Evaluation of construct and criterion validity for the 'Liverpool Osteoarthritis in Dogs' (LOAD) clinical metrology instrument and comparison to two other instruments

Resistin concentrations in serum and stifle synovial fluid from normal and cruciate deficient dogs with osteoarthritis

OBJECTIVE

To compare synovial fluid (SF) resistin concentrations in healthy dogs to dogs with osteoarthritis (OA) secondary to cranial cruciate ligament (CrCL) injury and to correlate resistin concentrations with body condition score (BCS) and evaluate resistin release from peripheral blood mononuclear cells (PBMC) and adipocytes.

STUDY DESIGN

Controlled, prospective, clinical study ANIMALS: Thirty-nine client-owned dogs, 13 healthy and 26 with secondary OA, were enrolled. Blood was collected from six healthy purpose-bred dogs for PBMC culture. An additional six mixed-breed dogs were used for adipocyte collection and culture.

METHODS

Resistin concentrations were measured with a canine-specific enzyme-linked immunoabsorbent assay. Resistin was compared between healthy SF and OA SF with Student's t test. Correlation of resistin concentrations to BCS was performed. Peripheral blood mononuclear cells and adipocytes were cultured under three conditions: negative control, lipopolysaccharide, and concanavalin A (Con A). A linear mixed model was used to determine differences in resistin concentrations among treatments.

RESULTS

Resistin concentrations in OA SF were comparable to healthy SF. Neither serum nor SF resistin was correlated with BCS. Cultured PBMC stimulated with Con A released resistin, while adipocytes did not.

CONCLUSION

Neither serum nor SF resistin were altered in dogs with OA secondary to CrCL insufficiency. In addition, resistin was not correlated with canine body fat and did not appear to function as adipocytokine in the dog.

CLINICAL SIGNIFICANCE

Resistin may not be involved in the pathogenesis of OA. However, resistin may be important in inflammation because it is released from inflammatory cells.

Contribution of Habitual Activity to Cruciate Ligament Rupture in Labrador Retrievers

OBJECTIVE

 The aim of this study was to describe the contribution of signalment and habitual activity in the development of cruciate ligament rupture (CR) in Labrador Retrievers.

STUDY DESIGN

 Four hundred and twelve client-owned purebred Labrador Retrievers were recruited. Dogs were assigned either as affected with CR or as controls based on signalment, physical examination and radiographic evidence of disease. Clients were asked to complete a questionnaire related to signalment, concurrent disease and a questionnaire pertaining to their dog's activity before development of CR or general activity during the dog's most active years.

RESULTS

 Habitual activity was not significantly different between dogs affected with CR and controls. There was no significant difference in neuter status or body weight between CR affected dogs and controls. Labrador Retrievers with a yellow coat, and Labradors that did not maintain an optimal body weight in the opinion of their veterinarian were at increased risk of developing CR.

CONCLUSIONS

 Habitual activity level is not a risk factor for development of CR in Labrador Retrievers. Our study did not show neuter status, sex or body weight to be risk factors for CR. However, coat colour and not sustaining optimal body condition are significant risk factors for CR.

A report on the use of a single intra-articular administration of autologous platelet therapy in a naturally occurring canine osteoarthritis model - a preliminary study

Background

Osteoarthritis (OA) represents a significant burden to societies, as it affects quality of life, performance and poses a large healthcare cost. We aimed to describe the use of a single intra-articular (IA) injection of an autologous platelet therapy in the management of osteoarthritis (OA) in a naturally occurring canine model.

Methods

Fifteen police working dogs with bilateral hip OA were treated with 3 ml of platelet concentrate per hip joint, produced with the V-PET kit. Response to treatment was measured by the Canine Brief Pain Inventory (CBPI, divided in pain interference score – PIS, and Pain Severity Score - PSS), Liverpool Osteoarthritis in Dogs (LOAD), Canine Orthopedic Index (COI, divided in four dimensions: function, gait, stiffness and quality of life - QOL) and the Hudson Visual Analogue Scale (HVAS). Seven different time points were considered: T0 (before treatment), T1 (after 15 days), T2, T3, T4, T5 and T6 (after 1, 2, 3, 4 and 5 months respectively). Results from each evaluation moment were compared with T0 with a Paired Samples T-Test, and a p < 0.05 was set.

Results

Significant differences were observed at T1 (p < 0.01 for HVAS, PSS, COI, Gait and QOL; p = 0.01 for PIS; p = 0.02 for Function; and p < 0.05 for Stiffness), T2 (p < 0.01 for PSS, PIS and Gait; p = 0.01 for COI; p = 0.02 for HVAS, Function and QOL; and p = 0.04 for Stiffness), T3 (p < 0.01 for HVAS, PSS, PIS, Function and Gait; p = 0.01 for COI; and p = 0.02 for QOL), T4 (p < 0.01 for PSS; p = 0.03 for PIS and Gait), T5 (p < 0.01 for COI, Function and Gait; p = 0.03 for PSS, PIS and Stiffness), T6 (p < 0.01 for PSS, Function and Gait; p = 0.04 for PIS; p < 0.05 for COI) and T7 (p < 0.01 for PSS, Function and Gait; p = 0.01 for COI; and p < 0.05 for PIS).

Conclusions

Autologous platelet therapy was used without apparent harm in the subjects. A single administration produced significant improvements, which lasted several months, and therefore warrants further study.

Spontaneous dog osteoarthritis - a One Medicine vision

Osteoarthritis (OA) is a global disease that, despite extensive research, has limited treatment options. Pet dogs share both an environment and lifestyle attributes with their owners, and a growing awareness is developing in the public and among researchers that One Medicine, the mutual co-study of animals and humans, could be beneficial for both humans and dogs. To that end, this Review highlights research opportunities afforded by studying dogs with spontaneous OA, with a view to sharing this active area of veterinary research with new audiences. Similarities and differences between dog and human OA are examined, and the proposition is made that suitably aligned studies of spontaneous OA in dogs and humans, in particular hip and knee OA, could highlight new avenues of discovery. Developing cross-species collaborations will provide a wealth of research material and knowledge that is relevant to human OA and that cannot currently be obtained from rodent models or experimentally induced dog models of OA. Ultimately, this Review aims to raise awareness of spontaneous dog OA and to stimulate discussion regarding its exploration under the One Medicine initiative to improve the health and well-being of both species.

Osteoarthritis occurs spontaneously in pet dogs, which often share environmental and lifestyle risk-factors with their owners. This Review aims to stimulate cooperation between medical and veterinary research under the One Medicine initiative to improve the welfare of dogs and humans.

Dogs have many analogous spontaneous diseases that result in end-stage osteoarthritis (OA).

Inbreeding and the predisposition of certain dog breeds for OA enable easier identification of candidate genetic associations than in outbred humans.

Dog OA subtypes offer a potential stratification rationale for aetiological differences and alignment to analogous human OA phenotypes.

The relatively compressed time course of spontaneous dog OA offers longitudinal research opportunities.

Collaboration with veterinary researchers can provide tissue samples from early-stage OA and opportunities to evaluate new therapeutics in a spontaneous disease model.

Awareness of the limitations and benefits of using clinical veterinary patients in research is important.

Pain and Problem Behavior in Cats and Dogs

We argue that there is currently an under-reporting of the ways in which pain can be associated with problem behavior, which is seriously limiting the recognition of this welfare problem. A review of the caseloads of 100 recent dog cases of several authors indicates that a conservative estimate of around a third of referred cases involve some form of painful condition, and in some instances, the figure may be nearly 80%. The relationship is often complex but always logical. Musculoskeletal but also painful gastro-intestinal and dermatological conditions are commonly recognized as significant to the animal's problem behavior. The potential importance of clinical abnormalities such as an unusual gait or unexplained behavioral signs should not be dismissed by clinicians in general practice, even when they are common within a given breed. In general, it is argued that clinicians should err on the side of caution when there is a suspicion that a patient could be in pain by carefully evaluating the patient's response to trial analgesia, even if a specific physical lesion has not been identified.

Correlation of Artemin and GFRα3 With Osteoarthritis Pain: Early Evidence From Naturally Occurring Osteoarthritis-Associated Chronic Pain in Dogs

Arthritis, including osteoarthritis (OA) and other musculoskeletal-associated pain, is a worldwide problem, however, effective drug options are limited. Several receptors, neurotransmitters, and endogenous mediators have been identified in rodent models, but the relevance of these molecules in disease-associated pain is not always clear. Artemin, a neurotrophic factor, and its receptor, glial-derived neurotrophic factor (GDNF) family receptor alpha-3 (GFRα3), have been identified as involved in pain in rodents. Their role in OA-associated pain is unknown. To explore a possible association, we analyzed tissue from naturally occurring OA in dogs to characterize the correlation with chronic pain. We used behavioral assessment, objective measures of limb use, and molecular tools to identify whether artemin and GFRα3 might be associated with OA pain. Our results using banked tissue from well-phenotyped dogs indicates that artemin/GFRα3 may play an important, and hitherto unrecognized, role in chronic OA-associated pain. Elevated serum levels of artemin from osteoarthritic humans compared to healthy individuals suggest translational relevance. Our data provide compelling evidence that the artemin/GFRα3 signaling pathway may be important in OA pain in both non-humans and humans and may ultimately lead to novel therapeutics.

Intra-Articular Umbilical Cord Derived Mesenchymal Stem Cell Therapy for Chronic Elbow Osteoarthritis in Dogs: A Double-Blinded, Placebo-Controlled Clinical Trial

Background: Intra-articular stem cell therapy may help alleviate lameness caused by osteoarthritis in dogs. Umbilical cord-derived stem cell (UMSC) therapy has not yet been investigated in a veterinary clinical study. We hypothesized that dogs treated with intra-articular UMSC will have improved limb function and quality of life when compared to dogs treated with a saline placebo injection. Methods: This was a prospective, double-blinded, placebo-controlled clinical trial in client-owned dogs with chronic elbow osteoarthritis with a follow-up time of 6 months. Dogs were assigned to receive intra-articular UMSC (n = 38) or a saline placebo intra-articular injection (n = 30). Outcome measures included the Canine Brief Pain Inventory score (CBPI) and peak vertical force (PVF) from force-platform gait analysis. Treatment was considered successful when there was a decrease in the Pain Severity Score of at least one and a decrease in the Pain Interference Score of at least one from baseline. Success rates and PVF were compared between groups. Results: No adverse effects associated with UMSC were noted. Of the dogs completing the study, treatment success in the UMSC (n = 28) vs. placebo groups (n = 23) was observed in 54 vs. 28% of dogs at 1 month, 50 vs. 27% at 3 months, and 46 vs. 14% at 6 months, respectively. Success rate in the UMSC group was significantly higher than the placebo group at 1 and 6 months after treatment. However, no differences in PVF of the affected limb over time was observed in either group. Conclusions: Intra-articular UMSC for osteoarthritis may improve clinical signs based on owner observations.

The effectiveness of marine based fatty acid compound (PCSO-524) and firocoxib in the treatment of canine osteoarthritis

Background

NSAIDs are accepted as the most predictably efficacious medical treatment of the clinical signs of osteoarthritis (OA). The marine-based fatty-acid compound PCSO-524 has been proposed as an adjunctive treatment for canine OA, however benefits of this agent is still controversial. The purpose of this study was to evaluate and compare the effectiveness of PCSO-524 combined with the NSAID firocoxib using force plate gait analysis, orthopedic assessment score (OAS) and canine brief pain inventory score (CBPI) in dogs with OA.

A prospective, randomized, double-blinded study was conducted. Seventy-nine dogs that had hip and/or stifle OA were assigned randomly into three treatment groups: firocoxib, PCSO-524 and combination of firocoxib and PCSO-524, orally for 4 weeks. Peak vertical force (PVF, expressed as a percentage of bodyweight), OAS, CBPI, serum prostaglandin E₂ concentration, hematology and blood chemistry values were evaluated before treatment (Day0), as well as at the second (Day14) and fourth week (Day28) during treatment.

Results

Within group analysis revealed significant increases in PVF over the 4-week treatment period for firocoxib, PCSO-524 and the combination (p < 0.05). Mean increases in PVF were 3.25 ± 4.13, 2.01 ± 3.86, 4.11 ± 4.69%BW (mean ± SD) respectively. The OAS showed non-significant change in all treatment groups. There were significant decreases in CBPI pain severity score (PSS) and CBPI pain interference scores (PIS) within some groups over time, however no significant differences were found between the groups. Significantly decreased serum PGE₂ concentration (p < 0.05) was found in the combination group. Significant increases in BUN and creatinine (p < 0.05) compared to pre-treatment values were found in the firocoxib and combination groups but not in the PCSO-524 group at day28, but all values in all dogs remained within the normal ranges.

Conclusions

The results of this study suggested combination of both PCSO-524 and firocoxib is more effective in alleviation of inflammation and improvement of weight bearing ability when compared to the uses of either PCSO-524 or firocoxib alone. Further clinical studies are needed to confirm this, and to determine if there is any benefit of PCSO-524 over placebo.

Placebo-controlled pilot study of the effects of an eggshell membrane-based supplement on mobility and serum biomarkers in dogs with osteoarthritis

Osteoarthritis (OA) is a debilitating disease in dogs. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat OA; however, many dogs do not obtain adequate pain relief with an NSAID alone. This pilot study evaluated the systemic anti-inflammatory and mobility enhancing effects of an eggshell membrane-based nutritional supplement in dogs with OA-associated pain and mobility impairment. Twenty-seven dogs with OA-associated pain were enrolled into a randomized, double-masked, placebo-controlled, proof of principle pilot study and received either placebo or an eggshell membrane-based nutritional supplement over a 12-week period. Inflammatory biomarkers (IL-2, IL-6, IL-8, tumor necrosis factor-α, C-reactive protein, S100A12, and N-methylhistamine) were measured at Day 0 and Day 84. Owner questionnaires (CBPI and LOAD) were completed at Day 0, Day 42, and Day 84. Differences between groups over time were calculated. Twenty-two dogs completed the pilot study. Inflammatory biomarker IL-2 decreased in the supplement group, compared to the placebo group. Although small, the difference was statistically significant at an alpha of 0.1 (P=0.069). LOAD scores were numerically lower in the supplement group, but not significantly different from the placebo group at Day 0. Day 84 LOAD scores were significantly lower in the supplement group compared to the placebo group (P=0.034). CBPI results did not show the same pattern. The changes in biomarkers and LOAD scores were small, and do not provide definitive evidence of positive effects. However, these pilot results provide a rationale for performing a larger placebo-controlled study of the potential effects of the eggshell membrane-based nutritional supplement.

Evaluation of the Effects of Undenatured Type II Collagen (UC-II) as Compared to Robenacoxib on the Mobility Impairment Induced by Osteoarthritis in Dogs

Osteoarthritis (OA) is a chronic disease that requires a multimodal therapeutic approach. The aim of this study was to evaluate the effects of undenatured type II collagen (UC-II) as compared to robenacoxib in dogs affected by OA. Our hypothesis was that the two compounds would be similar (non-inferiority) in improving mobility. To test this hypothesis, a complete orthopedic examination, x-ray and the Liverpool Osteoarthritis in Dogs (LOAD) survey were performed in dogs affected by OA before and after the treatments. The study was designed as a clinical, randomized, controlled and prospective study. Sixty client-owned dogs were randomized in the R group (n = 30, robenacoxib 1 mg/kg/day for 30 days) and in the UC-II group (n = 30, UC-II 1 tablet/day for 30 days). Thirty days after the beginning of the treatment (T30), the dogs were reassessed for the LOAD, MOBILITY and CLINICAL scores. Based on the data obtained from the study, a significant reduction in LOAD and MOBILITY scores was recorded between T0 and T30 with a similar magnitude among the two groups (R = 31.5%, p < 0.001; UC-II = 32.7%, p = 0.013). The results of this study showed that UC-II and robenacoxib were able to similarly improve mobility of dogs affected by OA.

A novel device to measure static hindlimb weight-bearing forces in pronograde rodents

BACKGROUND

Joint pain is composed of both spontaneous and movement-induced pain. In animal models, static bodyweight distribution is a surrogate for spontaneous joint pain. However, there are no commercially-available instruments that measure static bodyweight distribution in normal, pronograde rodents.

NEW METHOD

We designed a Static Horizontal Incapacitance Meter (SHIM) to measure bodyweight distribution in pronograde standing rodents. We assessed the device for feasibility, repeatability, and sensitivity to quantify hindlimb bodyweight distribution. Mice and rats with unilateral inflammatory pain induced by subcutaneous injections of capsaicin or Complete Freund's Adjuvant (CFA) into the plantar surface of the left hind paw were used to measure static weight-bearing. The ability to attenuate inflammatory pain-associated weight-bearing asymmetry was tested by administering a non-steroidal anti-inflammatory drug, meloxicam.

RESULTS

The SHIM's ability to detect significant reductions in limb loading on the injected hindlimb in mice and rats was validated using both acute and sub-chronic pain models. Treatment with meloxicam partially reversed CFA-induced effects.

COMPARISON WITH EXISTING METHODS

In contrast with assays that measure kinetic or static weight-bearing forces (e.g., walking, or standing at a 45 ° incline), the SHIM allows evaluation of weight-bearing in rodents that are standing at rest in their normal pronograde position.

CONCLUSIONS

The SHIM successfully detected: (a) asymmetric weight-bearing in acute and sub-chronic pain models; and (b) the analgesic effects of meloxicam. This study provides a novel tool to objectively evaluate limb use dysfunction in rodents.

Comparison of activity levels derived from two accelerometers in dogs with osteoarthritis: Implications for clinical trials

Accelerometer measurements are frequently reported as total weekly activity counts (AC). Methods of utilizing activity parameters to allow differentiation of activity intensities (i.e., manually derived cut-points) have been described. While this information may provide valuable data for researchers, only few investigators have utilized these methods. This may, in part, be due to the challenge associated with data processing. Some devices, however, generate activity intensity data automatically. This study was conducted to evaluate a novel accelerometer that allows for remote download of data via Wi-Fi (Heyrex), to compare automatically generated parameters quantifying activity levels to previously established cut-points (Actical) and to describe the variability of accelerometer data in dogs with osteoarthritis. Twelve client-owned dogs with osteoarthritis were fitted with a collar with two accelerometers (Heyrex and Actical). Accelerometer data were recorded for 28 days. Pearson bivariate correlations and coefficient of variation (CV%) were calculated for accelerometer data. There was a strong correlation between the AC reported by Heyrex and Actical devices. Several automatically generated parameters showed strong correlations to previously validated cut-points and displayed lower CV% than weekly AC. The activity intensity derived from the Heyrex was associated with the lowest CV% of all parameters from both accelerometers. Automatically generated activity intensity parameters should be considered as potential outcome measures in clinical trials for dogs with osteoarthritis. This novel technology may allow for convenient acquisition of activity intensity data in companion animals. However, technical difficulties (e.g., lack of Wi-Fi connectivity) may pose challenges when using this novel device.

Measurement of chronic pain in companion animals: Discussions from the Pain in Animals Workshop (PAW) 2017

In the face of increasing recognition and interest in treating chronic pain in companion animals, we struggle with a lack of therapeutic options. A significant barrier to the development of new therapeutics, or the critical evaluation of current therapies, is our inability to accurately measure chronic pain and its impact on companion animals. Over the last 20 years, much progress has been made in developing methods to measure chronic pain via subjective and objective methods - particularly in owner assessment tools and measurements of limb use and activity. Most work has been focused on chronic joint pain conditions, but there has been relatively little work in other areas of chronic pain, such as neuropathic and cancer pain. Although progress has been made, there is a considerable interest in improving our assessment of chronic pain, as evidenced by the multiple disciplines across industry, academia, and clinical practice from the veterinary and human medical fields that participated in the Pain in Animals Workshop held at the National Institutes of Health in 2017. This review is one product of that meeting and summarizes the current state of knowledge surrounding the measurement of chronic pain (musculoskeletal, cancer, neuropathic), and its impact, in cats and dogs.

Adaptation of the Canine Orthopaedic Index to evaluate chronic elbow osteoarthritis in Swedish dogs

BACKGROUND

Owner questionnaires may be used to assess osteoarthritis (OA) in dogs. The validated American College of Veterinary Surgeons' (ACVS) Canine Orthopaedic Index Questionnaire quantifies quality of life in dogs with orthopaedic disease. This index was modified and translated into Swedish and evaluated for validity, reliability and sensitivity. One group with confirmed moderate elbow dysplasia (n = 117) and one healthy control group (n = 146) without radiographic elbow disease and without lameness were included. Telephone interviews with the dog owners were conducted throughout the study using owner-completed questionnaires.

RESULTS

A 16-item questionnaire developed from an initial data set including 22 items, were able to differentiate between the affected group and the control group with good readability. Validity was measured through factor analysis which yielded a three-factor model accounting for 66.3% of the variance. Cronbach's α was 0.89 for the total instrument, > 0.7 for stiffness, lameness and function, but < 0.7 for quality of life. Based on the process the modified questionnaire can be used in Swedish, as the ACVS COI, to make intra-patient comparisons and evaluation of disease progression.

CONCLUSIONS

A sound owner-completed questionnaire translated into Swedish and modified, able to differ healthy dogs from dogs suffering from chronic osteoarthritis is presented. Performed statistical analysis show the items of the instrument to be reasonable and have high construct validity. The questionnaire may be used in the clinical setting and for research.

Correlation of serum and synovial leptin concentrations with body condition scores in healthy and osteoarthritic dogs

OBJECTIVE

To evaluate the relationship between serum and synovial fluid (SF) leptin concentrations and body condition score (BCS) in healthy and osteoarthritic dogs.

STUDY DESIGN

Controlled, prospective, clinical study.

ANIMALS

Nineteen healthy dogs and 29 dogs with osteoarthritis (OA) secondary to cranial cruciate ligament injury.

METHODS

Synovial fluid was obtained from the femorotibial joint under sedation (healthy dogs) or during surgery (OA dogs). Serum and SF leptin and interleukin (IL)-1β concentrations were measured via enzyme-linked immunosorbent assay. Dogs were classified as optimal weight (BCS 4-5/9) or overweight (BCS >5/9). Radiographs were scored for OA severity by a radiologist. Owners completed the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire.

RESULTS

Mean (± SD) SF leptin (4.09 ± 4 ng/mL) was lower than serum leptin (6.88 ± 5.52 ng/mL, P < .0001). Synovial fluid leptin was higher in overweight (5.28 ± 4.21) than in optimal body weight dogs (1.54 ± 1.72 ng/mL, P < .0001). Serum (P < .001) and SF leptin (P = .004) concentrations were associated with BCS. Concentration of SF leptin did not differ between healthy (2.4 ± 2.04 ng/mL) and OA (4.9 ± 4.3 ng/mL, P = .25) dogs. Synovial fluid leptin and LOAD scores were weakly associated (P = .03). No association was detected between SF leptin and radiographic score or IL-1β (P = .73).

CONCLUSION

Serum and SF leptin correlated with BCS in this population. Synovial fluid leptin was weakly associated with LOAD scores but not with radiographic severity of OA or IL-1β.

CLINICAL SIGNIFICANCE

Serum and SF leptin concentrations do not predict radiographic severity of canine OA but contribute to joint pain and dysfunction.

Synthetic osteochondral resurfacing for treatment of large caudocentral osteochondritis dissecans lesions of the humeral head in 24 dogs

OBJECTIVE

To report the outcome of dogs with large, caudocentral, osteochondritis dissecans (OCD) lesions of the humeral head treated with synthetic osteochondral resurfacing (SOR) implants.

STUDY DESIGN

Retrospective case series.

ANIMALS

Twenty-four client-owned large breed or giant dogs.

METHODS

The medical records of all dogs treated with first generation (G1) and second generation (G2) SOR implants were reviewed. All dogs were assessed with clinical examination and imaging 12 weeks after surgery. Assessment of outcome was based on subjective assessment of lameness, scoring of postoperative radiographs, and the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire.

RESULTS

Osteochondral resurfacing was performed with a G1 implant in 13 dogs (15 shoulders) and a G2 implant in 11 dogs (13 shoulders). Lameness resolved in all dogs treated with G1 implants and in 10 dogs treated with G2 implants by 12 weeks after surgery. One dog treated with a G2 implant was found to have an implant-associated infection, requiring implant removal. No recurrence of lameness was reported in 9 limbs treated with G1 implants and 10 limbs treated with G2 implants that were available for clinical review at a median time of 387 and 365 days, respectively, after surgery. Mean postoperative LOAD scores were 4.2 of 52 and 5.2 of 52 in dogs treated with a G1 or a G2 implant, respectively.

CONCLUSION

Synthetic resurfacing was technically feasible in all joints of this study and resulted in good clinical results.

CLINICAL SIGNIFICANCE

The use of SOR implants seems viable to treat large caudocentral OCD lesions of the humeral head in dogs and warrants prospective comparison with conventional arthroscopic treatment.

Initial psychometric testing and validation of the French version of the Canine Brief Pain Inventory

OBJECTIVE

The Canine Brief Pain Inventory (CBPI) is an owner-completed questionnaire quantifying the severity and impact of chronic pain in dogs. The English version of the CBPI was adapted into French and the objective of this study was to validate this French version of the CBPI.

STUDY DESIGN

Prospective clinical study.

ANIMALS

A group of 32 dogs with a medical history, clinical signs and radiographic evidence consistent with osteoarthritis.

METHODS

Owners of dogs with osteoarthritis who were native French speakers completed a single administration of the translated questionnaire. The psychometric properties were evaluated including construct validity (by factor analysis), reliability (internal consistency) and convergent validity.

RESULTS

Factor analysis on the responses from this cohort confirmed a two-factor questionnaire: the Pain Severity (PS) factor and the Pain Interference (PI) factor. The mean inter-item correlation for PS and PI questions was 0.74 and 0.53, respectively. These findings reveal strong internal consistency, suggesting that the questions contained within each factor measure the same concept and can be pooled to generate the PS score (PSS) and PI score (PIS). Cronbach's α was 0.91 and 0.87 for PSS and PIS, respectively. There was strong negative correlation between PSS and PIS with the overall quality of life score (r = -0.62 and r = -0.79, respectively, with p < 0.001 for both), consistent with the hypothesis that increases in PS and PS with function are highly correlated with a corresponding decrease in overall quality of life.

CONCLUSIONS AND CLINICAL RELEVANCE

Initial validation of this French version of the CBPI represents an important step in the expanded use of validated owner-completed outcome assessment instruments for use by researchers and clinicians who seek reliable methods to quantify the severity and impact of chronic pain in dogs with osteoarthritis.

Evidence-Based Veterinary Medicine: A Tool for Evaluating the Healing Process After Surgical Treatment for Cranial Cruciate Ligament Rupture in Dogs

This study aims to validate a tool, the Bologna healing stifle injury index (BHSII), for the evaluation of the clinical picture and the healing after surgical treatment for cranial cruciate ligament (CCL) rupture. The study included 158 client-owned dogs with CCL rupture and 20 healthy dogs. The BHSII is a questionnaire made up of 34 multiple-choice questions, divided into a part directed to the clinician and a part for the dog's owners. It was applied twice in the healthy dogs in order to test and retest the device. It was evaluated for reliability, validity, and responsiveness to clinical changes involving the dogs treated at the time of surgery, and 1, 3, and 6 months postoperatively. Statistical analyses were performed and the intraclass correlation coefficient test was ≥0.9 and the Cronbach-α was 0.84 suggesting good stability and good internal consistency of the tool. The area under the curve of the receiver operating characteristic curve was >0.9, indicative of the high accuracy of this tool. The clinician survey correlated with the owner questionnaire. In dogs with CCL rupture, the scores of the BHSII increased significantly postoperatively as compared with baseline. In conclusion, this clinical study proved the reliability, validity, and responsiveness of the BHSII. The results achieved from the BHSII provided an instantaneous, collective complete vision of the healing process of the stifle joints treated. It can be considered a valid tool for collecting data and for assessing successful surgical treatment in clinical practice.

41 Cases of Treatment of Cranial Cruciate Ligament Rupture with Porous TTA: Three Years of Follow Up

Tibial Tuberosity Advancement (TTA) is a surgical technique based on a linear osteotomy that determines a cranial advancement of the tibial tuberosity in patients suffering from cranial cruciate ligament rupture (CCL). The aim is to neutralize the cranial tibial thrust (CTT) and to reach a 90° angle between the patellar tendon and the tibial plateau with a physiological knee extension of 135°. In our study, a Ti6AI4V ELI (Titanium Aluminium Vanadium) titanium scaffold for the Porous TTA, with excellent properties of osteointegration and osteoconduction when subjected to cyclic loading has been adopted. Based on the previous scientific work on an ovine model, the use of this type of porous scaffolds has subverted the previous models. Scaffold production technology is based on direct mechanical manufacturing called Electron Beam Melting (EBM). For this study, 41 dogs, different breeds, medium-large size, weighing between 10 and 80 kg, aged between 1 and 13 years, were enrolled. The inclusion criteria were based on clinical evaluations (different gaits), drawer test and tibial compression, LOAD score (Liverpool Osteoarthritis in Dogs questionnaire), radiographic diagnosis in sedation with a 135° positioning of the joint and baropodometric investigations (Stance Analyzer). The results show that Porous TTA is an excellent method for functional recovery of the knee joint following the partial and total rupture of the CCL.

Development, initial validation and reliability testing of a web-based, generic feline health-related quality-of-life instrument

OBJECTIVES

The objective of this study was to develop a valid, reliable, web-based generic feline health-related quality-of-life (HRQoL) questionnaire instrument to measure the affective impact of chronic disease.

METHODS

A large initial item pool, obtained through interviews with cat owners, was reduced using predetermined criteria, survey scores for relevance and clarity, and the ability of individual items to discriminate between healthy and sick cats when owners completed a prototype questionnaire. Using these data, factor analysis was used to derive a scoring algorithm and provide evidence for factorial validity. Validity was demonstrated further in a field trial using a 'known groups' approach (sick vs healthy cats will have a different HRQoL profile, and the HRQoL profile of cats will deteriorate as comorbidities increase). Test-retest reliability was assessed using intra-class correlation coefficients (ICCs).

RESULTS

In total, 165 items were reduced to 20 and, on the basis of a factor analysis that explained 72.3% of the variation in scores input by 71 owners of 30 healthy and 41 sick cats using the prototype, these were allocated to three domains (vitality, comfort and emotional wellbeing [EWB]) with a scoring algorithm derived using item loadings. Subsequently, the owners of 36 healthy and 58 sick cats completed one or two (n = 48) assessments. Median scores (healthy vs sick) for all domains were significantly different ( P <0.001), 78% of cats were correctly classified as healthy or sick and for comorbidities the correlation coefficients were moderate (vitality 0.64; comfort 0.63; EWB 0.50). Test-retest reliability was good (ICC vitality 0.635; comfort 0.716; EWB 0.853).

CONCLUSIONS AND RELEVANCE

This study provides initial evidence for the validity and reliability of a novel HRQoL instrument to aid the assessment and management of chronic diseases of cats.

Avaliação psicométrica em português do indicador de dor crônica de Helsinki em cães com sinais crônicos de osteoartrite

RESUMO Objetivou-se determinar a validade, a confiabilidade e a sensibilidade do indicador de dor crônica de Helsinki (IDCH) em português, além de estabelecer correlação entre a plataforma de pressão em cães com displasia coxofemoral (DCF). O questionário foi preenchido por tutores de 40 animais com DCF e por 16 tutores de cães saudáveis. Os animais com DCF foram tratados com carprofeno 4,4mg/kg (GT= 21) ou placebo (GP= 19), administrados uma vez ao dia, durante quatro semanas. A avaliação consistiu no preenchimento do questionário (IDCH), na escala analógica visual de dor (EAVdor) e na escala analógica visual de locomoção (EAVloc) com duas semanas (A1) e imediatamente antes do tratamento (A2), duas (S2) e quatro (S4) semanas de tratamento e após duas semanas do término do tratamento (S6). A consistência interna dos dados foi considerada excelente (alfa de Cronbach = 0,89). Houve correlação moderada entre o IDCH e a EAVdor e boa entre o IDCH e a EAVloc, porém não houve diferença entre o grupo tratado com carprofeno e placebo no IDCH. Não houve correlação entre os dados da plataforma de pressão e o IDCH. O questionário apresentou validade de constructo, critério e fidedignidade e pode-se empregá-lo em países de língua portuguesa em cães com osteoartrite.

Lack of effectiveness of tramadol hydrochloride for the treatment of pain and joint dysfunction in dogs with chronic osteoarthritis

OBJECTIVE To investigate the effectiveness of tramadol for treatment of osteoarthritis in dogs. DESIGN Randomized, blinded, placebo-controlled crossover study. ANIMALS 40 dogs with clinical osteoarthritis of the elbow or stifle joint. PROCEDURES Dogs orally received 3 times/d (morning, midday, and night) for a 10-day period each of 3 identically appearing treatments (placebo; carprofen at 2.2 mg/kg [1 mg/lb], q 12 h [morning and night], with placebo at midday; or tramadol hydrochloride at 5 mg/kg [2.3 mg/lb], q 8 h) in random order, with treatment sessions separated by a minimum 7-day washout period. Vertical ground reaction forces (vertical impulse [VI] and peak vertical force [PVF]) were measured and Canine Brief Pain Inventory (CBPI) scores assigned prior to (baseline) and at the end of each treatment period. Repeated-measures ANOVA was performed to compare VI and PVF data among and within treatments, and the χ² test was used to compare proportions of dogs with a CBPI-defined positive response to treatment. RESULTS 35 dogs completed the study. No significant changes from baseline in VI and PVF were identified for placebo and tramadol treatments; however, these values increased significantly with carprofen treatment. Changes from baseline in VI and PVF values were significantly greater with carprofen versus placebo or tramadol treatment. A significant improvement from baseline in CBPI scores was identified with carprofen treatment but not placebo or tramadol treatment. CONCLUSIONS AND CLINICAL RELEVANCE 10 days of treatment with tramadol as administered (5 mg/kg, PO, q 8 h) provided no clinical benefit for dogs with osteoarthritis of the elbow or stifle joint.

Evaluation of the effect of signalment and owner-reported impairment level on accelerometer-measured changes in activity in osteoarthritic dogs receiving a non-steroidal anti-inflammatory

In veterinary medicine, evaluation of osteoarthritis (OA) treatment efficacy remains challenging. Measurement of activity, utilizing accelerometers, provides a surrogate measure of pain through measuring effects on activity, and the objective data collected can be used to assess the efficacy of treatments. However, little is known about how dog characteristics impact the accelerometry-measured response to treatment. The objectives of this study were to evaluate the effect of signalment and initial impairment level on accelerometer-measured changes in activity in osteoarthritic dogs after receiving a non-steroidal anti-inflammatory (NSAID). Fifty-seven client-owned dogs with OA-associated pain and mobility impairment were administered meloxicam for 2 weeks, following a 2-week baseline, and spontaneous activity was measured using an Actical accelerometer unit. Signalment factors and disease variables were recorded (age, sex, weight, impairment level, forelimb or hindlimb pain). Initial degree of impairment had a significant effect on changes in weekly (P=0.009), weekday (P=0.044) activity following NSAID treatment. Greater initial impairment was associated with larger positive changes in activity. Degree of impairment should be taken into consideration during the development of a clinical trial. Appropriate selection of candidates based on initial degree of impairment may permit a greater treatment effect, therefore increasing the power of the study.

Assessment of quality of life and chronic pain in dogs

Assessment of chronic pain and quality of life (QOL) are integral to clinical veterinary research and practice, and recent years have seen an increase in the published tools available for the assessment of both. However, the relationship between chronic pain and QOL in veterinary patients has received insufficient attention. This narrative review for the first time explores similarities, differences and interactions between chronic pain and quality of life and identifies common challenges to their assessment in dogs. In the opinion of these authors, assessments of both chronic pain and quality of life should be pro-active, global, regular, applied to answer specific questions for researchers and decision makers, and transparent about what has, and has not, been assessed. Collaboration in this field between animal welfare scientists, veterinary researchers and clinicians appears rare, and should be prioritised.

Initial evaluation of PetPace activity monitor

Mobility is considered a vital component of health and quality of life in humans and companion animals. Wearable devices for pets that can monitor activity and other aspects of health are increasingly being marketed to veterinarians and owners, with claims around their ability to monitor aspects of health. However, there is little scientific evidence to support the validity of these claims. To address this, the objective of this study was to assess the correlation of the activity measurement from the PetPace device compared to activity output from Actigraph and the validated Actical device. Ten client-owned, healthy dogs were used for the study. The three devices were mounted simultaneously on a dedicated collar and activity was recorded during a period of 7 days. There were moderate correlations between the Actical and the PetPace (r²=0.59, P=<0.001). There was high correlation between the PetPace and the Actigraph (r²=0.85, P=<0.001) and between the Actical and the Actigraph (r²=0.72, P=<0.001). If the Actical activity counts were limited under 50,000 per hour, there was strong correlation between the Actical and the PetPace (r²=0.71, P=<0.001) and between the Actical and the Actigraph (r²=0.86, P=<0.001). PetPace has a moderate correlation with the most validated activity monitor that has been used in veterinary medicine. Its real-time data acquisition, user friendly interface for owners and cost make this device an attractive tool for monitoring activity in dogs. Further studies maybe needed to evaluate its performance, validity and clinical utility in the field.

Translational pain assessment: could natural animal models be the missing link?

Failure of analgesic drugs in clinical development is common. Along with the current "reproducibility crisis" in pain research, this has led some to question the use of animal models. Experimental models tend to comprise genetically homogeneous groups of young, male rodents in restricted and unvarying environments, and pain-producing assays that may not closely mimic the natural condition of interest. In addition, typical experimental outcome measures using thresholds or latencies for withdrawal may not adequately reflect clinical pain phenomena pertinent to human patients. It has been suggested that naturally occurring disease in veterinary patients may provide more valid models for the study of painful disease. Many painful conditions in animals resemble those in people. Like humans, veterinary patients are genetically diverse, often live to old age, and enjoy a complex environment, often the same as their owners. There is increasing interest in the development and validation of outcome measures for detecting pain in veterinary patients; these include objective (eg, locomotor activity monitoring, kinetic evaluation, quantitative sensory testing, and bioimaging) and subjective (eg, pain scales and quality of life scales) measures. Veterinary subject diversity, pathophysiological similarities to humans, and diverse outcome measures could yield better generalizability of findings and improved translation potential, potentially benefiting both humans and animals. The Comparative Oncology Trial Consortium in dogs has pawed the way for translational research, surmounting the challenges inherent in veterinary clinical trials. This review describes numerous conditions similarly applicable to pain research, with potential mutual benefits for human and veterinary clinicians, and their respective patients.

Influence of class IV laser therapy on the outcomes of tibial plateau leveling osteotomy in dogs

OBJECTIVE

To determine the effects of low-level laser therapy (LLLT) on clinical outcomes in dogs with cranial cruciate ligament disease treated with tibial plateau leveling osteotomy (TPLO).

STUDY DESIGN

Randomized, placebo-controlled clinical trial. Owners and surgeons (care providers and assessors) were masked.

ANIMALS

Ninety-five dogs were admitted for TPLO and assigned to 1 of 2 groups, laser group (LG; n = 51) or placebo group (PG; n = 44).

METHODS

Three treatments (laser or placebo) were administered within a 4-day perioperative period. A fourth treatment was recommended and was accepted in 28.4% of cases (LG, n = 14; PG, n = 13). Dogs in the LG group received laser at wavelengths 660 nm red (100 mW) and at 800, 905 and 970 nm infrared (maximum 15 W continuous wave, 20 W peak pulsed wave), administered simultaneously. Dogs in the PG group received placebo laser (660 nm, 4 mW). Other treatments were identical. Outcomes were measured by difference in clinical metrology instruments (Liverpool Osteoarthritis in Dogs and adjusted Canine Orthopedic Index [COI]), osteotomy healing on a radiographic scale, time to cessation of nonsteroidal anti-inflammatory drug administration, and wound healing by owner questionnaire.

RESULTS

The only difference detected between groups consisted of a greater improvement in the gait section of the adjusted COI (ACOI) in the LG group (median [interquartile range; IQR] = 6 [4-7.5]) compared with the PG group (median [IQR] = 4 [2-6]; P < .05).

CONCLUSION

The laser protocol used in this study was associated with a greater improvement in ACOI gait in dogs treated with TPLO but did not improve any other clinical metrology instrument scores or bone healing.

CLINICAL SIGNIFICANCE

This study provides some evidence that LLLT may improve the gait of dogs recovering from a TPLO, as assessed by owners.

Spontaneous painful disease in companion animals can facilitate the development of chronic pain therapies for humans

OBJECTIVE

To outline the role that spontaneous osteoarthritis (OA) in companion animals can play in translational research and therapeutic pharmacological development.

OUTLINE

Narrative review summarizing the opportunities and limitations of naturally occurring, spontaneous OA as models of human OA pain, with a focus on companion animal pets. The background leading to considering inserting spontaneous disease models in the translational paradigm is provided. The utility of this model is discussed in terms of outcome measures that have been validated as being related to pain, and in terms of the potential for target discovery is outlined. The limitations to using companion animal pets as models of human disease are discussed.

CONCLUSIONS

Although many steps along the translational drug development pathway have been identified as needing improvement, spontaneous painful OA in companion animals offers translational potential. Such 'models' may better reflect the complex genetic, environmental, temporal and physiological influences present in humans and current data suggests the predictive validity of the models are good. The opportunity for target discovery exists but is, as yet, unproven.

Lameness associated with tarsal haemarthrosis as the sole clinical sign of idiopathic immune-mediated thrombocytopenia in a dog

A four-year-old, male Cocker Spaniel was presented for investigation of pelvic limb stiffness. There was palpable effusion of both tarsi, and analysis of synovial fluid from these joints indicated previous haemorrhage. After further investigation a diagnosis of idiopathic immune-mediated thrombocytopenia was made. The dog responded to treatment with prednisolone and azathioprine. To the authors’ knowledge, this is the first reported case of confirmed haemarthrosis as the sole presenting clinical sign for canine idiopathic immunemediated thrombocytopenia.

Therapeutic response analysis in dogs with naturally occurring osteoarthritis

OBJECTIVE

Reporting the rate of positive (+) and negative (-) responders based on an objective outcome measure of pain-related functional disability/lameness in dogs with naturally occurring osteoarthritis (OA), and the relationship between initial lameness severity and the odds of being a (+) responder.

STUDY DESIGN

Retrospective analysis of published peer-reviewed clinical trials in dogs with naturally occurring OA.

ANIMALS

Dogs (n = 213) with hip and/or stifle afflicted-joints.

METHODS

A responder analysis was undertaken using a previously determined cut-off value of ±2.0% of body weight using the peak of vertical force (PVF). Among the selected trials, PVF was acquired under similar conditions. Therapeutic approaches were therapeutic diets, natural health products and nonsteroidal anti-inflammatory drugs.

RESULTS

Among dogs receiving a therapeutic approach as described above (n = 121), 62.8% [95% confidence interval, 53.9-70.9] were defined as (+) responders, whereas 11.6% [7.0-18.5] were (-) responders, accounting for a net (+) response rate by 51.2% [42.0-60.4]. In dogs receiving a negative control (n = 92), the net (+) response rate was 1.1% [0.0-5.9]. The number needed to treat was 4, and the effect size 0.7 [0.4-1.0]. The odds ratio of being a (+) responder under the therapeutic approaches was 2.85 [1.57-5.17] (p < 0.001). For every less severe lameness manifested with an increment in PVF by 1% body weight, the chance of being a (+) responder following treatment decreased by 9% (odds ratio 0.91 [0.86-0.97], p = 0.006).

CONCLUSION AND CLINICAL RELEVANCE

The rate of (+) responder optimizes decision making for the management of pain-related clinical signs of OA. Evidence-based medicine was further supported by clinical metrics based on an objective outcome measure of pain-related functional disability/lameness. This study also revealed that dogs with a mild lameness are less prone to be improved, emphasizing the need to carefully manage OA dogs in spite of a more subtle affliction.

Effect of acupuncture on pain and quality of life in canine neurological and musculoskeletal diseases

This prospective study investigated the effects of acupuncture alone or combined with analgesics in chronic pain and quality of life assessed by owners for up to 24 weeks in 181 dogs with neurological and musculoskeletal diseases. The scores before and after the onset of treatment were evaluated using the Wilcoxon test and the evolution of success was evaluated by Kaplan-Meier curves. Differences were considered significant at P < 0.05. The success rates for Helsinki chronic pain index (HCPI), quality of life assessment, and visual analog scales (VAS) for pain and locomotion were 79%, 84%, 78%, and 78% of the animals, respectively, when both diseases and groups of treatment were combined. Dogs with musculoskeletal disorders had greater improvement in HCPI (P = 0.003) and VAS locomotion (P = 0.045) than those with neurological disorders. Use of acupuncture alone or in combination with analgesics reduced pain and improved quality of life in dogs with neurological and musculoskeletal diseases.

Owner assessment of chronic pain intensity and results of gait analysis of dogs with hip dysplasia treated with acupuncture

OBJECTIVE To evaluate pain intensity and kinetic variables in dogs with hip dysplasia (HD) treated with acupuncture, carprofen, or a placebo. DESIGN Randomized, controlled clinical study. ANIMALS 54 HD-affected dogs and 16 healthy dogs. PROCEDURES Seven HD-affected dogs were removed from the study. Dogs with HD were treated in a blinded manner for 30 days with acupuncture (once weekly for 5 sessions; n = 15), carprofen (4.4 mg/kg [2.0 mg/lb], PO, q 24 h; n = 16), or placebo capsules containing lactose (1 mg/kg [0.45 mg/lb], PO, q 24 h; n = 16). Dogs were evaluated 2 weeks and immediately before (baseline) and 2, 4, and 6 weeks after the onset of treatment. Owners evaluated the dogs' pain intensity with 2 validated questionnaires and a visual analogue scale (VAS) for pain and evaluated degree of lameness with a VAS for locomotion. Kinetics of the hind limbs were also evaluated. Sixteen HD-free dogs were used to assess the evaluation protocol. RESULTS Owners' assessments revealed that outcomes of the 3 treatments did not differ significantly. The Canine Brief Pain Inventory and VAS pain intensity assessments were decreased from baseline at weeks 4 and 6, respectively, but only in acupuncture-treated dogs. The locomotion VAS values were decreased at week 4 in acupuncture-treated and carprofen-treated dogs. Kinetic evaluation findings did not differ among the groups or over time. CONCLUSIONS AND CLINICAL RELEVANCE Neither acupuncture nor carprofen was significantly different from placebo. Acupuncture and carprofen reduced the degree of subjectively evaluated lameness, and acupuncture was associated with a decrease in validated chronic pain scores.

Psychometric evaluation of the canine brief pain inventory in a Swedish sample of dogs with pain related to osteoarthritis

BACKGROUND

To evaluate intervention, implement evidence-based practice and enhance the welfare of dogs with naturally occurring osteoarthritis (OA), access to valid, reliable and clinically relevant outcome measures is crucial for researchers, veterinarians and rehabilitation practitioners. The objectives of the present study were to translate and evaluate psychometric properties, in terms of internal consistency and construct validity, of the owner-reported measure canine brief pain inventory (CBPI) in a Swedish sample of dogs with pain related to OA.

RESULTS

Twenty-one owners of clinically sound dogs and 58 owners of dogs with pain related to OA were included in this observational and cross-sectional study. After being translated according to the guidelines for patient-reported outcome measures, the CBPI was completed by the canine owners. Construct validity was assessed by confirmatory factor analysis, by repeating the principal component analysis and by assessing for differences between clinically sound dogs and dogs with pain related to OA. Internal consistency was estimated by Cronbach's α. Confirmatory factor analysis was not able to confirm the factor-structure models tested in our sample. Principal component analysis showed a two-component structure, pain severity and pain interference of function. Two components accounted for 76.8% of the total variance, suggesting an acceptable fit of a two-component structure. The ratings from the clinically sound dogs differed from OA dogs and showed significantly lower CBPI total sum. Cronbach's α was 0.94 for the total CBPI, 0.91 for the pain severity and 0.91 for the pain interference of function.

CONCLUSIONS

The results indicate that the translated version of the CBPI is valid for use in the Swedish language. The findings suggest satisfying psychometric properties in terms of high internal consistencies and ability to discriminate clinically sound dogs from OA dogs. However, based on the confirmatory factor analysis, the original factor structure in the CBPI is not ideally suited to measure pain related to OA in our sample and the hypothesis of the presented two-factor structure was rejected. Further research needs to be conducted to determine whether the original psychometric results from CBPI can be replicated across different target groups and particularly with larger sample size.

Ethical use of animal models in musculoskeletal research

The use of animals in research is under increasing scrutiny from the general public, funding agencies, and regulatory authorities. Our ability to continue to perform in-vivo studies in laboratory animals will be critically determined by how researchers respond to this new reality. This Perspectives article summarizes recent and ongoing initiatives within ORS and allied organizations to ensure that musculoskeletal research is performed to the highest ethical standards. It goes on to present an overview of the practical application of the 3Rs (reduction, refinement, and replacement) into experimental design and execution, and discusses recent guidance with regard to improvements in the way in which animal data are reported in publications. The overarching goal of this review is to challenge the status quo, to highlight the absolute interdependence between animal welfare and rigorous science, and to provide practical recommendations and resources to allow clinicians and scientists to optimize the ways in which they undertake preclinical studies involving animals. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:740-751, 2017.

Anti-nerve growth factor therapy increases spontaneous day/night activity in mice with orthopedic surgery-induced pain

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are 2 of the most common and successful surgical interventions to relieve osteoarthritis pain. Control of postoperative pain is critical for patients to fully participate in the required physical therapy which is the most influential factor in effective postoperative knee rehabilitation. Currently, opiates are a mainstay for managing postoperative orthopedic surgery pain including TKA or THA pain. Recently, issues including efficacy, dependence, overdose, and death from opiates have made clinicians and researchers more critical of use of opioids for treating nonmalignant skeletal pain. In the present report, a nonopiate therapy using a monoclonal antibody raised against nerve growth factor (anti-NGF) was assessed for its ability to increase the spontaneous activity of the operated knee joint in a mouse model of orthopedic surgery pain-induced by drilling and coring the trochlear groove of the mouse femur. Horizontal activity and velocity and vertical rearing were continually assessed over a 20 hours day/night period using automated activity boxes in an effort to reduce observer bias and capture night activity when the mice are most active. At days 1 and 3, after orthopedic surgery, there was a marked reduction in spontaneous activity and vertical rearing; anti-NGF significantly attenuated this decline. The present data suggest that anti-NGF improves limb use in a rodent model of joint/orthopedic surgery and as such anti-NGF may be useful in controlling pain after orthopedic surgeries such as TKA or THA.

Widespread somatosensory sensitivity in naturally occurring canine model of osteoarthritis

Osteoarthritis (OA)-associated pain is a leading cause of disability. Central sensitization (CS), as a result of OA, is recognized as an important facet of human patients' chronic pain and has been measured in people using quantitative sensory testing (QST) testing. The spontaneous canine OA model has been suggested as a good translational model, but CS has not been explored in this model. In this study, QST was performed on dogs with and without spontaneous hip or stifle OA to determine whether OA is associated with CS in this model. Mechanical (von Frey and blunt pressure) and thermal (hot and cold) sensory thresholds obtained in dogs with chronic OA-associated pain (n = 31) were compared with those of normal dogs (n = 23). Dogs were phenotyped and joint-pain scored, and testing was performed at the OA-affected joint, cranial tibial muscle, and dorsal metatarsal region. QST summary data were evaluated using mixed-effect models to understand the influence of OA status and covariates, and dogs with OA and control dogs were compared. The presence of OA was strongly associated with hyperalgesia across all QST modalities at the index joint, cranial tibial muscle, and metatarsal site. Mechanical QST scores were significantly moderately negatively correlated with total joint-pain scores. The spontaneous canine OA model is associated with somatosensory sensitivity, likely indicative of CS. These data further validate the canine spontaneous OA model as an appropriate model of the human OA pain condition.

Glucosamine and chondroitin use in canines for osteoarthritis: A review

Osteoarthritis is a slowly progressive and debilitating disease that affects canines of all breeds. Pain and decreased mobility resulting from osteoarthritis often have a negative impact on the affected canine’s quality of life, level of comfort, daily functioning, activity, behaviour, and client-pet companionship. Despite limited and conflicting evidence, the natural products glucosamine hydrochloride (HCl) and chondroitin sulfate are commonly recommended by veterinarians for treating osteoarthritis in dogs. There is a paucity of well-designed clinical veterinary studies investigating the true treatment effect of glucosamine and chondroitin. The purposes of this review article are to provide a brief background on glucosamine and chondroitin use in canine osteoarthritis and to critically review the available literature on the role of these products for improving clinical outcomes. Based on critical review, recommendations for practice are suggested and a future study design is proposed.

The method of attachment influences accelerometer-based activity data in dogs

Background

Accelerometer-based activity monitoring is a promising new tool in veterinary medicine used to objectively assess activity levels in dogs. To date, it is unknown how device orientation, attachment method, and attachment of a leash to the collar holding an accelerometer affect canine activity data. It was our goal to evaluate whether attachment methods of accelerometers affect activity counts. Eight healthy, client-owned dogs were fitted with two identical neck collars to which two identical activity monitors were attached using six different methods of attachment. These methods of attachment evaluated the use of a protective case, positioning of the activity monitor and the tightness of attachment of the accelerometer. Lastly, the effect of leash attachment to the collar was evaluated. For trials where the effect of leash attachment to the collar was not being studied, the leash was attached to a harness. Activity data obtained from separate monitors within a given experiment were compared using Pearson correlation coefficients and across all experiments using the Kruskal-Wallis Test.

Results

There was excellent correlation and low variability between activity monitors on separate collars when the leash was attached to a harness, regardless of their relative positions. There was good correlation when activity monitors were placed on the same collar regardless of orientation. There were poor correlations between activity monitors in three experiments: when the leash was fastened to the collar that held an activity monitor, when one activity monitor was housed in the protective casing, and when one activity monitor was loosely zip-tied to the collar rather than threaded on using the provided metal loop. Follow-up, pair-wise comparisons identified the correlation associated with these three methods of attachment to be statistically different from the level of correlation when monitors were placed on separate collars.

Conclusions

While accelerometer-based activity monitors are useful tools to objectively assess physical activity in dogs, care must be taken when choosing a method to attach the device. The attachment of the activity monitor to the collar should utilize a second, dedicated collar that is not used for leash attachment and the attachment method should remain consistent throughout a study period.

The Use of Functional Data Analysis to Evaluate Activity in a Spontaneous Model of Degenerative Joint Disease Associated Pain in Cats

Introduction and objectives

Accelerometry is used as an objective measure of physical activity in humans and veterinary species. In cats, one important use of accelerometry is in the study of therapeutics designed to treat degenerative joint disease (DJD) associated pain, where it serves as the most widely applied objective outcome measure. These analyses have commonly used summary measures, calculating the mean activity per-minute over days and comparing between treatment periods. While this technique has been effective, information about the pattern of activity in cats is lost. In this study, functional data analysis was applied to activity data from client-owned cats with (n = 83) and without (n = 15) DJD. Functional data analysis retains information about the pattern of activity over the 24-hour day, providing insight into activity over time. We hypothesized that 1) cats without DJD would have higher activity counts and intensity of activity than cats with DJD; 2) that activity counts and intensity of activity in cats with DJD would be inversely correlated with total radiographic DJD burden and total orthopedic pain score; and 3) that activity counts and intensity would have a different pattern on weekends versus weekdays.

Results and conclusions

Results showed marked inter-cat variability in activity. Cats exhibited a bimodal pattern of activity with a sharp peak in the morning and broader peak in the evening. Results further showed that this pattern was different on weekends than weekdays, with the morning peak being shifted to the right (later). Cats with DJD showed different patterns of activity from cats without DJD, though activity and intensity were not always lower; instead both the peaks and troughs of activity were less extreme than those of the cats without DJD. Functional data analysis provides insight into the pattern of activity in cats, and an alternative method for analyzing accelerometry data that incorporates fluctuations in activity across the day.

Replicate effects and test-retest reliability of quantitative sensory threshold testing in dogs with and without chronic pain

OBJECTIVE

To evaluate replicate effects and test-retest reliability of mechanical and thermal quantitative sensory testing (QST) in normal dogs and dogs with osteoarthritis (OA)-associated pain.

STUDY DESIGN

A prospective clinical study.

ANIMALS

A total of 54 client owned dogs (OA, n=31; controls, n=23).

METHODS

Mechanical [electronic von Frey (EVF) and blunt pressure] and thermal (hot and cold) sensory thresholds were obtained in dogs with OA-associated pain and control dogs at two visits, 7 days apart, to assess test-retest reliability. Thresholds were measured at the OA-affected joint (hip or stifle), over the tibial muscle and over the midpoint of the metatarsals. Five replicates were obtained for each modality at each site bilaterally.

RESULTS

Overall, there was no significant effect of replicates on QST response. EVF thresholds were significantly lower at the second visit in OA dogs at the affected and metatarsal sites (p=0.0017 and p=0.0014, respectively). Similarly for control dogs, EVF thresholds were significantly lower at the second visit at the metatarsal site (p=0.001). Significantly higher hot thermal latencies were seen in OA dogs at the affected and tibial testing sites (p=0.014 and p=0.012, respectively), and in control dogs at the tibial site (p=0.004).

CONCLUSIONS

In QST, a replicate does not show a strong effect. However, QST results show variability over time, particularly for EVF and hot thermal stimuli.

CLINICAL RELEVANCE

If QST is to be used clinically to evaluate a sensitized state, the variability over time needs to be accounted for in the study design.

Severity of Nasal Inflammatory Disease Questionnaire for Canine Idiopathic Rhinitis Control: Instrument Development and Initial Validity Evidence

BACKGROUND

Effective treatments are needed for idiopathic chronic rhinitis in dogs, but assessment of efficacy requires a practical, quantifiable method for assessing severity of disease.

OBJECTIVES

To develop and perform initial validity and reliability testing of an owner-completed questionnaire for assessing clinical signs and dog and owner quality of life (QOL) in canine chronic rhinitis.

ANIMALS

Twenty-two dogs with histopathologically confirmed chronic rhinitis and 72 healthy dogs.

METHODS

In this prospective study, an online questionnaire was created based on literature review and feedback from veterinarians, veterinary internists with respiratory expertise, and owners of dogs with rhinitis. Owners of affected dogs completed the questionnaire twice, 1 week apart, to test reliability. Healthy dogs were assessed once. Data were analyzed using the Rasch Rating Scale Model, and results were interpreted using Messick's framework for evaluating construct validity evidence.

RESULTS

Initial item generation resulted in 5 domains: nasal signs, paranasal signs, global rhinitis severity, and dog's and owner's QOL. A 25-item questionnaire was developed using 5-point Likert-type scales. No respondent found the questionnaire difficult to complete. Strong psychometric evidence was available to support the substantive, generalizability, content, and structural aspects of construct validity. Statistical differences were found between responses for affected and control dogs for all but 2 items. These items were eliminated, resulting in the 23-item Severity of Nasal Inflammatory Disease (SNIFLD) questionnaire.

CONCLUSIONS AND CLINICAL IMPORTANCE

The SNIFLD questionnaire provides a mechanism for repeated assessments of disease severity in dogs with chronic rhinitis.