A Discussion of Evidence-based Arthritis Management for Dogs

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!

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17 Responses to A Discussion of Evidence-based Arthritis Management for Dogs

  1. Carol says:

    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!

  2. skeptvet says:

    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.

    Efficacy: Efficacy of Adequan® Canine was demonstrated in two studies. A laboratory study using radiolabeled PSGAG established distribution of PSGAG into canine serum and synovial fluid following a single intramuscular injection of 2 mg/lb. A clinical field trial was conducted in dogs diagnosed with radiographically-confirmed traumatic and/or degenerative joint disease of 1 or 2 joints. Joints evaluated included hips, stifles, shoulders, hocks and elbows. Fifty-one dogs were randomly assigned to receive either Adequan® Canine at 2 mg/lb of body weight or 0.9% saline. Both treatments were administered by intramuscular injection twice weekly for 4 weeks (8 injections total). Investigators administering treatment and evaluating the dogs were unaware of the treatment assignment. A total of 71 limbs in 51 dogs were evaluated. Of these, 35 limbs in 24 dogs were in the Adequan® Canine treated group. Each lame limb was scored for lameness at a walk, lameness at a trot, pain, range of motion, and functional disability. The scores for the individual parameters were combined to determine a total orthopedic score. At the end of the treatment period, dogs treated with Adequan® Canine showed a statistically significant improvement in range of motion and total orthopedic score over placebo treated control dogs.

    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.

  3. Carol says:

    Thank-you so much for that detailed response about Adequan. Carol

  4. Cady says:

    Is there any evidence that N-butyryl glucosamine is helpful?

  5. skeptvet says:

    No reason to think it is meaningfully different form other forms of glucosamine, which probably do little for arthritis.

  6. Billy says:

    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!

  7. Michelle Michlewicz says:

    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.

  8. skeptvet says:

    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.

  9. Jim says:

    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.

  10. skeptvet says:

    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.

  11. art malernee dvm says:

    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?

  12. 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 🙂


  13. skeptvet says:

    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.

  14. Anne L Gillingham says:

    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.

  15. Sarah J says:

    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.

  16. skeptvet says:

    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.

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