Holistic OA management: an overview

More than 1.7 million dogs in the UK suffer from OA and it is one of the leading causes of elective euthanasia in older dogs.

Arthritis is a lifestyle disease that is debilitating for patients and distressing for owners, with some owners perceiving a diagnosis of arthritis as a sign of the end stage of their pet’s life.

With lifestyle factors having such an impact on disease onset and progression, it makes sense to not only treat the patients’ pain with a combination of analgesic drugs, but also consider their lifestyle and changes that can be put into place to help slow disease progression and reduce pain levels.

Missing the signs

Canine arthritis management (CAM), a veterinary-driven initiative founded in 2016, firmly believes a holistic approach to arthritis management is the best way to get a good outcome for both dog and owner. Its primary aim is to simply raise awareness of the condition, as many owners do not recognise the subtle signs of OA development and, therefore, do not seek treatment until the disease is advanced, if at all.

As vets, it is our responsibility to discuss this condition in any at-risk patient and ensure owners fully understand the welfare implication of leaving animals with this painful condition untreated. We need to be open to discussing a range of treatment options and lifestyle changes – we often fall short as a profession in recommendation of the latter.

A good example of this is obesity, a well-recognised contributing factor in OA. Weight loss of as little as 5% in an obese patient will have a significant impact on mobility and quality of life. Despite this, so many of our patients on long-term NSAIDs for joint pain are left struggling under high bodyweights. A more proactive approach in this area is needed. We need to make sure owners know they are responsible for their dog’s obesity, now officially recognised by some companion animal groups (such as the American Veterinary Medical Association) as a disease state.

Principles of joint protection

In human medicine, occupational therapists assess individuals in their own home and with their own unique challenges in mind; they specialise in finding solutions to problem areas by either modifying the environment or the task. They use the principles of joint protection to improve the shock absorbing capabilities of the joints. This has been shown to improve the outcome for patients with rheumatoid arthritis over and above the use of pain relief alone.

It makes logical sense that, in our canine patients with similar pathology in the joints, we apply similar joint protection principles – but, in too many cases, we don’t.

As OA patients are less able to exercise, many will become sedentary and often bored. Again, from human medicine, we know that lack of mental stimulation leads to an increased perceived level of pain. We need to be discussing alternative options to activities potentially detrimental to joint health, not just allowing these periods of mental stimulation to be withdrawn for the daily routine entirely.

Exploring complementary therapies

CAM works toward the use of an evidence-based and rational approach to exploring the use of complementary treatments and management techniques to help improve quality of life. Therapies such as physiotherapy, hydrotherapy, massage and acupuncture are too often overlooked, despite us knowing they can be beneficial in many patients.

A greater level of understanding in the profession is needed to allow us to confidently discuss these options and refer to professionals in these fields where needed.

Over the next few weeks I will discuss these ideas in greater detail. In the meantime, visit the CAM website to find out more about the work volunteers for this organisation do. The site is also a great, reliable resource for pet owners, and one you can direct them towards, knowing vets, nurses and physical therapists are responsible for all the information provided.