I had the enjoyable experience of participating in a Facebook Live Discussion with Dr. Hannah Capon of the Canine Arthritis Management Project about evidence-based arthritis management for dogs. We talked about how to evaluate treatments for arthritis and whether or not they are working, as well as taking questions about specific treatments from viewers.
Check it out!
This was fantastic! I am so sorry to have missed the Live, but appreciate you posting the recording.
My 7 year old agility border collie has arthritis in her wrist from an old injury. I’ve retired her from competition. Now she is a hiking dog. My Vet prescribed NSAIDs as needed (which is not very often). She also prescribed Adequan, which did set off some red flags for me. My research shows that Adequan is “polysulfated glycosaminoglycan, and is very similar to the more familiar oral supplement known as glucosamine.” I know glucosamine has very little effect in dogs.
Do you have any evidence for Adequan being effective? Does it really slow “the disease process through inhibiting some of the destructive process within the joint, as well as some anti-inflammatory effect.” That’s the question I would have asked had I caught this Live.
Thank-you for continuing to be a voice of reason and evidence in the Veterinarian world. I am a fan!
Adequan was approved by the FDA for use in dogs with arthritis in 1997. The study done to support this approval is theoretically available from the FDA, but I have never been able to find the actual data, just the summary in the prescribing information insert.
There is also a published study showing no significant difference from placebo.
It’s widely used in horses, and the evidence is pretty poor for that too. It’s plausible, and there is some limited evidence it might help, but overall I think any benefit is probably small, and the risk is probably negligible. I sue it sometimes when NSAIDs are not enough or not an option, but I have little confidence in it.
Thank-you so much for that detailed response about Adequan. Carol
Is there any evidence that N-butyryl glucosamine is helpful?
No reason to think it is meaningfully different form other forms of glucosamine, which probably do little for arthritis.
Hi, I found your above reply about Adequan very interesting, but the link to the published study (showing no significant difference from placebo) doesn’t work anymore. And I couldn’t find the study myself. Do you have another link by chance? Thank you for the very informative talk, very helpful!
Here is the study:
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-950X.1994.tb00468.x
There are A LOT of alternative supplements and alternative modalities out there. Even the CAM website includes “complementary therapies” in their keys to managing arthritis, which was confusing.
In this overwhelming and frankly, expensive landscape, what can owners do to be able to select what will be likely to actually help their suffering pets, and not deplete their finances on what won’t? Thank you for any insight.
Yes, it’s a challenge because almost none of the therapies available have any reliable evidence for benefits. Obviously, weight loss and NSAIDs are the best proven approaches and should always be the first choice. If not possible or sufficient, then it’s really a roll of the dice whatever else you try. I have written about many specific therapies for OA here, as well as cited some of the literature reviews, but the bottom line is that anecdotes are unreliable and we rarely have anything better.
Reading the article, it says there is no statistical difference between the different treatments groups (varying doses of adequan), it does not say there is no difference between treatment and placebo groups.
The study done to support this approval is theoretically available from the FDA, >>>>>
has anyone read the studies who can comment on how they got possession of the adequan studies to read? i used adequan for a few years when it came out 30-40 ago but it did not seem to help my patients and what i read on Dr Barrets quackwatch newsletter at the time made me think it was just another glucosamine like mistake of mine only with fda blessing approval . Has a NNT been promoted for this drug taken from the statistically significant fda studies?
What is your take on this study about using chiropractic manipulation in young boxers in an attempt to reduce spondylosis? It looks like monthly manipulation for the first year reduce the risk by nearly 50%. Seems way too good to be true but…what do you think? Thanks 🙂
https://pubmed.ncbi.nlm.nih.gov/34564593/
I actually did a post on that last year.
It is a classic example of Tooth Fairy Science. Before running a clinical trial to test a medical intervention, it is necessary to have a plausible reason to think the treatment will work. If I wanted to run a study testing whether waving a goose feather over a person’s head twice cured brain cancer, no one would participate because there’s no reason to think it would help. Given the lack of evidence for any plausible mechanism to explain how chiropractic works, it makes little sense to continue running such studies. This one isn’t convincing on its own anyway (as I discuss in the earlier post), but it would have to be an exceptionally strong study too overcome the existing negative evidence and lack of plausible mechanism.
How could chiropractic work for quadrupedal mammals? If there is a mechanical manipulation that relieves pressure on nerves in the human spine, that is the mechanism of action. However, the human spine has the problems it has, because we stand upright and walk on two feet. The human hips and knees wear out for the same reason.
Chiropractic also requires the patient to verbally communicate with the practitioner. Mechanically manipulating an arthritic canine or feline patient’s joints (especially the hips) sounds just plain cruel to me.
Thanks for this overview. I am curious, a quick search of whether NSAIDs are considered to slow the progress of OA shows very mixed results and some negative results. I know they can help quality of life for some dogs. But slowing progression? Thanks.
You are correct that the evidence is mixed and uncertain. At this point, I don’t think we can conclude with confidence whether NSAIDs slow, worsen, or do not affect ling-term progression of OA.
Thanks for the information. Have there been any studies that look at the safety of NSAIDS on senior dogs (dogs over 10-12 years of age).? (I have a 17 year old dog with hind leg weakness issues, mildly elevated kidney and liver values). For me, NSAIDS are scary because of other issues that many old dogs have (kidney) and I turn to other meds first that might not have the research behind them because of this.
Age itself isn’t really the issue, it’s whatever health conditions may go with it. NSAIDs at proper dosages don’t cause kidney or liver disease, but in dogs with pre-existing disease, they can make it worse. If a dog doesn’t have these issues, then NSAID use shouldn’t be higher risk just due to age. In your case, there is some potentially increased risk. This doesn’t mean NSAIDs can’t be used, only that the risk has to be considered and any use monitored closely.
Of course, against any risk must be balanced the benefits, all in light of the alternatives available. No dog with pain should go without effective pain control just because we are anxious about possible side effects, but we have to use what knowledge we have to try and balance risks and benefits as best we can. Unfortunately, there aren’t a lot of effective pain relievers for dogs, so these options are limited. The new injectable product Liberal is an option for some dogs with arthritis. Other things may be useful as add-on treatments (e.g. fish oil), or may be of uncertain value (e.g. gabapentin, physical therapy), or may simply not work (e.g. tramadol). In a situation like yours, you will want to work closely with your vet and communicate clearly about how your dog is doing, what options you can try, how they are working, and how to monitor for and manage undesirable effects. Using tools like pain scales and at-hoe assessment of function can help a lot to minimize placebo effects and give you and your vet the clearest possible picture of your dog’s needs and what is or is not working.
Here is a post with links to literature on NSAID safety and risks.
Good luck!