stem cells. Euthanasia remains an option for continuous and severe pain as the condition progresses.
The decision tree provides a useful structure that can be used to deliver a consistent approach. In all chronic conditions it is vital to support the owner as well as the patient. The Xpertise programme also offers tips on communication to help vets and nurses support the client during this journey.
