Veterinary Arthritis Treatments

Over the couple of years of producing this blog, I have written about many different subjects. Some have come up repeatedly, and because they represent common and important issues, I thought it might be useful to collect related posts I’ve done into quick reference lists for some of these subjects. Maintaining an exhaustive and up-to-date list of resources on any one subject isn’t really feasible for a “spare time” project like this blog, but I will try to create and update some of these topic-based references as far as is practically possible.

SkeptVet Arthritis Treatment Reference List

Arthritis is a painful and potentially debilitating disease that commonly affects our animal companions. It is most often seen in older animals as a result of the normal wear and tear of living. However, certain congenital or developmental orthopedic abnormalities, such as hip dysplasia, as well as trauma, obesity, and other health problems, can create arthritis in younger pets as well. There are a number of well-supported conventional therapies for arthritis, including weight loss and non-steroidal anti-inflammatory drug therapy. There are also plausible and potentially useful treatments that have not yet been adequately studied, such as physical therapy and some supplements. And finally, there are implausible, unproven, and even demonstrably useless therapies, such as homeopathy and glucosamine. I have written about many of these therapies, and below are links to relevant articles along with brief summaries. I will try to update this reference list as I continue investigate and write about these and other arthritis therapies.

1. Acupuncture

The historical theories behind the use of acupuncture are unscientific and almost certainly false. And most of the marketing of acupuncture involves misleading and untrue claims about its historic origins and use. There is, however, very limited data concerning its use for arthritis in dogs and cats, and not much more for other conditions. What veterinary research there is is of poor quality and does not strongly suggest a benefit.

The research is much more extensive for humans and does suggest a subjective improvement in comfort when acupuncture is used to treat pain. However, the details of the research suggest this is almost certainly accomplished through psychological mechanisms and possible through very non-specific mechanisms. So while the benefit is small but real for some patients, it probably does not involve any actual change in the underlying disease. Whether such a “placebo” benefit would meaningfully help pets with arthritis is uncertain, but it does not seem likely.

Veterinary Acupuncture

Another acupuncture study shows it’s a placebo

The history of veterinary acupuncture: It’s not what you think

Electroacupuncture for intervertebral disk disease

2. Chiropractic

The theoretical foundations of chiropractic are vitalist pseudoscience and almost certainly false. There is no evidence that the “vertebral subluxation” chiropractors often claim to treat exists at all, and even many chiropractic professional organizations are beginning to distance themselves from this historical concept. There is virtually no controlled scientific research on the subject of chiropractic for arthritis in pets, though it is commonly recommended by chiropractors and some veterinarians. The research in humans shows some likely benefit for uncomplicated lower back pain, essentially equivalent to standard therapies such as physical therapy, stretching and exercise, massage, and non-steroidal anti-inflammatory medications. The evidence does not support the use of chiropractic for any other conditions.

Veterinary Chiropractic

The end of chiropractic? Of course not!

Chiropractic: the more we look the less we find

3. Homeopathy

The theoretical foundations of homeopathy are completely incompatible with well-established scientific understanding of physics, chemistry, and biology. The extensive research in humans shows no convincing evidence of any benefit for any condition beyond placebo effects. The research in animals is sparse and of poor quality and does not support the use of homeopathic remedies in the treatment of arthritis.

Veterinary Homeopathy

Homeopathy works for arthritis: Or maybe not

4. Glucosamine and Chondroitin

Glucosamine and chondroitin are chemicals found naturally in joints and cartilage. There was once good reason based on sound scientific reasoning and in vitro studies to think that oral supplementation of these chemicals would be useful in the prevention or treatment of arthritis. However, the research in companion animals, which is quite limited and of variable quality, has not shown convincing evidence that this is actually true in the real world. And the extensive research in thousands of humans over decades pretty clearly shows that these products have no benefit beyond placebo. They are almost certainly safe, and very likely useless for most pets.

Veterinary Glucosamine and Chondroitin

Growing skepticism about glucosamine for arthritis in dogs and cats

Is recommending glucosamine for arthritis evidence based medicine or wishful thinking?

Nope, glucosamine and chondroitin still don’t work in humans

Cognitive dissonance in action: Glucosamine no matter what!

LEGS Glucosamine Study-Little evidence of meaningful benefit

5. Fish Oil

Essential fatty acids from fish, including EPA and DHA, have many potential benefits based on sound theoretical and in vitro work showing their potential to reduce inflammation. There have been very few studies in companion animals on their usefulness for arthritis, and these do not seem to show much if any benefit, though the work is preliminary. The research in humans is also variable in quality and in results. Fish oils are very likely safe for most pets, and they may or may not have any beneficial effects on arthritis, but the data so far is not encouraging.

Two studies of fish oil for canine arthritis

Another study of fish oil for canine arthritis

5. Electromagnetic Therapy (PEMF)

Various devices that expose arthritis joints to electromagnetic fields as a treatment for arthritis are available and in use for humans and animals. There is some in vitro evidence that electrical fields certainly have effects on living cells, but this says nothing about exactly what these effects are and if they are helpful, harmful, or insignificant in living animals. Much of the marketing of these devices uses misleading pseudoscientific language to talk about mystical vitalist notions of “energy” as if they were established scientific principles. There is so far no reliable scientific research on the use of these devices for treatment of arthritis in dogs and cats. The limited research in humans is variable in quality and results and is so far inconclusive.

PEMF devices for pets

6. Cold Laser Therapy

Non-cutting laser therapy is widely used by chiropractors and some other CAM practitioners to treat pain and many other conditions. While laser light does have measurable effects on cells in vitro, this says nothing about potential clinical uses of laser light. Much of the marketing of these devices uses misleading pseudoscientific language to talk about mystical vitalist notions of “energy” as if they were established scientific principles. There is so far no reliable scientific research on the use of these devices for treatment of arthritis in dogs and cats. The limited research in humans is variable in quality and results and is overall very weak.

Cold laser therapy

7. Stem Cell Therapy

One of the hottest, most fashionable new therapies for a wide range of ailments is autologous stem cell therapy, in which fat is taken out of an animal, stem cells are extracted from it, and then these cells are injected back into the patient. There is extensive theoretical and laboratory work in animals and humans to indicate a variety of effects of these cells, and there is good reason to believe that clinical benefits may be possible. Unfortunately, there is no agreement about what these cells do in living animals and how they do it, and there is very little clinical research evidence to support any one of the many different commercial stem cell therapies marketed for arthritis in dogs and cats. Leading researching in human and veterinary stem cell therapies caution that our knowledge about these cells and what they do is too preliminary to justify claims that they are safe or effective in real patients. I am hopeful that safe and effective stem cell therapies will one day be available, but so far none have proven themselves and using them is still a gamble.

Veterinary stem cell research: Is this the best we can do?

Vet Stem’s stem cell therapy and Chemaphor’s Oximunol join forces

Selling veterinary stem cell therapies: Medivet’s dodgy advertising

Stem cell therapy: Still an uncontrolled experiment on our pets

Veterinary stem cell therapies discussed at Fully Vetted blog

8. Non-steroidal anti-inflammatory drugs (NSAIDs)

There is a huge group of NSAIDs license for treatment of arthritis in dogs, and the evidence from the theoretical and in vitro level through multiple clinical studies is unequivocal that they have a significant positive effect on arthritis. There is no doubt that they have potential side effects, as all effective medicines due. But these are mostly well-understood, and with proper use of the medicines and proper monitoring of the patient the risks are far less than the benefits, or than the propaganda of alternative medicine proponents often suggests.

Safety and efficacy of NSAIDs for canine arthritis

A new tool for evaluating the effects of arthritis treatments in dogs

9. Prolotherapy

Prolotherapy is a purported treatment for connective tissue and joint pain and disability. It involves injecting substances which induce inflammation and other chemical and cellular reactions into affected tissues. These reactions are theorized to relieve pain and improve function. The logic of this theory is questionable, and no clear mechanism for beneficial effects from prolotherapy has been described, but it is possible that the theory could be valid.

The clinical research on prolotherapy in humans is generally of low quality and results have been mixed. There is great variation in the techniques used by different investigators, so it is difficult to compare or generalize between studies.

There is virtually no controlled research investigating prolotherapy in companion animals, and all claims made for safety and efficacy in these species are based solely on anecdotal evidence.

The use of proltherapy in pets should be viewed as experimental with unknown risks and benefits. Such treatments should be reserved for patients that have significant symptoms that have failed to respond or cannot be treated by conventional means.

Prolotherapy for Dogs and Cats

10. Autologous Platelet Therapy

Encouraging Study of Platelet Therapy for Arthritis in Dogs

11. Other Supplements

Duralactin for Arthritis

12. Other Reviews

American Academy of Orthopaedic Surgeons Review of Arthritis Treatments

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54 Responses to Veterinary Arthritis Treatments

  1. Pingback: Sorting through arthritis treatment options for your dog | Gilgablog

  2. Jana Rade says:

    Let them eat drugs …
    Is that the only solution you approve of?

  3. skeptvet says:

    Did you even read the article?

    1. Weight loss and physical therapy are also options with proven or highly likely benefits that I recommend.

    2. Glucosamine and fish oil are “drugs.” They are chemicals believed by some to have a physiologic effect, so the fact that they are supplements rather than licensed pharmaceuticals only means they haven’t been as thoroughly tested as other drugs, not that they are inherently safe or effective.

    3. If a medication has great benefits and few risks, why wouldn’t I recommend it? And before you pull out the “lackey of Big Pharma” line, bear in mind I could make as much or more money selling acupuncture and laser therapy than I could off the judicious use of NSAIDs. The reality is that “drugs” (also known as “medicines”) are a valuable tool in health care that has made life dramatically better for me, my patients and, I would be willing to bet, you at some point in your life. Disparaging them is just blind prejudice.

  4. Tracy says:

    I have a cat who has had arthritis for years, but he’s developing various other problems, and unfortunately the non-steroidal anti-inflammatories he has used so far are becoming contraindicated by his other medical problems. It’s very discouraging.

    I was wondering if you make a distinction between oral glucosamine and injectable glucosamine (such as Adequan, polysulfated glycosaminoglycan)? We think that Adequan is helping our cat, but it’s so hard to be sure… that stuff is expensive and it’s hard to find evidence that it’s both safe and effective.

  5. skeptvet says:

    Yes, geriatric cats with arthritis are very challenging cases since they often cannot safely take NSAIDs. Injectable glucosamine products such as Adequan have been clearly shown to reach joints in reasonable amounts. However, very few published clinical trials are available to evaluate them, and those that have been done are methodologically weak and don’t show very convincing results. It is unlikely to harm your cat, but at this point that is about all we can say. Subjective impressions of effect are pretty unreliable, and there isn’t any solid objective data. I would certainly consult your veterinarian about other treatment options (weight control, other analgesics that are not NSAIDs, and so forth), but as of now there isn’t a satisfactory option for cats with arthritis, which makes the use of unproven but plausible therapies like Adequan more reasonable, though with the inevitable caveat that we don’t really know if we’re helping.

    Vet Surg. 1994 May-Jun;23(3):177-81.

    Evaluation of polysulfated glycosaminoglycan for the treatment of hip dysplasia in dogs.
    de Haan JJ, Goring RL, Beale BS.

    Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville.

    Abstract
    A double-blinded, controlled clinical study was performed to compare the response of adult dogs affected with hip dysplasia to a placebo and three different dosages of polysulfated glycosaminoglycan (PSGAG): 2.2 mg/kg, 4.4 mg/kg, and 8.8 mg/kg. Dogs were randomly assigned to treatment groups. The drug was administered intramuscularly every 3 to 5 days for a total of eight injections. Response to treatment was analyzed based on changes in lameness, range of motion (ROM), and pain on manipulation of the hip joints. Evaluation for adverse reactions included complete blood cell (CBC) count, blood urea nitrogen (BUN), creatinine, and physical examination. Data were collected on a total of 111 dogs. Eighty-four met all criteria for inclusion in the study. Dogs that were given 4.4 mg/kg of PSGAG showed the greatest improvement in orthopedic scores, whereas dogs in the placebo group showed the smallest improvement; however, the differences in clinical improvement between the four treatment groups were not statistically significant. No local or systemic adverse reactions related to the drug were observed.

  6. Tracy says:

    Thanks for the reference. I hunted around on the internet and could really not find anything newer, which was surprising — but then I don’t really expect every paper is visible on the web, anyway.

    In case you were at all curious — my vet has suggested gabapentin for my cat’s arthritis pain, so I guess we’ll be trying that.

  7. Leo Saumure says:

    I just read an article in Canada.com regarding the use of stem cell therapy in dogs: http://www.canada.com/life/Stem+cell+therapy+gives+dogs+their+step/4874977/story.html

    From what I gathered from your blog entry, you believe that the clinical research shows that it is effective, but we don’t yet understand the mechanism. Is that correct?

  8. skeptvet says:

    Actually no. There is almost no clinical research on stem cell therapy for small animals, and what there is has been done by the company selling it and is not very convincing. Here is my discussion of the two clinical trials publised to date. I think stem cells could possibly be a useful therapy, but in addition to not having semonstrated a mechanisms for the supposed benefit, the research to date has not yet demonstrated any real benefit. The International Society for Stem Cell Research, a group of scientists studying stem cells for use in humans, warns that this treatment has not yet been proven safe and effective, and there is even less proof for veterinary uses. The bottom line is it could work, but at this point there is no proof that it does, and as compelling as personal stories are, they are useless in determining if such a treatment is effective or not.

  9. Michelle MacKenzie says:

    Is pulsed signal therapy the same thing as PEMF?

  10. skeptvet says:

    Pulsed signal therapy is one of many electromagnetic therapies on the market, like PEMF, magnetic braclets, and others. The problem is distinguishing these by the details of their design and activity and the scientific evidence behind them. Static magnets, such as one might wear around a wrist or ankle, have no convincing evidence of any effect whatsoever. Pulsed megnetic fields of much higher strengths do have some legitimate evidence of physiologic effects and clinical benefits in people. But the details matter, and it can be difficult to distinguish a potentially legitimate therapy from quackery. And it is often the case that promoters of unproven or useless devices provide research papers that appear to support their cliaims but which, when one looks at the details, refer to very different devices and treatment applications.

    So far, I think there is some potential for some pulsed electromagnetic fiel devices to have benefits in veterinary patients based on the existing evidence in humans, but there are, as far as I am aware, no studies at all in dogs and cats, so we are relying on extrapolation and anecdote only at this point, which might or might not turn out to be correct later.

  11. Tina Snapper says:

    Have an 11 year old dog with autoimmune issues on 2.5mg prednisone daily. I understand that tramadol is the only pain medication suitable for her osteoarthritis. Also gets a series of 3 pentosan shots every 3 months. How safe is tramadol and would you recommend it?
    Thanks.

  12. skeptvet says:

    The most effective medications for arthritis are the non-steroidal anti-inflammatories, but those cannot be given along with prednisone. Tramadol is a reasonable alternative, and while there is little ubjective research data, my experience suggests it is not an especially potent pain reliever. Very few side effects are routinely seen, so I think it’s quite safe, but I don’t think it’s enough for dogs with significant pain. It is often helpful to add other medications, such as gabapentin and amantidine, to tramadol in such cases, so I would ask your vet about other options. Oral glucosamine and other neutraceuticals most likely do nothing. Fatty acid supplements (fish oils) may have some benefits, though the limited research so far is not encouraging. And injectable products like Adequan are not well-studied, so they might have some benefits but they might not.

    The most important therapy for arthritis in most dogs is weight loss, so if your pet is overweight this would be a valuable thing to work on. Physical therapy has good evidence of benefit in humans, though it’s new and there is as yet little data in animals, so it’s worth considering. Acupuncture is mostly a placebo in humans, and unlikely to benefit animals despite the hype about it.

    You might also look at the web site for the International Academy of Veterinary Pain Management for things to ask your vet about.

  13. jp says:

    Thanks a lot for this list. About glucosamine and chondroitin, I wonder what you think of this study:

    “Randomised double-blind, positive-controlled trial to assess the efficacy of glucosamine/chondroitin sulfate for the treatment of dogs with osteoarthritis.”
    Vet J. 2007 Jul;174(1):54-61. Epub 2006 May 2.
    http://www.ncbi.nlm.nih.gov/pubmed/16647870

    Acording to the abstract, “The results show that Glu/CS has a positive clinical effect in dogs with osteoarthritis.” Unfurtonately, we don’t have free access to the full text, so I don’t know if it’s a well conducted study, but I guess not if there’s no convincing evidence of efficacy.

    See also this one:

    “Comparative therapeutic efficacy and safety of type-II collagen (UC-II), glucosamine and chondroitin in arthritic dogs: pain evaluation by ground force plate.”
    J Anim Physiol Anim Nutr (Berl). 2012 Oct;96(5):770-7. Epub 2011 May 30.
    http://www.ncbi.nlm.nih.gov/pubmed/21623931

    Still, we don’t have free access to the full text. but according to the abstract, evaluations were both subjective (observational pain) and objective (using piezoelectric sensor-based GFP for peak vertical force and impulse area). It’s interesting to note that based on observations, pain was significantly reduced for all tested products (collagen, glucosamine and chondroitin) , but based on GFP, only collagen seemed to have effects.

    It leads me to two questions:

    – About glucosamine and chondroitin being effective subjectively but not objectively, can it be the result of caregiver placebo effects?

    – What’s the point about collagen, supposedly effective on both evaluations? You don’t list it in this article.

    Thanks a lot.

  14. skeptvet says:

    Thanks for the quetsion. The first study you cite was included in my brief review of research evidence concerning glucosamine:
    J Am Vet Med Assoc. 2010 Dec 15;237(12):1382-3. doi: 10.2460/javma.237.12.1382.
    What is the evidence? There is only very weak clinical trial evidence to support the use of glucosamine and chondroitin supplements for osteoarthritis in dogs.
    http://www.ncbi.nlm.nih.gov/pubmed/21155677

    Here’s what I said:

    “Dogs with osteoarthritis of hip or elbow joints were assigned to groups by alternate allocation,
    and no placebo was used as a control treatment. Forty-two subjects were enrolled, and 6 failed to complete
    the study (5 in the glucosamine-chondroitin group and 1 in the carprofen group). Changes in 5 subjective
    measures of clinical signs assessed by participating veterinarians were compared between groups at 3 points
    during the 70-day treatment period and at 1 point after cessation of treatment. Results indicated that carprofentreated
    dogs had improvement in all measures, often at multiple assessment times for each measure. On the
    other hand, dogs treated with glucosamine-chondroitin had significant improvement in 3 of 5 measures but only
    at the final assessment point during the treatment period. The only adverse events associated with treatment
    pertained to 2 dogs in the glucosamine-chondroitin group, which were withdrawn from the trial because of
    unspecified adverse drug reactions.”

    Given the existence of a higher-qualty trial with even more clearly negative results, I concluded it was not sufficient to support use of glucosamine for arthritis:

    Moreau M, Dupuis J, Bonneau NH, et al. Clinical evaluation of a nutraceutical, carprofen and meloxicam for the treatment of dogs with osteoarthritis. Vet Rec 2003;152:323–329.

    The second study you mention has a couple of problems in that 1) there is no positive control, 2) there is no glucosamine only group, so it’s hard to establish efficacy of glucosamine in this kind of trial. I’m not able to access the full text either, so it’s imposisble to thoroughly evaluate it. Certainly, caregiver placbeo effects are a big problem in arthritis trials, and we have to have good controls in place to account for them. I’ll try to evaluate the paper if I can find a full copy of it.

  15. Pingback: Arthritis research updates | Gilgablog

  16. Lisa Smith says:

    Have you considered the newer HA supplements for arthritis? I have a rescue for geriatric, special needs and hospice dogs and pain relief for arthritis along with mobility improvement for neurological issues like IDD are daily issues for my 15 charges.

    As an aside, I prefer tested, evidence based treatments, but I am not above trying alternative therapies when traditional medicine has failed. I have tried acupuncture for a dog with significant neurological and arthritic issues and found it worthless. We have had good results with about 60-70% of our dogs with cold laser therapy, however.

    We currently have a 10 y/o, 20 lb. female pug who came to us after being severely abused over a long period of her life. She had been kicked and hit daily for years and had been doused in household and yard insecticides. She had a broken elbow, which had healed poorly and neurological issues in her spine which had her unable to walk with extreme weakness in the rear legs. Prednisone returned her mobility. I was able to get her down to 2.5 mg. twice a day, but almost immediately she began to display Cushings symptoms. Assuming that her mobility was more important than the Cushings, we kept up the pred (after briefly trying dexamethasone instead), then she came down with a serious case of calcinosis cutis…again from the Cushings/pred. On top of that she also acquired an enterococcus UTI that was resistant to everything on the culture and sensitivity, also likely from the pred.

    We are treating her with DMSO for the calcinosis cutis and it seems to be helping, although the stench is nearly unbearable and franlkly, the stuff scares me. I have been giving her methanamine, D-Mannose, colloidal silver and oil of oregano for the UTI for a week….and by gosh, her last UA was clear of bacteria! We have reduced her pred to .5 mg every other day, but she has lost almost all ability to walk. She also takes tramadol and gabapentin. For this dog, laser therapy did not help. NSAIDs did not help either.

    Do you have any suggestions for therapy to preserve her mobility but avoid the calcinosis cutis and other terrible effects of the steroids? I have two in my care that are paraplegic and do great dragging themselves, however they are much smaller and don’t have the elbow problem this girl does.

    Lisa Smith
    Pug Rescue of San Diego

  17. skeptvet says:

    I appreciate your desire to do whatever you can for these animals, and I admire how hard you and many folks in rescue work for these poorly treated dogs. But I’m afraid it is a real problem when we only evaluate success or failure by how things look rather than through controlled research. Frustratingly, human beings just get it wrong most of the time when we do that, which is why we have science in the first place. SO I’d be really careful about deciding whether or not individual therapies work based on uncontrolled observations.

    I’d be very cautious, for example, of believing you can control a UTI in a Cushinoid dog with unproven (e.g. oil of oregano) or proven worthless (e.g. colloidal silver) remedies. It is very common in immunocompromised patients (e.g. with Cushing’s, diabetes, etc) to have a negative urine sediment but still have a UTI, so you always need a urine culture. And such chronic UTIs can come and go on their own. You don’t want to get caught thinking you’ve resolved it only to have the pet develop kidney failure later from an undetected subclinical infection, and this is a real risk without proper monitoring and culture-guided antibiotic therapy.

    If prednisone works for a dog with arthritis, then non-steroidal drugs will work as well with fewer side effects. However, it sounds more likely, given the bred and neurologic issues, that you’re dealing with intervertebral disk disease or some other cause of dysfunction other than just simple arthritis. You can try to wean off the prednisone and try NSAIDs, but you may not be successful, and then you have to choose the lesser of evils. Supplements will not solve this dilemma. I would also suggest considering physical therapy. Though still in its infancy in veterinary medicine, with less evidence than for humans, physical therapy is a plausible approach.

    Good luck!

  18. Daniel says:

    Hello, have you looked into stem cells therapy? It seems to be very good: my friend works in a clinic in Mexico where they give embryonic stem cells treatment and she told me they get better result than anything else… What’s your thought about this kind of treatment? Most people that i talk with are scared because it’s so new!

  19. skeptvet says:

    I’ve written about stem cell therapy several times, and links to all those posts are in this post. But, since you included a commercial stem cell company URL in your profile, I’m guessing you already know that and are just marketing.

  20. Beccy Higman says:

    Thank you very much for this review.

    My six year old GSD snapped her right cruciate in June, underwent a successful TTA and has recovered well. She has significant degeneration in that knee, although happily none showing on the x-ray of her left knee. The orthopaedic surgeon has recommended nutraquin (basically glucosamine and chondroitin) once she’s back to full stamina (any day now). While I’m happy with his orthopaedic work I was less convinced by the nutraceutical recommendation and have been looking for hard evidence either way;finally I have found it so again, thank you very much!

  21. skeptvet says:

    Glad the article was useful!

  22. Jo Gunter says:

    Love your blog and am grateful to you for your time and expertise in making it available to the public!

    I have 4 elderly cats, 2 of which have moderate osteoarthritis either in the hip and/or spinal area. They also have chronic renal disease and mild (well controlled) heart disease. One is also being treated with methimazole for hyperT. None are overweight and the one with hyperT is a few pounds underweight despite a few months of treatment under his belt and a low-normal T4 level.

    I had planned to make an appointment with the vet for acupuncture, but after reading this article, I am reluctant to follow through.

    So is gabapentin about the only safe medication to give elderly cats with these other health problems…or are there other good drugs to consider?

    And has gabapentin been proven to truly help with osteoarthritis pain in animals/cats?
    One of my two cats takes 12.5mg of gabapentin BID, but it doesn’t seem to help her much if any.

    I wish the veterinary/university/veterinary pharmaceutical community would put more research effort into treatment remedies for cats with arthritis pain and pain in general. It is very frustrating and depressing to see them suffer. After all these many tears, you would think greater progress would have been made and more treatment options be found by now!!!

  23. alyxzandra says:

    I came across your blog after doing some research into acupuncture. My dog has been suffering from arthritis for over 4 years. She is on meloxicam and has been for a few years. Last week she started to limp, which she has not done so for a long time as the meloxicam has kept things under control. I took her to the vet yesterday and for the first time she had acupuncture. I have been a skeptic of it, but I was shocked to see her actually run outside today, jump over something and there is no limping. I do not know if it is the acupuncture or not, but what else could it be?

  24. skeptvet says:

    Arthritis is a chronic disease, and as such the symptoms are sometimes better and sometimes worse. When do we seek a new treatment? When the symptoms are worse than usual. So it is very common for people to go see a doctor just as their chronic disease is about to improve on its own. This is called “regression to the mean” and it is one reason clinical trials are necessary.

    It I also possible that your dog injured her already arthritic joints, or some other part of her leg altogether, and now she is healing on her own. There have also been studies that show owners and veterinarians frequently report their pets arthritis pain and function are improved even when getting the placebo in a clinical trial, so sometimes our hope and desire for our pets to be better fool us.

    I can’t, of course, tell you why you dog is doing better. I’m glad she is, but unfortunately it doesn’t mean the acupuncture is responsible. Every medical therapy ever used has been supported by individual anecdotes like this, and yet many of them turn out not to work when properly studied, so such anecdotes are far less reliable than they seem.

    Good luck with your pet.

  25. Jonathan says:

    “but as of now there isn’t a satisfactory option for cats with arthritis”

    You wrote that three years ago. Is it still true today? Our fifteen-year old’s vet recommended Cosequin (as apparently is in vogue).

    I did some quick research that didn’t seem promising, but the Internet is so full of crap and quackery when it comes to pets, that I don’t trust my google-fu to sift through it.

  26. skeptvet says:

    Cosequin is just glucosamine, and as you can see from the articles I have collected here on that, the evidence seems pretty clear it is safe, harmless, and of no value. Injectable hyaluronic acid (e.g. Adequan) is also in vogue, and there is little data on that in cats, so who knows? Meloxicam is an NSAID which is widely used in Europe for chronic arthritis. People here are afraid of it because NSAIDs in general can worsen kidney disease, which older cats often have. There is some limited evidence that suggests meloxicam may not be as risky as feared for this, but as always the risk and benefits have to be weighed. I have used it in older cats with severe arthritis and no documented kidney disease, but only when the risk is outweighed by the need to treat. Aspirin is also recommended sometimes, but again not any real controlled research data. So yes, there is still little in the way of well-studied and clearly safe and effective arthritis therapy for cats.

    Good luck.

  27. Cathy Hasty says:

    Thank you for your generous blog. My older cat is in pain. We were given Buprenex .1ml BID. Do you have any reflections on this treatment? It will be somewhat expensive and I am not sure how to evaluate the effectiveness.

  28. skeptvet says:

    Yes, it is always very difficult to assess the effectiveness of pain control in cats. There is good evidence that narcotics like buprenorphine provide good pain control. However, there is some concern about the buildup or tolerance over the long term, so it depends on what you are using it for. For short-term pain relief, with injuries and surgeries and such, it is a great choice. I’m not convinced it is as useful for chronic pain, like arthritis, but the options are somewhat limited, so sometimes it is used for this as well.

    The options for chronic pain control in older cats are a bit complex, so I would encourage you to have a detailed discussion with your vet about your choices.

    Good luck!

  29. Lisa says:

    I also have an older cat (16) with arthritis pain. I have been offered glucosamine, ‘Cartrophen Vet’, and/or Metacam. I have said ‘no’ to glucosamine because I can’t find the evidence to support its use (thank you for your thorough reviews!). Metacam, being a NSAID, worries me greatly, and so far I have not taken a prescription for it given that his pain has been intermittent and largely mild until very recently. But what about Cartrophen? I cannot seem to find any reliable information for this product. It is pentosan polysulphate that is injected once a week for 4 weeks and then booster as needed. Have you heard of this product? Does it fit somewhere in your list? Is metacam our best option or should I be requesting something like gabapentin? Thank you for any thoughts.

  30. skeptvet says:

    There is limited research on pentosan polysulphate. Some of it is suggestive, but it isn’t clear how much real benefit it might offer, and of course there are reports of potential adverse reactions. As usual, even less information on use in cats than in other species. So overall, might have some use, but it isn’t likely to dramatically improve comfort:

    http://www.ncbi.nlm.nih.gov/pubmed/?term=pentosan+polysulfate+arthritis

    Gabapentin is used largely on theoretical grounds, and again not much research in veterinary species to show it really helps. Pretty low risk, but lots of uncertainty. As for metacam, there is good evidence for its benefits. The safety issue is less clear. Individual reports of adverse effects are certainly reported, and there are theoretical reasons to be concerned about effects on the kidneys. However, it is fairly widely used in Europe in cats, apparently successfully.

    http://www.ncbi.nlm.nih.gov/pubmed/?term=meloxicam+cat

    As always, the need to intervene has to be balanced against the degree of uncertainty about each therapy. If the symptoms are mild and intermittent there is less justification for interventions with unknown effects or significant risks. If the symptoms are interfering with an acceptable quality of life, then the balance changes.

    Good luck!

  31. Lisa says:

    Thank you for the information and your thoughts!

  32. Mark Shields says:

    Thank you for this article. I was looking for a legit source for acupuncture as I know in humans it’s basically no better than sham, figured as much for dogs. And well, dogs aren’t gonna be fooled thinking it will work.

  33. Pingback: Duralactin for Arthritis | The SkeptVet

  34. Steve says:

    I have an 18 year old cat that has CKD approx stage 2 and severe arthritis to the point where he now hardly moves off his bed, he sometimes makes an attempt to go for a walk outside but never gets very far.
    I have tried all of the neutroceuticals which some seemed to help for a while but are completely ineffective now.
    Have also tried Gabapentin and Tramadol as transdermals because of inability to get them in oraly and they have had no effect, i guess this now leaves me with Metacam or Onisor which i don’t like the idea of because my Vet has told me my cat can’t have them because of his CKD, but then also told me they are the only treatment otion left.

    Is there anything else or is it a case of pain vs death from NSAID’s accelerating kidney failure ?

  35. skeptvet says:

    There is some controversy about whether meloxicam and/or onsior negatively impact kidney function in cats. It’s true that NSAIDs have been documented to interfere w/ the normal autoregulation of blood flow through the kidneys, and cases of renal failure associated with their use have been reported. On the other hand. there are studies in cats showing no deleterious effects with judicious use. So while we generally avoid them if we can just to be safe, if it is a choice between taking some risk of worsening the kidney disease and leaving a pet in intractable pain that impedes everyday activity, I don’t think we should think of these drugs as totally taboo.

    There are a couple of other options. Low-dose aspirin has not been shown to harm the kidneys, and it may have some analgesic effects in cats with arthritis, though I am not aware of controlled studies on the subject. And prednisone can certainly improve comfort and is safe for the kidneys, but it does have other long-term health effects, including worsening cartilage damage over time. In an 18 year old cat, however, these effects may take so long to develop that they may not be relevant.

    Good luck!

  36. v.t. says:

    Another option is adequan (injections) – I believe there is an indication that caution (monitoring lab values) should be used in older cats or liver/kidney issues – but worth talking to your vet about.

  37. Carleen says:

    What is your opinion of Green Lipped Mussel as an anti-inflammatory? I am aware of at least one study on it, but am not sure how well conducted it was: http://www.ncbi.nlm.nih.gov/pubmed/15136981

  38. skeptvet says:

    A systematic review from 2012 reviewed the literature for GLM:

    J.-M. Vandeweerd, C. Coisnon, P. Clegg, C. Cambier, A. Pierson, F. Hontoir, C. Saegerman, P. Gustin, S. Buczinski. Systematic Review of Efficacy of Nutraceuticals to Alleviate Clinical Signs of Osteoarthritis. Journal of Veterinary Internal Medicine. 2012. Epub ahead of Print.

    Their conclusion was “Green lipped mussel powder (GLMP) had a significant effect in 3 of 4 studies,41–44 and because of this inconsistency between studies, we could not conclude to a strong indication for its clinical use.”

    The paper also includes a quality analysis of each of the 4 studies:

    ID Ref Species Supplement Design N Duration Outcome Measures Funding
    14 41 Dog GLMP RCT, DB, PBO, NOA 81 56 SOA, SUA Y
    15 42 Dog GLMP RCT, DB, NOA 96 42 SOA Y
    16 43 Dog GLMP RCT, DB, NOA 31 42 SOA Y
    17 44 Dog GLMP CS RCT, DB, PBO, NOA 58 84 SOA, SUA N
    The trials can be randomized (RCT) or not (NRCT), placebo controlled (PBO), and double blinded (DB). Supplements were tested in
    naturally occurring OA (NOA) in horses, dogs and cats, but also in models of OA (MOA) in horses. The number of animals (N)
    included and the duration of treatments (in days) are reported. Three types of outcome measures were identified: either subjective (SUA,
    eg, owner’s opinion), semiobjective (SOA, eg, clinical test performed by a veterinary surgeon), or objective (OA, eg, force plate). Studies
    can be supported by sponsors or funded (Y) or not (N).
    18 45 Dog Compound (GLU, CS, MN) RCT, DB, PBO, NOA 71 60 SOA, SUA, OA Y

  39. Barbara says:

    My 10 year old cat has been getting injections of adequan twice a week for 4 weeks and he is now on once a week for 4 weeks the problem is he’s stopped eating. Could this be a side effect? I can’t find any information. He has feline AIDS and has been pretty healthy until the arthritics. Thank you.

  40. skeptvet says:

    There is very little information about Adequan in terms of risks and benefits. It appears to be helpful in some cats, but this is mostly anecdotal, and I have not seen any significant side effects but this too is only uncontrolled observation. I would recommend checking for other causes with your vet.

    Good Luck!

  41. Lynn says:

    Hi,

    My 9.5 year old chocolate Labrador bitch has had “malformed” paws since puppyhood (overgrown pads and splayed feet with long claws/digits) so developed arthritis in them at around 5. (Her black littermate is problem-free). She went on to a common NSAID (can’t remember which) but was vomiting on it so a month later switched to Metacam and within a month of that collapsed with a perforated duodenal ulcer and nearly died. From 5.5-9.5 we have used Synflex (a glucosomine-based supplement), then YouMove and lately organic turmeric and black pepper capsules. On top of that her weight is closely controlled (23.3kg) and her exercise limited to 20-30 gentle minutes twice a day. We’ve managed fine but I have had to concede defeat this week and have gone back to the vet.

    I considered acupuncture but she is mainly front paws, elbows and hips and a) my understanding is that acupuncture works best for spinal arthritis in canines (human placebo effect aside) and b) my vet wasn’t that convinced of referring her for it (even though it’s done in his practice). So today she is starting on Gabapentin 300mg BD and he is going to refer us to a local equine specialist for a course of 6 laser treatments. He says that the science is weak, at best, with talk of “moving water molecules around” etc. but his experience of the anecdotal outcomes is good (and then we go back to human placebo as a possibility). However, as I am avoiding NSAIDS like the plague (and Tramadol, as her very well littermate had a horrible reaction to it post-dental surgery – as did I, post a neck injury!), I feel that this is as good as I can aim for right now. Your piece above appears to concur. My question really then is, in your opinion, is Gabapentin safe and appropriate for her, all things considered? Research seems pretty limited….

  42. skeptvet says:

    I think you’re quite right. If she is unable to tolerate NSAIDs, which are unfortunately the most effective pain medication for arthritis, then gabapentin is a reasonable thing to try, but there isn’t much direct evidence.
    Tramadol is also reasonable, and again not much evidence, though anecdotally I feel like it doesn’t work very well.
    Glucosamine is safe and inexpensive and almost certainly useless.
    Turmeric is promising, but the real risks and benefits aren’t yet known, so it’s a roll of the dice.
    The evidence concerning acupuncture is complex, but the more I look into it (I’m taking a training course now), the less I think it is likely to be effective. It’s reasonably safe if done by someone properly trained, but unfortunately many acupuncturists liberally mix a whole lot of nonsense into their acupuncture practice.
    Laser, too, is promising but entirely unproven for most uses and marketed way beyond any claims reasonably supported by evidence. It seems unlikely to be harmful, though no direct evidence speaking to that either.
    Stem cell therapy is another plausible and promising but unproven approach you might consider.

    Good luck!

  43. Lynn says:

    Thank you very much. My only concern is dosage as there seems to be huge range based on guesswork, some splitting it into analgesic (much smaller dosage) versus anti-convulsant. I asked to start conservatively and my vet went for 300mg BD (26mg/kg/day) but I see some vet sites saying they give 75mg OD for dogs as a standard and that seemed to go up to about 100mg BD. I have hence asked my vet to reduce it to 100mg BD only based on her general sensitivity to everything and I don’t want her turning into a zombie. There seems to be no definitive guide but I’d rather start low and work up than start by whacking her with an epilepsy-type dose?

  44. skeptvet says:

    Sounds like a reasonable approach to me.

  45. Merry Frazer says:

    I have an 18 year old much loved cat who began dramatically slowing down 6 months ago and getting U characteristically irritable as well. She is and always has been slim. She has been on prednisilone(sp?)and theophylline for asthma for 7 years. If she misses more than two doses she has an asthma attack. Her complete panel of recent bloodwork was excellent except her kidney function was at the bottom of the normal range which our vet is not particularly worried about given her age
    . She had infected anal glands found because she was holding her rear up in the air and howled if her tail was lifted. Yet after two rounds of antibiotics and having them expressed they appear normally functioning but she was worsening her stance and howled if you touched her back or tail so we had her back to vet. An X-ray and reading by a veterinary radiologist diagnosed severe arthritis in her spine as well as severe disc disease. The vet wants to give her the nutrisuticals you mention and special prescription food as well as laser and acupuncture AND give her her prednisone from an inhaler(!) if we try an NSAID. We have said no to all of it yesterday to think and research.
    My silver dollar question is – realistically speaking now – is she likely EVER at 18, to really have a decent quality of life even with all this stuff or with a possible other NSAID or other pain meds( I forgot to say she is getting gapapentin and it is doing zip) ???

    I am troubled we are keeping her alive merely to suffer because arthritis isn’t a fatal condition like the cancer we have lost other cats to over the years and we feel guilty letting her go from something not fatal….

    She will no longer move off the bed (except to eat and use the box) we have set up in our warmest room ( the laundry room unfortunately but we are both work from home home all day so we visit to pet and check on her every hour or so ) and howls when we pick her up or try to move her. She still eats and drinks well though.
    I so appreciate your site and the info you provide and if you have any time to reply I would be very forever grateful. Thank you…

  46. skeptvet says:

    I am sorry that you are having to face this with your pet. I agree, it is difficult sometimes to know when it is better to stop treatment or to try things that may or may not improve a pet’s quality of life. I cannot do much to help you with that decision from a distance. You can find a lot of information on this site about the various therapies your vet is recommending, and this may help you. In general, acupuncture seems unlikely to make a major difference, the results of laser are uncertain, and NSAIDs probably do help with arthritis pain but they can certainly have some risks in older cats. Most supplements aren’t well-tested, so their risks and benefits aren’t clear. I don’t think it’s wrong to try some uncertain therapies when a pet is clearly uncomfortable, but I do think we have to be careful not to imagine improvement just because it is what we hope to see, and we have to think very carefully about how long to persist when we clearly aren’t making enough of a difference. It sounds like your cat’s life is very limited, so I would imagine it would be best for her not to experiment for too long without clear improvement.

    Good luck!

  47. Merry Frazer says:

    Thank you so much for your quick reply and advice on not experimenting too long. It has clarified our wa forward. We went through your site again on the various treatments and their merits or lack of and the info on options from our vet. We see the vet tomorrow and we have decided to go only with an NSAID trial even if it may be a bit dangerous for a cat of her age. If we see marked improvement – as in her getting off her bed and moving modestly with visible comfort around the house again, we will continue it. If it causes the life threatening side effects we will have no choice but to let her go…. Thank you for writing this blog – and for your compassion……

  48. Cecilia Laureys says:

    Can you tell me of any medication or supplement to treat my dog in what is, to clearly an anomalous situation. Three different vets, with different diagnosis or none other than, “Idiopathic”. I’ve read your blog for a time now, and you seem more knowledgeable and focused regarding suggestions to writers presenting circumstances than the vets I’ve been to that toss out different opinions, counter to the circumstances, each prescribing different meds.. Here is the scenario, please bear with the slogging through it, but it IS what the vets don’t seem to understand, is THE significant matter: a sudden, total and extreme change in my dogs temperament from docile 12 years, to an aggressive biter.

    10 years ago, I took him, a small mixed breed dog, away from a very abusive situation. Right away, took him to a vet, and his age was assessed at btn 5 and 9 y/o. Throughout that first year or so, different vets, and none could determine his age, because his teeth were worn down close to gums, from what could be any number of yrs, eating off of surface like cement or asphalt- as opposed to the normal wear that helps estimation of age. Also, his fur had been burned off & it took @ yr of attention to issues, for it to begin to grow from all areas, and about another for a new, full healthy coat. Every vet asked, said they could only give a ballbark of a span of about the same: between about 5 and 10 y/o. So, 10 plus years later, I have no idea of his age, other than he is older than 10… Possible 15 or older. However, up until a year ago, he became more active and remained so, unlike a dog for even the at least 10 years of age . Had been very cautious at first, but within weeks of positive life and love, began to play with my other dog, was receptive to affection from me & visitors, I could bath and groom him w ZERO negative reaction… TOTAL trust, incredibly fast learner, so devoted… Relevance is that for 10 yrs this was an exceptionally vibrant, intelligent, affectionate dog & was NEVER aggressive. Had never even heard him growl.

    Then, about a year ago, when putting down his food, he growled at me! This behavior progressed within weeks to point where he’d lunge at me, so I’d put his food down then pick him up & bring him to it. No problem until I put him down, and had to quickly withdraw hands and self, or he’d try to bite, even lunge. It was clearly reversed response- GIVING him food, caused aggression. It then progressed to point where he began to growl when I’d pick him up! Then he bit me the first time was when picking him up to bring to food, and his bite was so intent, he was latched onto my hand still, in mid air when I pulled my hand away. From the sudden start about a year ago, he is a different dog, exhibiting aggression towards me when even touching him. I have been bitten about a dozen times, with such intent that, despite his worn down teeth, some bites have broken skin via the one incisor tooth that is less worn down, causing some pretty bad, single tooth bite wounds. It’s insane. Note, I live alone, with the two dogs, and he is not aggressive to the other dog at ALL, doesn’t lunge at visitors, even goes to greet them like he always did, brushing his head on their legs, and some have pet him in greeting, without incident, before I warn them not to, because he now has begun to allow a pet, happily, then decides to snap. In 10 years, I have NEVER hit or yelled at this dog… There was never cause even if I was the type, so there is no cause for his sudden aggression there.
    Vet first said it was due to pain from arthritis, and gave me liquid prednisone and tramadol pills. But it was impossible to administer without being bitten, would not eat food w prednisone & hidden tramadol tablet, and w thick garden gloved hands, could not administer syringe of pred or tab to a fiercely resistant dog. When this dog had ulcerated cornea, putting drops in was nothing. For resistant ulcer, he was so docile for a corneal debridement, vet called him Ghandi. But months later, he was a different dog. Difficulty administering above, led to switching to Meloxicam, for arthritic pain management, and he will eat food w the Meloxicam liquid in it. But it couldn’t have been pain related, as his change to an aggressive dog progressed and that is his state a year later. I can pick him up, now, as needed, only because I learned how to avoid his range of reach with mouth. But he does attempt to bite when picking up, and putting down- only. That’s weird too, because, inbetween being picked up and put down, once held, he is instantly calm and not agressive, until being put down. This seems to indicate it has little to do with pain being handled, so the agression seems as irrational as that exhibited when GIVING him food. Even that progressed to point that I can’t even walk by a few feet away, when there is food down, without him now growling and bearing his stumped, but effective teeth.

    I’ve taken him to several vets a few times each over the year, and each say something different. Including, ‘idiopathic’, and give me prescrips for different meds. All have kept him on the meloxicam though. The first vet, changed her diagnosis a few months into the meloxicam, from caused by pain, to it being Canine Cognitive Dysfunction. This was based upon her re-read of records taken back at the start, over a year ago, when I’d told her then, that I’d observed him standing w face to walls, or under chairs for clearly, no purpose until I moved chair or urged him away from walls. And that he had stopped all play, and was pacing during that same time. But He exhibited these CCD traits for a short time only in the beginning a year ago, and it had stopped way back, even prior to starting meloxicam. He hasn’t done any of that since, has gone outside to urinate and defecate, all along. The one thing that did not change, however, is his sudden abandonment then, of play that he had always engaged in frequently and daily, and his change to an aggressive dog.
    Another vet most recently said it could be a brain tumor, but due to his age, didn’t recommend putting him through all the scans etc, and that if it is, the progression will lead to eventual humane euthanasia. I am glad the meloxicam relieves him of possible arthritic pain, but what kind of life is this for his remaining time? And no one has been able to associated the sudden aggression to any of the many opinions of CCD, of which, aggression isn’t even among traits, much less the sole trait.
    I want to know if you can glean any possible opinion, not as a doctor giving me a diagnosis, just if you have ever seen, treated, heard of similar, because it’s IS something, for it to just snap into a totally different dog. Artheritis, CCD, brain tumor….idiopathic… all are among the guesses I’ve paid a great deal of money for, in trying to help my dog be himself again, so he can be happy…. to no avail. At this point, what he needs is something to assuage the aggression that is robbing him of the quality of life I want him to enjoy in his time left here. A dog that’s always on guard, is aggressive re interaction, uninterested in affection or play, is clearly not a happy dog, and all I want, is for his time left, to be the happy dog he was until this sudden, mysterious change took him away.

  49. L says:

    While you are waiting for the Dr to respond, if I may, I would like to add my 2 cents.

    First of all, I think you are wonderful for taking care of a senior the way you do. I know it is not easy. I have had many dogs over the years and this last stage is always the hardest.

    I have a Peke that will turn 16 in 2 weeks (if he makes it) . He has been diagnosed with dementia. At first they thought it was arthritis and he was on tramadol and rimadyl, the rimadyl gave him diarrhea so that was discontinued, the tramadol was discontinued also.
    However, he is up at night at least 2 times, howling, walking into walls, confused and agitated. Oh, and he was a biter in his youth, I have some scars to prove it.
    I have to help him with his bathroom duties (occasional incontinence). He is unsteady on his feet and doesn’t walk very well anymore.

    I take it day by day, he is on a low dose of acepromazine, it is strong stuff, but it is the only way any of us will get any sleep.
    It is what it is, I have a vet that I trust and that returns my calls, the day I can no longer keep him comfortable, I will take him in.

  50. Merry Frazer says:

    A follow up from my posts in March regarding our 18 year old cat.
    We gave NSAIDs a trial. It was a HUGE mistake in hindsight and I regret trying it though of course I know why I did. Our girl really suffered for those last three weeks . It did zero that we could tell to reduce her discomfort to any meaningful measure. We finally after 3 weeks had to say goodbye.
    I will never try last ditch efforts for an elderly pet again without absolute clear assurance it will reduce pain or discomfort dramatically. And of course that is rarely possible.
    We recent adopted a wonderful cat that arrived with an injured eye to our door( we have never seen a stray in our area before!). His eye was removed by our vet as it was malformed and undersized and infected and he had never had sight in it. He was an is such a joy after losing our beloved old girl.
    Then…. Picking up pet food our local Pet Valu which works with a rescue in our area, two weeks ago, there was tiny emaciated female that had to have an eye removed from injury and a fractured tail. Of course we alpplied and she was home with us in a week and gaining weight, and surprisingly adoring her new brother and vice versa. Both are about a year. We have never had young cats – always older to senior adoptions. I hope we will have many healthy years together!!
    Thank you for all you do advising pet parents with sensible realistic advice.

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