Canine Arthritis is a common condition affecting more than one out of every four dogs (Anderson et al, 2018). The progression of arthritis and the pain experience in individual dogs can be complex and challenging to manage, although many treatments and management options are available. Arthritis will progress through four stages, and the treatment and management of dogs will vary depending on the veterinary team and owner involved in their care.
Canine osteoarthritis can be divided into four stages. Treatment interventions for each stage can include owner education, rehabilitation, NSAIDs, environmental modifications, weight management, dietary changes, and exercise. Secondary treatment options that are less well established can be included as part of a multi-modal treatment approach to control pain and dysfunction in the individual patient.
A team of veterinary professionals specialising in the treatment of canine osteoarthritis (OA) came together to discuss and create guidelines that may be used by professionals in the treatment of canine OA, to create a science-based and effective treatment strategy for individual patients with this condition. Here we share the results of their findings.
Proposed Canadian Consensus Guidelines on Osteoarthritis Treatment Based on OA-COAST Stages 1–4, Mosley et al., 2022
To create guidelines for the treatment of canine OA, a group of Canadian experts, including board-certified surgeons, anesthesiologists, sports medicine and rehabilitation practitioners, a pharmacologist and a general practitioner, came together to discuss the protocols and treatment plans they would use in the treatment of specific cases of OA at different points in the progression of the disease.
Using these different treatment protocols, the group discussed general treatment guidelines for each of the stages of OA progression according to the Canine OsteoArthritis Staging Tool (COAST).
Each treatment was evaluated, discussed and voted on. For it to be considered a core part of the treatment of canine OA at a specific stage, every member of the panel needed to unanimously agree on the inclusion of the treatment.
Secondary treatments were considered when they received less than unanimous support from the panel, and when there was a lack of available research supporting the modality.
Within the veterinary field, chronic pain management still lacks an appropriate level of evidence, primarily as a result of an inadequate objective pain assessment and the continued knowledge gaps within most treatment options.
COAST Stages of Canine Arthritis Progression
OA is a disease that affects the entire joint, leading to loss of function of the joint. It is usually highly inflammatory and will progress throughout the dog’s life. There is no cure for canine osteoarthritis, but it can be treated and managed to allow dogs to maintain a good quality of life.
COAST has divided canine OA into five stages. The first two are pre-clinical, where the dog shows no signs of OA, while the last three are clinical, with the dog showing changes in their movement, posture, function and level of pain.
Pre-clinical arthritis, Stage 1
In Stage 1, there are no signs or symptoms of OA, but there are risk factors of the dog developing OA. The risk factors include:
- a genetic predisposition
- atypical limb conformation
- congenital or traumatic deformities
- participation in activities that may predispose to injury
- joint injury or surgery
- excess body weight
- advancing age
Treating OA in this stage focuses on prevention of the disease, which is very closely linked to owner education and compliance. An owner who understands the risks of developing OA and what they can do to prevent or slow the progression of OA will be more likely to implement preventative measures, as well as recognise the early signs of OA in their dog.
For these dogs, it is important to consider and adjust their diet, weight and exercise to reduce the risk of developing OA. Diet and weight contribute to reducing overall inflammation in the body, reducing the load on joints, and ensuring the body has the building blocks it needs to maintain joint health.
Exercise is important to ensure that joints receive the stimulation and loading they need to stay healthy, without excessive concussive force or overuse trauma occurring. Specific exercises can also be incorportated into the daily routine of dogs to strengthen specific muscles and joint ranges of motion, acting as further protection against the development of OA.
Mild Arthritis, Stage 2
In Stage 2, arthritis becomes clinically significant. Dogs will probably show signs of lameness during some activities, but not in others. Changes in their gait might be seen, as well as subtle changes in their posture, limb loading and weight distribution. We might find that the range of motion of the specific joint is slightly reduced, and during X-ray assessment early signs of OA may be visible.
Treatment in this phase focuses on preserving the health of the joint cartilage and treating flare-ups promptly and effectively. Flare-ups will occur throughout the progression of arthritis, and refer to an increase or spike in pain and inflammation in the joint. If pain is not properly treated and controlled, peripheral and central sensitisation may start to occur, which will greatly complicate the treatment of the individual dog’s OA in the future.
At this stage, owner education is critical. Owners need to be able to monitor and recognise pain, have strategies at hand to treat flare-ups, and control baseline pain and discomfort. They need to understand how OA progresses and the importance of regular re-assessments to monitor that progression.
Treatments in this phase will include the use of NSAIDs, dietary adjustments, weight control and rehabilitation, together with regular and appropriate exercise. Environmental or home modifications may also be considered.
Moderate Arthritis, Stage 3
In Stage 3, the symptoms of OA become more consistent and obvious. Most dogs will be referred for veterinary evaluation during this stage. The signs of pain or dysfunction will be more obvious and consistent during all the dog’s gaits and activities. Changes in weight distribution and limb loading will be clearly visible, with an obvious reduction in the use of the affected limb. Muscle atrophy will be present, together with a reduced range of motion of the affected joint. Radiographs will also reveal obvious changes around the affected joint.
Treatment goals will become more individualised to the patient and their needs or goals during this stage. Pain becomes far more individualised and multi-faceted, since patients will respond to interventions differently. Controlling pain and inflammation remains a primary treatment goal, together with maintaining and improving mobility in the patient.
The primary treatment intervention continues to focus on client education. During this stage we want to start discussing quality of life while highlighting and deepening the understanding of effective pain management strategies.
Formal rehabilitation in this phase is highly recommended to facilitate pain control, function and mobility of the patient. Appropriate exercise will be facilitated during rehabilitation, and the necessary environmental changes will be explained.
Pain management becomes more complex, and can include additional pharmacological strategies together with NSAIDs.
Secondary treatment options will often be incorporated into this stage of OA management, and can include cannabinoids, joint injections, photobiomodulation or laser therapy, PEMF, and acupuncture.
Severe Arthritis, Stage 4
In Stage 4, arthritis has advanced significantly and the patient will have a higher level of dysfunction and pain which will be obvious and constantly present. These symptoms will significantly impact the dog’s quality of life. You will see severely abnormal limb loading, shifting of weight, restlessness when standing and a reluctance to move. During movement there will be significant lameness, and difficulty in rising from lying down or sitting. Range of motion will be limited and crepitus will be present, together with muscle atrophy. Radiography will reveal significant changes and signs of bone remodelling.
The goals of treatment will be very individualised, but will focus on controlling pain, facilitating and supporting mobility, and improving or maintaining quality of life in the patient.
Owner education during this stage will focus on quality of life as the disease progresses, pain management, and home modifications.
In these patients, muscle wastage is a significant concern, especially in senior dogs who are challenged with sarcopenia. These patients need a regular exercise schedule that will facilitate joint health and allow them to build or maintain muscle. An exercise routine and schedule will also help maintain mental health in these patients.
Formal rehabilitation is highly recommended to facilitate pain control, monitor the progression of the disease, maintain joint health and mobility, maintain muscle mass and strength, and maintain the health and integrity of compensatory structures in the body.
Environmental modifications become increasingly important during this phase, and may start to include the use of assistive devices in the daily routine of the patient.
Pain management continues to become more complex, and should include NSAIDs together with other pharmacological agents, anti-inflammatory dietary components, and the use of secondary treatment modalities to complement the pain management regimen. These might include the previously mentioned modalities, together with shock wave therapy or end stage surgical interventions.
Canine Osteoarthritis is a progressive and complex pathology. There are many available treatment options, leading to variations in treatment approaches and preferences among clinicians. This study proposes guidelines for the treatment of canine OA based on the stages of progression. It is built on a multi-discipinary team approach, and hinges on the education and compliance of the owner.
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- Mosley, C, Edwards, T, Romano, L, Truchetti, G, Dunbar, L, Schiller, T, Gibson, T, Bruce C, & Troncy, E. (2022). Proposed Canadian consensus guidelines on osteoarthritis treatment based on OA-COAST Stages 1–4, Frontiers in Veterinary Science, 9, Article 830098 https://www.frontiersin.org/articles/10.3389/fvets.2022.830098/full