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PHARMACEUTICALS AND NUTRICEUTICALS
There are numerous treatments and products available to manage joint pain and each one has proponents and detractors. One thing that is agreed on by experts is that arthritis management should be "multimodal" which means best results come when many different approaches are used concurrently. (Not just a variety of medications and supplements but also other techniques such as weight loss and physical therapy.)
The goal of this page is to review the most common medications and supplements so you can more wisely choose how to cover multiple areas of the inflammatory cascade and achieve good pain-free mobility in your pet. But what should you choose? What products should you ask your veterinarian about when your pet's regimen is assembled? You want safety for your pet but also good effect and you certainly do not want to use incompatible products accidentally. We will divide options up into groups.
TABLE OF CONTENTS: MEDICATION CLASSES REVIEWED IN THIS PAGE
CARTILAGE AND MUSCLE SUPPORT SUPPLEMENTS/CHONDROPROTECTANTS
The body has natural mechanisms to rebuild damaged cartilage and improve muscle mass on its own but these mechanisms require raw materials. A common method of addressing arthritis, especially when it is in earlier stages, is to provide these materials orally as nutritional supplements. There are numerous supplement brands available both on the human and the pet retail markets, no prescription required. There are two important caveats:
GLUCOSAMINE AND CHONDROITIN SULFATE (Dog or Cat)
CREATINE (Dog or cat)
MSM (dog or cat)
These materials are almost always included in anti-inflammatory supplement products (listed later) and may have anti-inflammatory features beyond simply being cartilage or muscle building blocks.
FAST-ACTING PRESCRIPTION ANTI-INFLAMMATORIES (NON-STEROIDAL ANTI-INFLAMMATORIES AND THE NEW PIPRANT CLASS)
Use only one medication from this group as they are not compatible with each other nor with corticosteroids.
These medications work by suppressing the effects of prostaglandins. Prostaglandins are important mediators of inflammation and pain in joints and we definitely want less of them. That said, there are "good" prostaglandins that one needs to maintain kidney and stomach circulation as well and we definitely want to keep those. So we want to hamper bad prostaglandins and leave the good ones alone.
COX PREFERENTIAL NSAIDS
Prostaglandins are created with certain fatty acids are liberated from our cell membranes and converted into prostaglandins by an enzyme called cyclooxygenase. There are two main forms of cyclooxygenase: COX-1 (which makes "good" prostaglandins) and COX-2 (which makes the bad ones). A huge development in pain management for pets as well as humans was the development of NSAIDs that preferentially suppress COX-2 over COX-1. Less suppression of COX-1 opened a new door in safety. Medications of this category are:
COX-SELECTIVE NSAIDS (THE COXIB CLASS)
Soon there was a next generation in NSAIDS: medications that didn't just prefer COX-2 over COX-1; they only suppressed COX-2. Whether or not this advancement actually translates into even greater safety is of some controversy but theoretically, at least, it represents an advancement in maintaining "good" prostaglandins. There are numerous members of the coxib class available for pets:
THE PIPRANT CLASS
In 2017, a new pharmaceutical approach entered the scene: the piprant class. These anti-inflammatories do not suppress either COX; instead they interfere with the EP4 receptor, a prostaglandin receptor involved in pain generation. This new way to address inflammation solves the issue of preserving COX-1 and solving some of the side effects issues that have been problematic for more traditional NSAIDs. At the present time there is only one piprant on the market:
The beauty of the prescription medications is that they work quickly (minutes to hours) though since pets cannot talk, it may take a week or so before an obvious improvement in mobility becomes evident. They have reliable efficacy plus they also carry with them the background of thorough scientific testing for both safety and efficacy that go with FDA approval (at least for dogs).
A WORD OR TWO ON ASPIRIN AND HUMAN NSAIDS
Human beings are much more resistant to the problems caused by suppressing "good" prostaglandins. Some of us are sensitive and need special NSAIDs like celebrex® but most of us can just grab a bottle of ibuprofen out of the medicine cabinet and take a couple of pills when we have inflammatory pain. The problem with the human over-the-counter NSAIDS is that they suppress all prostaglandins both good and bad and this is not really optimal/safe pain treatment for dogs and is out of the question for cats. When it comes to NSAIDs in particular, it is crucial to consult your veterinarian.
THE FELINE SITUATION
STRAIGHT PAIN RELIEF MEDICATIONS (usually adjuncts to the NSAIDs)
The anti-inflammatory pain relievers not only relieve pain but they do so by actually altering the disease process. Straight pain relievers do nothing for the disease process but they do help with the pain. They can be combined with each other and/or with an any of the other medications/supplements listed here assuming the individual patient does not have a condition precluding their specific use. These medications have some potential for drowsiness which will make a weak animal even weaker so it is important to find the dose that relieves pain and improves mobility without making the pet sleepy (which would discourage mobility).
GABAPENTIN (dog or cat)
This medication is particularly beneficial for neurologic/spinal pain as it alters how pain is transmitted in the spinal cord. It also has anti-anxiety effects. It definitely has a drowsiness side effects and is used as a tranquilizer in higher doses especially in cats. It comes in a capsule which means it is hard to dose in small patients as the capsules cannot be cut accurately at home. Custom-made liquid formats have been especially popular.
In cats (and people), this medication is split in the body into two active metabolites: a narcotic pain reliever and an anxiety relief medication. It should have good pain relieving properties but can create sedation or mental alteration. It may be difficult to reduce the dose with accuracy as feline doses are typically quarter tablets and it is hard to cut pills smaller than this.
AMANTADINE (dog or cat)
This medication helps reduce what is called "wind up pain" where chronic pain has sensitized nerves to a point where experiences that should not normally be painful become painful. This sensitization phenomenon happens after pain has gone unrelieved for a long time (exactly how long is of some controversy). Availability of a reasonably priced oral liquid has been very helpful for administration to small patients but there is some potential for sedation especially when combined with other medications on this list.
SUPPLEMENTS WITH ANTI-INFLAMMATORY PROPERTIES
There are a number of natural extracts and herbal products with anti-inflammatory properties. Some are anti-oxidants (which strike at the actual progression of arthritis) while others interfere with the inflammatory cascade to limit pain as well as the inflammation. Most are modest in their abilities. Some are fast acting while others must build up in the body for several weeks. Many have multiple therapeutic actions. As with all supplements, the FDA does not require proof of efficacy or quality control, only proof of safety so the reputation/certification of the manufacturer is very important.
GREEN-LIPPED MUSSEL EXTRACT (PERNA CANALICULUS) (dog or cat)
As mentioned, inflammation is mediated by prostaglandins (produced by cyclooxygenase) and leukotrienes (produced by 5-lipoxygenase). Green-lipped mussel extract is inhibitory to 5-lipoxygenase. It's effect produces mild pain relief only and take several weeks to exert visible effects.
OMEGA THREE FATTY ACIDS (dog or cat)
Certain dietary fats, typically from cold water fish oils, have been found to have anti-inflammatory properties. While this finding has primarily been utilized in the treatment of itchy skin, many arthritic dogs and cats have also benefited from supplementation. While there are no toxic issues to be concerned with, these products require at least one month to build up to adequate amounts. Effects are not usually dramatic but can be helpful.
Caution about flax seed oil: It should be noted that the flax seed oil is readily converted to omega three fatty acids in the human body. This conversion is not so easy in the canine or feline body (only about 10% of the oil is converted). It is a waste to add flax seed oil to pet food; fish oils are needed. Numerous brands are available and the chances are your veterinarian stocks one. The appropriate dose is still somewhat controversial but the ratio of EPA (eicosapentanoic acid) to DHA (docosahexanoic acid) should be 3:2.
DRIED MILK PROTEINS (dog or cat)
To create an anti-inflammatory product, dairy cows are hyperimmunized so as to produce milk rich in assorted anti-inflammatory factors. These are refined into medical treats for dogs and cats. Unlike chondroprotectants, the onset of action is rapid (starts working in 4-7 days with maximum effect in 10-14 days) as they are anti-inflammatory biochemicals, and refilling a depleted store of cartilage building blocks.
POLYPHENOLS: PHYCOCYANIN, GRAPE SEED OIL, GREEN TEA EXTRACTS, TURMERIC (dog or cat)
AVOCADO/SOYBEAN UNSAPONIFIABLES (OFTEN SIMPLY CALLED "ASU") (dog or cat)
These are anti-inflammatory biochemicals extracted from avocados and/or soybeans leaving the fats behind. They promote cartilage repair and inhibit the inflammation-associated cartilage degradation that occurs in arthritis.
Free radicals are harmful biochemicals that can attack us from external sources (such as pollution, sunlight, etc.) or we make them ourselves as by-products of oxygen use. These harmful little molecules are highly reactive and attack our structural proteins as well as cause production of assorted inflammatory proteins. One prominent theory of aging centers on free radicals with the idea that the damage free radicals cause to our brains, skin, joints etc. is the foundation of age-related debilitation. Normally, our bodies use natural anti-oxidants to inactivate free radicals; by supplementing with additional anti-oxidants, age-related change can be retarded.
Anti-oxidants that are readily available include Vitamin C, Vitamin E, SAMe, Superoxide Dismutase (S.O.D.) and others.
This technique, currently only available using a product called "Synovetin OA," employs radioactive agents injected directly into the joint to increase joint fluid and reduce inflammation. The treatment is performed once a year and is currently only licensed for canine elbow arthritis. Because radioactive materials are involved, only specially certified locations may offer this therapy. The technology is very new but more information is available at synovetin.com
INJECTIONS AND SPECIALIZED PRODUCTS
PLATELET RICH PLASMA
The concept here is to harvest blood from the patient and separate out the red and white blood cells leaving behind the plasma and platelets. The platelets would be active and present in a concentration much higher than what is circulating in the regular bloodstream. The plasma is at this point said to be "platelet rich" and is injected into the patient's diseased joints.
Platelets are blood cells involved in blood clotting but it turns out they are also packed with growth and healing factors that are useful in inflammatory joint disease. This is a new therapy and how it compares to less exotic treatments is still in question but it does function as an alternative to drugs. Possible pitfalls include the fact that virtually all the necessary blood processing equipment is made for human blood and the canine plasma quality that results is not consistent with what the same equipment produces for human samples. Also, the plasma must be injected directly into the joint so care must be taken not to introduce infection.
STEM CELL THERAPY
This is an other regenerative therapy that yields a product that is made from the patient's own tissue (usually fat) and processed into a product that is injected into the patient's own joint. The necessary fat harvesting requires general anesthesia and is a surgical procedure. The fat is either processed in the animal hospital or sent to a laboratory for refinement. As with platelet rich plasma therapy, stem cell use for arthritis is a new therapy and while it has been shown to have good effect, it has not been compared to less invasive/expensive modes of therapy.
Injecting corticosteroids into joints is not a new practice and neither is injecting hyaluronic acid (a natural portion of the cartilage structure). There is controversy regarding the effectiveness and risk of infection in these procedures.
This technique, currently only available using a product called "Synovetin OA," employs radioactive agents injected directly into the joint to increase joint fluid and reduce inflammation. The treatment is performed once a year and is currently only licensed for canine elbow arthritis. Because radioactive materials are involved, only specially certified locations may offer this therapy. The technology is very new but more information is available at synovetin.com.
In conclusion, the arthritic pet has a large menu of medications to select from and while proper medication is an important part of therapy, weight control and proper exercise should not be forgotten. Proper exercise is excellent physical therapy for the arthritic pet, as it is crucial to maintain as much muscle mass as possible to support the abnormal joint. Remember, treatment for joint disease is likely to involve a combination of medications in addition to physical activities and to check with your veterinarian before attempting to assemble a regimen on your own.
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Page last updated: 3/11/2018