March 2007 Issue
Canine Arthritis Treatment
Many effective tools can help in the fight against canine arthritis.
Osteoarthritis is the number one cause of chronic pain in dogs, affecting one in five adult dogs, with the incidence more than doubling in dogs seven years and older. It is a degenerative disease that causes pain, loss of mobility, and a decreased quality of life. Signs of canine arthritis include stiffness when getting up or lying down, limping, slowing down on walks, pain after exercise, or reluctance to jump or climb steps. It’s important to recognize these signs and begin treatment early, to slow the progression and help preserve your dog’s quality of life.
When my dog, Piglet, was diagnosed with severe dysplasia in both elbows at a year old, I was told that, even with the surgery we did, she would develop arthritis in those joints. I gave her a daily glucosamine supplement, but knew of no other way to help her. By the time she was six, she was on daily NSAIDs (non-steroidal anti-inflammatory drugs, such as Rimadyl and Etogesic) to relieve the pain that otherwise caused her to limp. At the time, I thought I’d be lucky if she made it past the age of 10 before becoming too lame to walk.
It was then that I learned about the benefits of a natural diet, and began researching dog supplements that I could use to improve her condition. I switched her onto a raw, grain-free diet just after she turned 7, and within a few months, she no longer needed any drugs for pain.
As time went on and her joints continued to deteriorate, I tried more and more supplements and natural therapies, rotating between those that seemed to help, and replacing those that didn’t seem to make a difference. I was able to keep her off drugs until she was almost 12, then began adding them to her nutraceutical “cocktail.” The net result? At age 15, her elbows are visibly deformed and vets cringe when they see her x-rays, but she still enjoys one- to two-hour walks every day. She no longer runs, but jogs along at a comfortable pace. I let her decide how far and how fast we go so that I don’t risk pushing her beyond her limits, but occasionally I have to convince her it’s time to head for home when we’re miles away and she still wants to keep going. Following are the things that have helped my dog, and others like her.
Glucosamine and chondroitin
The first step in treating canine arthritis is the use of nutraceutical supplements called glycosaminoglycans (GAGs), also known as mucopolysaccharides. These include glucosamine (both the sulfate and the HCl forms) and chondroitin sulfate, from sources such as chitin (the shells of shellfish), green-lipped mussel (perna canaliculus), and cartilage. Also included in this category are the injectable forms sold under the brand names Adequan in the U.S. and Cartrophen (pentosan polysulfate) elsewhere.
GAGs are important because they actually protect the joint rather than just reduce symptoms, by helping to rebuild cartilage and restore synovial (joint) fluid. GAGs may also have some preventative effect on arthritis, though this is speculative.
Oral GAG products may be most effective if given separate from meals, though it’s fine to give them with food if needed. Always start with high doses so that you will be able to tell whether or not your dog responds. If you see improvement, you can then reduce the dosage to see if the improvement can be maintained at a lower dose.
If you don’t see any change within three to four weeks, try another supplement. Different dogs respond differently to the various supplements.
Brands that have worked for dogs I know include Arthroplex from Thorne Veterinary, Syn-Flex from Synflex America, Synovi-G3 from DVM Pharmaceuticals, Flexile-Plus from B-Naturals, and K-9 Glucosamine from Liquid Health. You can also use products made for people that contain ingredients such as glucosamine, chondroitin sulfate, and green-lipped mussel. The use of manganese in the supplement may help with absorption.
Injectable GAGs may help even more than the oral forms, and may work even when oral supplements do not. It’s very important to start with the full “loading” dose, following the instructions in the package insert, before tapering off the frequency to the least that is needed to maintain improvement (often one injection per month). You should continue to use the oral supplements as well.
It is interesting to note that the label instructions for Adequan say that it must be injected IM (intramuscularly), while Cartrophen is injected sub-q (subcutaneously, which is less painful and easier to do at home). Many vets believe that Adequan works just as well when injected sub-q as IM, and I have heard reports from people who have used this method effectively.
A related product is called hy-aluronic acid. It has been used with horses for many years, and more recently with dogs. In the past, it had to be injected into the joint under anesthesia in order to be effective, but newer oral forms have been developed that also work. You can use products made for dogs, horses, or humans, such as Synthovial 7 and Hyaflex (made by Hyalogic), Trixsyn from Cogent Solutions, and K-9 Liquid Health Glucosamine & HA.
Certain foods may increase inflammation and aggravate arthritis. Some people have found that eliminating grains from the diet improves their dogs’ symptoms, sometimes to the point that no other treatment is needed. In addition, plants from the nightshade family, including potatoes (not sweet potatoes), tomatoes, peppers (all kinds), and eggplant may aggravate arthritis.
Unfortunately, it’s not easy to avoid these foods unless you feed a homemade diet, where you control all the ingredients. The vast majority of dry foods contain grains, and those that do not often contain potatoes instead. There are a few brands that use only sweet potatoes or tapioca that would be worth trying for a dog with arthritis, to see if your dog improves. Canned foods usually have fewer carbohydrates than dry foods, so that might be another option to try, especially for smaller dogs where the higher cost of canned food is not such an obstacle.
Certain foods may help with arthritis: celery, ginger, alfalfa, tropical fruits such as mango and papaya, and cartilage are all good to add to the diet of a dog with arthritis. Remember that vegetables must be either cooked or pureed in a food processor, juicer, or blender to increase digestabilty by dogs, and fruits are more easily digestible when overripe.
A few people have reported that organic apple cider vinegar (with the “mother,” a stringy sediment comprised of enzymes) has provided some benefit when added to food or water. Be sure your dog is still willing to drink water with the vinegar added if you try it, or provide a separate, plain water source.
Weight and exercise
It’s extremely important when dealing with a dog who has arthritis to keep him as lean as possible. Extra weight puts added stress on the joints, and makes it harder for your dog to get proper exercise. If necessary, get an inexpensive postal scale and weigh your dog’s food to help you control his intake.
Carbohydrates supply the same number of calories as proteins do, but offer less nutritonal value to dogs. A low-carb, high-protein diet is better for a dog with arthritis than one that is high in carbs, which is more likely to lead to weight gain. Keep fat at moderate levels, to avoid weight gain from a high-fat diet and excess hunger from a diet that is too low in fat.
If your dog needs to go on a diet to lose weight, remember to reduce portions gradually, so the body doesn’t go into “starvation mode,” making it harder to lose weight.
Moderate, low-impact exercise, such as walking or swimming, is important for dogs with arthritis, as regular exercise will help maintain flexibility and well-developed muscles help to stabilize the joints. It’s important to prevent your dog from exercising to the point where he is more sore afterward. Swimming is an excellent exercise for dogs with arthritis, as it is non-weight-bearing, so your dog can exercise vigorously without damaging his joints. If your dog is unused to exercising, start slowly and work up only gradually, as he begins to lose weight and develop better muscle tone. Several short walks may be easier on him than one long one.
When your dog shows signs of arthritis, there are a number of natural anti-inflammatory supplements that you can try before resorting to medications.
First and foremost is fish oil, a source of the omega-3 fatty acids EPA and DHA, which reduce inflammation and provide other benefits to the body. Be sure to use fish body oil, such as salmon oil or EPA oil, not liver oil, which is high in vitamins A and D and lower in omega-3 fatty acids. (Also, liver oil would be dangerous at the high doses needed to fight inflammation).
Most fish oil gelcaps contain 300 mg combined EPA and DHA, and you can give your dog as much as 1 of these gelcaps per 10 lbs of body weight daily. If using a more concentrated product, containing 500 mg EPA/DHA, give 1 gelcap per 15-20 lbs of body weight daily. If using liquid fish oil, adjust the dosage so that you are giving up to 300 mg combined EPA/DHA per 10 lbs of body weight. Be sure to keep the product refrigerated so that it doesn’t become rancid.
You must supplement with vitamin E as well whenever you are giving oils, as otherwise the body will be depleted of this vitamin. Give around 100 IU to a small dog, 200 IU to a medium-sized dog, or 400 IU to a large dog daily or every other day. Vitamin E in high doses also has some anti-inflammatory effect.
High doses of vitamin C may help with arthritis. It’s best to use one of the ascorbate forms, such as calcium ascorbate or sodium ascorbate, rather than ascorbic acid, which is harder on the stomach and may be irritating to arthritis. Look for one that contains flavonoids as well, which also help to reduce inflammation. If desired, you can give vitamin C to bowel tolerance, which means increasing the amount every few days until your dog develops loose stools, then backing off to the next lower dosage.
Bromelain, an enzyme found in pineapples, has strong anti-inflammatory properties. It works best if given separately from meals (at least one hour before or two hours after). Its effectiveness may be increased when it is combined with quercetin, a flavonoid. There are many combination products available, or you can give each separately.
Certain herbs help to reduce inflammation. Some of the best ones to use for arthritis are boswellia, yucca root, turmeric (and its extract, curcumin), and hawthorn. Nettle leaf, licorice, and meadowsweet can also be used.
I usually rotate between various herbs and herbal blends. I’ve had the best results using liquid tinctures or glycerites when available, such as Animal’s Apawthecary’s Alfalfa/Yucca blend and Azmira’s Yucca Intensive. Other folks have had success using DGP (Dog Gone Pain, see “Safe Pain Relief,” Whole Dog Journal May 2006). Note that willow bark is another herb often used for arthritis. It is a relative of aspirin that may be easier on the stomach, but should still not be combined with other NSAIDs.
SAM-e (s-adenosylmethionine), a supplement that is used to support the liver, can also reduce pain, stiffness, and inflammation caused by arthritis. It works best when given apart from food, and when combined with a B-complex vitamin.
Supplements that have worked for other people who have dogs with arthritis include MSM, Duralactin (this product is derived from milk, so creates digestive discomfort in some dogs), and Wobenzyme. There are also some newer herbal blends being marketed as replacements for NSAIDs, including Kaprex from Metagenics and Zyflamend from New Chapter, but I have not heard much feedback on them.
Other natural therapies
Dogs with arthritis often respond to acupuncture and chiropractic treatments. Massage therapy can also be very beneficial, and is something you can learn to do yourself at home. Hydrotherapy using warm pools or underwater treadmills is becoming increasingly popular and can be very helpful, particularly for dogs recovering from surgery or injury.
If acupuncture helps your dog, you may want to consider gold bead implants, which are a form of permanent acupuncture. Many dogs respond to chiropractic treatments, which can be especially beneficial if your dog tends to become “misaligned” due to favoring one limb.
Warmth can help reduce arthritis pain. Thick, orthopedic beds that insulate your dog from the cold floor or ground as well as cushioning the joints provide a lot of comfort. There are also heated dog beds available, but be sure that the cords cannot be chewed. A product called “DogLeggs” can be custom-made to keep elbows, hocks, or wrists (carpus) warm. Some people have reported success using the homeopathic treatments Traumeel and Zeel by Heel Biotherapeutics.
Eventually, no matter what you do, your dog may require treatment for chronic pain. There is one more nutraceutical that can help with this: dl-phenylalanine (DLPA), an amino acid that is used to treat both depression and chronic pain.
The most common dosage range for dogs is 1 to 5 mg/lb (3 to 10 mg/kg) of body weight, but I have seen dosage recommendations as high as 5 to 10 mg per pound (2 to 5 mg/kg), two or three times a day. In humans, very high doses may cause numbness, tingling, and other signs of nerve damage, so be on the watch for any signs that your dog may be experiencing these if using such high doses. It takes time for DLPA to begin to work, so it must be used continuously rather than just as needed. Often, however, you needn’t continue to give DLPA daily once it has taken effect; sometimes it can be given as little as one week per month to retain results. It is safe to combine DLPA with all other arthritis drugs, but do not combine DLPA with MAOI drugs such as Anipryl (selegiline, l-deprenyl), used in the treatment of Cushing’s Disease and canine cognitive dysfunction, or amitraz (found in tick collars).
I use Thorne Veterinary’s Arthroplex, which includes DLPA, because it makes it easy to give the proper dosage for a small- or medium-sized dog, but you can use human DLPA supplements for larger dogs. They are available in 375 mg and 500 mg capsules.
Kay Jennings, who lives with three dogs in Bristol, England, has a young German Shepherd Dog who began limping as a puppy, and was diagnosed with elbow dysplasia. “I’ve kept my lad active and pain-free using just DLPA plus Syn-Flex, and my arthritic Border Collie too,” she says. “It’s so effective that they can both take it just every other week and its residual effect keeps them covered for the other week.”
Jennings also has a working sheepdog who required higher doses initially. “My Polly had to start at 1,000 mg a day (she weighs 45 lbs). I was about to write it off with her at 500 mg a day, assuming she was one of those for whom it doesn’t work. I found a starting dose of any less than 1,000 mg made no difference to her even after a couple of weeks. Once we hit the right dose it worked within three days, and after a few weeks I could reduce to a lower level (500 mg a day) that still provided relief. After several months at this level, I was able to reduce her further, to 250 mg/day, and even put her on the week-on-week-off schedule that has worked for my other dogs.
“I have to say, I’ve found DLPA to be remarkably effective: Polly is now 14, and doing better than she has for some time. Kiri, my Border Collie, has recently (at the age of 11!) started doing a bit of obedience again, and Ziggy, the GSD, is still totally sound and very active, when his vet was convinced he’d need NSAIDs for his entire life just to be able to get about.”
There is much controversy about the use of NSAIDs, such as Rimadyl (carprofen), Etogesic (etodolac), Deramaxx (deracoxib), Metacam (meloxicam), and aspirin. This is due to their potential for harmful side effects, which include not only gastric ulceration but also liver and kidney failure, leading to death in some cases, sometimes after only one or two doses.
While there is no doubt that these drugs can be dangerous, they do have their place in maintaining quality of life when nothing else works. Inflammation creates a vicious cycle, breaking down cartilage and causing pain that restricts activity, which leads to weight gain and muscle loss, further restricting your dog’s ability to exercise and enjoy his life. Natural anti-inflammatories can do a great deal to help, but in the end, they are not as powerful as drugs.
There are precautions you can take to make the use of NSAIDs safer, though you cannot eliminate their risk. First, it’s always a good idea to have blood work done before starting any NSAID, and every few months thereafter when using them regularly, to check for underlying liver or kidney disorders that would contraindicate their use.
Second, you should always give NSAIDs with food, never on an empty stomach, to help prevent the gastric ulceration that is a very common side effect. Third, never combine NSAIDs with each other, or with prednisone, which greatly increases the chance of ulcers and other dangerous side effects.
Fourth, discontinue immediately and contact your vet at the first sign of any problem, which may include lethargy, lack of appetite, drooling, vomiting, diarrhea, difficulty swallowing, jaundice (yellowing of the whites of the eyes), increased drinking and urination, or any behavioral changes such as aggression, circling, or ataxia (loss of balance or coordination).
Last, be very cautious when switching from one NSAID to another. If possible, wait at least a week in between, particularly if switching from one of the non-COX selective products, such as aspirin, to one of the newer, COX-2 selective drugs, such as Deramaxx.
Anecdotal reports indicate that Rimadyl and Deramaxx appear more likely to cause serious problems when first started than other NSAIDs. Be particularly watchful if you use either of these drugs, or ask your vet for another option.
There is also a drug you can give to help reduce the chance of gastric ulcers, called Cytotec (misoprostol). This is a human drug that can also be used for dogs. It helps to mitigate the effects of COX inhibition that are responsible for damage to the intestinal lining by NSAIDs.
Another prescription medication that can be helpful is sucralfate, which is used to heal ulcers. Sucralfate interferes with the absorption of all medications, so it must be given at least two hours before or after you give other meds. Herbs such as slippery elm and marshmallow may also help to protect the stomach and intestines, though they’ve never been tested specifically with NSAIDs. One product that contains both is Phytomucil from Animal’s Apawthecary.
When drugs are needed, ask your vet about using tramadol (Ultram), a synthetic opioid that provides pain relief without sedation or addiction and is safer than NSAIDs. Tramadol can be used in place of NSAIDs, though it is mostly for pain and has limited anti-inflammatory effect. It can also be combined with NSAIDs to increase pain control or lower the dosage needed, or pulsed periodically to give the body a break from taking NSAIDs.
Tramadol can be given continuously or used on an as-needed basis. It is less likely to create dependence than narcotics, but you should still wean off slowly rather than discontinuing abruptly if used long-term. Tramadol can cause constipation; if this is a problem, you can give your dog a stool softener to help. I’ve found that the price of tramadol varies significantly; Costco has the best prices I’ve seen (non-members can order prescriptions from Costco and they will ship for $2).
Gunner is an 11-year-old Rottweiler belonging to Sheila Jones of Highland, Michigan. He was diagnosed with elbow dysplasia at age two, and originally put on Deramaxx as needed, but was later switched to fish oil and yucca, which helped until a couple of years ago, when he became lame and needed something more to control his pain.
“I started him on tramadol at a low dose, but have worked up over time to 150 mg twice per day (¨ø of his maximum dose), and I add yucca root extract in liquid form when he needs an additional boost,” Jones says. “He also gets 2,000 mg of vitamin C twice per day.”
Jones is pleased with how well tramadol has worked for Gunner. “He is a little slow getting up in the mornings, but overall I believe he is doing very well. I am in contact with the owners of three of his littermates, and he seems to be doing the best of them. He still plays with our younger Rottie, and with his indestructible ball regularly. On days that he overdoes it, I give him a little extra tramadol.” Note: Dogs should not take Ultracet, a combination of tramadol and acetaminophen (Tylenol), which can be dangerous for dogs.
There are a few other medications that can be used for dogs’ chronic pain, when NSAIDs can’t be used, to decrease the dosage needed, or when more relief is needed. Most antidepressants, such as Elavil (amitriptyline) and Prozac (fluoxetine), offer some pain relief. Be careful about combining these drugs with Tramadol. See “Chill Pills,” July 2006, for more information.
Amantadine offers little in the way of pain control itself, but helps potentiate (increase the effectiveness of) other drugs used to control pain. It is inexpensive and can be used concurrently with Tramadol, NSAIDs, corticosteroids, gabapentin, and opioids. Neurontin (gapabentin) is an anti-convulsant medication also used to treat chronic pain. It can be combined with other medications, but is expensive.
When pain cannot be controlled in any other way, narcotics may be used. Hydrocodone can be combined with NSAIDs for greater relief. Vicodin (a combination of hydrocodone and acetominophen) is sometimes used, though acetominophen can cause liver failure in some dogs, and should not be combined with NSAIDs due to the danger of toxicity from acetominophen. Codeine can also be used, though it’s not as effective. Oxycodone or a fentanyl (Duragesic) patch can be used, but tend to have more of a narcotic effect and so are best used only for short periods, though even that may make a big difference. All narcotics are addictive, so they are best used intermittently rather than every day.
Lastly, there is some possibility that doxycycline may be helpful. This may be due to the fact that joint infection is common with arthritis, or because it has some anti-inflammatory effect of its own.
The future can be bright
There are an endless number of supplements and therapies that claim to help with arthritis, but the ones noted here are those that, in my experience, have the best records of success. It’s important to keep trying different combinations to find what works for your dog, as each dog is an individual, and what works for one may be different from what works for another.
At age 15, Piglet is on a grain-free raw diet. I also give her Arthroplex (which includes glucosamine, green-lipped mussel, DLPA, boswellia, bromelain, and vitamin C), high dose fish oil, turmeric, SAM-e, and vitamin E daily. I alternate between giving her herbal Senior Blend and Alfalfa/Yucca blend (both from Animal’s Apawthecary). I give her Metacam, and one dose of tramadol daily to help with walks. She is also on sertraline (Zoloft) for anxiety, which may help with pain as well.
This combination of natural and conventional treatment has kept Piglet going for years longer than I thought she would longer even than I dared hope. She is staring at me now, reminding me that it’s time for her walk, still the highlight of her day, and something she insists upon, even when it is pouring down rain. I am delighted to oblige.
Mary Straus does research on canine health and nutrition topics as an avocation. She is the owner of the DogAware.com website and lives in the San Francisco Bay Area with Piglet, her 15-year-old Chinese Shar-Pei.
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