Alternatives to veterinary surgery in osteoarthritis

It may originate from instability, chronic inflammation, joint incongruence or a pathological process that produces diseased cells in the joint. In dogs, it is often the result of mechanical wear due to different reasons. This wear initiates a physical disruption of the cartilage surface, which subsequently causes the onset of biochemical changes that will affect the entire joint by breaking down joint tissues.

When it comes to osteoarthritis, the sooner the better.

Osteoarthritis (OA), also known as degenerative joint disease or arthritis, is a very painful, chronic and degenerative inflammatory disease that affects the synovial joints and eventually leads to a loss of mobility. It is very common in older dogs and there is still no definitive cure. Treatment may involve veterinary surgery, but there are other alternatives.

It may originate from instability, chronic inflammation, joint incongruence or a pathological process that produces diseased cells in the joint. In dogs, it is often the result of mechanical wear due to different reasons. This wear initiates a physical disruption of the cartilage surface, which subsequently causes the onset of biochemical changes that will affect the entire joint by breaking down joint tissues.

The aim of the therapeutic approach is to improve the dog’s quality of life by eliminating or reducing pain and inflammation, thus recovering lost mobility. Given that the disease is degenerative and progressive, treatment should be started as soon as possible.

Conservative treatment to improve dog mobility: veterinary surgery or nonsurgical treatment

Osteoarthritis can be treated through veterinary surgery or by nonsurgical means. Nevertheless, nonsurgical treatment should be the first choice, as it is successful in a lot of cases.

Any treatment should be approached while considering all the components of the joint: cartilage, bone and synovial capsule.

Conservative medical treatment:

• Use of nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and as symptomatic pain relief. These will inhibit the inflammatory pathway of cyclooxygenase (COX I and COX II), while selective COX II inhibitors (e.g. carprofen) should be the drug of choice for long-term treatment as they have fewer gastrointestinal side effects and a greater clinical benefit. Pay attention to the gastrointestinal side effects.
• Pain relief with analgesics. Paracetamol and tramadol are the most widely used in veterinary medicine.
• Restriction of dietary intake to delay the onset and progression of OA. In overweight dogs, weight loss as monotherapy has achieved pain relief and improved the function of limbs with OA joint pain. Daily walks on a lead are recommended for these patients. Gentle exercise (swimming, walking) for short periods is ideal for improving the dog’s physical health and weight control. As a result, the limbs will have to support less load, thus facilitating joint mobility which is necessary to improve the condition of the synovial lining and cartilage, plus it also helps maintain body weight and reverses any muscle atrophy that may have developed.

Nutritional treatment:

A good nutritional approach can help reduce the pharmacological load in OA and, therefore, the consequent side effects.

• The available evidence suggests that the prescription of diets with high amounts of omega-3 fatty acids (n-3 fats) is effective in the management of OA. These supplements are widely used in human medicine and supporting evidence has also been presented in veterinary medicine. A high intake of n-3 fats displaces the biosynthesis of omega-6 fatty acid-derived eicosanoids, which have vasoactive and proinflammatory properties, in favour of n-3 series-derived eicosanoids, which have a lesser proinflammatory nature.
• Use of chondroprotectors: The combination of glucosamine and chondroitin sulphate stimulates cartilage metabolism, thereby inhibiting its degradation and reducing the clinical signs both in patients with OA and after veterinary surgery.
• Hyaluronic acid taken orally is absorbed in the intestine and  deposited in the joints. Its supplementation significantly improves the quality of life of patients with OA.
• Consuming vitamin K prevents the loss of bone mass and reduces the risk of fractures and incidence of osteoarthritis through increased bone mineralisation and bone/cartilage formation and the inhibition of cartilage calcification.

An appropriate diet combines nutrients in order to modify the different joint structures (bone, cartilage, synovial membrane) affected by OA and alter the pathological biochemical pathways (anti-inflammatory, antioxidant) to help slow the progression of the disease and alleviate the clinical signs.