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.
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.
Another acupuncture study shows it’s a placebo
The history of veterinary acupuncture: It’s not what you think
Electroacupuncture for intervertebral disk disease
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.
The end of chiropractic? Of course not!
Chiropractic: the more we look the less we find
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.
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.
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.
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
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
12. Other Reviews
American Academy of Orthopaedic Surgeons Review of Arthritis Treatments
Thank you for taking the time to share about the challenges of your elderly Peke companion. It is very kind. I understand the tribulations of elderly dogs, and cats, as throughout my many years here, domesticated animals have been a big part of my life. I appreciate the shared stories by respondents. But I understand very well, that when age renders them susceptible to maladies that begin the stages towards the close of ‘life’, nothing is more important, than returning their unconditional love, with the understanding, and acceptance of meeting responsibility to them, when a pain free, quality life, is no longer theirs. It has been my saddest last act of love several times throughout the decades. This is not a matter of subjecting a dying dog, to desperate measures to cling on. I have encountered such, and it is anathema for me.
My goal in posting to SkepVet, was to seek feedback from him/her or from SkepVet followers, regarding, like my dog, any experience with, why a dog with no illnesses, no actual diagnosis of disease besides an average degree of arthritis for a dog that may be above average age… And which is managed for potential pain with meloxicam. Other than that, the only medical issues in the 10 years since Lolo healed from the physical abuse he’d endured, has been one minor corneal ulcer, and one resistant corneal ulcer, treated successfully 2 yrs ago, and long since healed. Oh, he also had diahrea and a hot spot treated. My dog just became aggressive, one day he growled and that was it , with no significant reasons doctors can find, or nothing I can find with my constant observation as to why a formerly happy, vivacious gentle dog, for whom multiple examinations and blood work and xrays in the past year from various vets, have found nothing, changed completely and to the extreme, overnight. Any possible causes have been worked through, for ex in case of artheritic pain, meds were changed, upped, even though he walks the same as always, goes in and out to urinate and defecate, appetite same, all this, but one day, he suddenly growled and became progressively aggressive over the past year..
If SkepVet has encountered cases of dogs confirmed to have brain tumors, that exhibited the same, feedback would mean so much. If someone whose HAD A DOG THAT ALSO EXHIBITED SOLELY COMMENCEMENT OF and progressive aggression, for which a vet was able to determine a diagnosis, it would mean so much to get feedback. The vets aren’t lying to me when they say they don’t know. They have tried to determine by trying different things, but after a year of several vets and several efforts, they just don’t know, as, it seems, it is enigmatic. Although the most recent vet visit, vet took a long shot by recently considering Canine Cognitive Dementia, but she came up with that consideration, based upon records from a year before, in which I’d described him exhibiting, for a short time, characteristics of the malady. The problem with a diagnosis of CCD, is that he has exhibited absolutley none of those characteristics since the 2-ish weeks he had, over one year ago. None.
This is not a dog that is physically debilitated. This is not a dog with a single diagnosed illness, or disease, other than the highly unlikely recent, retroactive diagnosis of the one vet of CCD. She has run out of possible considerations for the sudden aggression and I appreciate her tossing out anything for me to hold onto as a cause, but I’m not an idiot, and CCD can be exhibited, intermittently or for a short time, if the degeneration of the brain and build up of plaque is not a chronic condition.
All the vets I went to back then, and the consequent research on what they shared with me then, did confirm this. A dog with … chronic (for lack of better word) CCD, exhibits the symptoms of the diseases progression. It’s been over a year since Lolo had the short phase I described in first posting. Lolo remains remarkably physically healthy according to each of the last 6 mos checkups and the exams I’d asked for regarding his aggression. So, it’s not a matter of whether his quality of life has waned because he is suffering from pain, unless all the many thousands spent on every test except scans for brain tumor, meant nothing.
I am truly looking for anything from anyone who had or has a dog that exhibited the same, sole sudden change. SkepVet is no nonsense about providing background on research and outcome or not, and no nonsense about what is fact or hype… I’m hoping that he may know something about this, or that his blog followers will.
Do you have any information about a product called Alenza, made by Bayer DVM? Our vet mentioned it as something we might try for arthritis pain and lameness in our 16-yr-old Jack Russell mix. She has Stage 3 kidney disease, so our vet advises against NSAIDS. Our dog is on tramadol and gabapentin — low doses of each because higher doses caused spaciness and incoordination. At the vet’s suggestion, we are now in the loading phase of Adequan; I don’t know whether to expect much but we decided to give it a try. As far as impact on quality of life, the mobility issues definitely are a bigger deal right now than the kidney disease. The dog is eating well, likes to go for short walks when her limp isn’t too bad, and even enjoys nosework training. If the Adequan doesn’t improve her mobility, we are considering trying Alenza just because we’ve tried everything else. However, I can’t find any information about either efficacy or safety for Alenza. Thanks!
Alenza contains some nutraceuticals that have been shown in lab studies to affect the activity of genes that produce inflammatory compounds such as those that appear in arthritic joints. This suggests it MIGHT be beneficial in arthritis patients and it MIGHT be safer than NSAIDs. That said, there are no clinical trials of this particular product to show it actually meets those theoretical expectations. There are some studies of other products with purportedly the same primary ingredient (though differences in their other ingredients) that suggest minimal side effects and some possible benefit. All together, this means Maybe. That’s the best we can do with the available information.
My young terrier has some hind leg weakness, I had him looked at early on, myasthenia gravis was ruled out and they said “keep an eye on it” it went away for 2 years except for a little stiffnes. With the hot, humid weather we have been having in New England I noticed him limping more and tiring easily after a slow walk. He is now 3 1/2 years old.
I looked into aquatic therapy, as it looks like early onset arthritis to me. At $140 for eval and $45 for 20 minutes of aquatic therapy (swimming in a pool)
Instead, I have been taking him to the local lake (on the sneak) for swimming for 20 minutes at least 3 times a week with excellent results, he is energized, limping less and tolerating walks better. I will continue this activity, however I may have to have him evaluated if it gets worse. He is healthy and happy otherwise, it doesn’t seem to bother him….or maybe he has adjusted.
Anyway, I just wanted to point out how therapeutic swimming is for some dogs.
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