Nonsurgical Management of Osteoarthritis in Dogs

The Single Intra-Articular Injection of Platelet-Rich Plasma vs. Non-Steroidal Anti-Inflammatory Drugs as Treatment Options for Canine Cruciate Ligament Rupture and Patellar Luxation

Cranial cruciate ligament rupture (CCLR) and patellar luxation (PL) are common pathologies affecting canines. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used as a non-surgical treatment plan in these cases. Clinical usage of platelet-rich plasma (PRP) is an emerging area of interest in veterinary medicine. There is a lack of studies comparing those two different treatment methods in veterinary medicine. The main purpose of this study was to evaluate and compare the use of oral NSAIDs and single intra-articular injection of PRP on treatment outcomes in cases of canine CCLR and PL. Dogs diagnosed with CCRL (n = 12) and PL (n = 10) were subgrouped by the severity of pathologies and administered treatment: half of the CCRL and PL groups were orally administered NSAIDs and supplements for 14 days, and the other half received a single intra-articular PRP injection into affected stifle joint. We measured serum TNF-α levels and clinical outcomes (lameness scores, painfulness to manipulations, goniometry of stifle joint in flexion and extension, and muscle strength) before treatment, at day 14 and day 28 of treatment. The results of TNF-α concentration indicates a significant difference between groups of differently treated partial CCLR groups on d14 (p = 0.006). Results of group CCLR-P1 on d14 were decreased, while results of group CCLR-P2 on d14 were increased. When comparing TNF-α concentration between all CCLR cases treated with NSAIDs and treated with PRP, there was a significant difference between those groups on d14 (p = 0.001). The results of TNF-α concentration indicates a significant difference between groups of differently treated PL-III on d28 (p = 0.036). Results of group PL-III1 indicate growth of TNF-α concentration, while at the same d28, results of group PL-III2 indicate decreased levels of cytokine, comparing results between the subgroups at the same time point and within subgroups from baseline. Results indicate a significant difference in muscle strength between group CCLR-P1 and group CCLR-P2 on d28 (p = 0.007), indicating an increment in muscle strength in group CCLR-P1 up to d14 and its reduction up to d28, and muscle strength of group CCLR-P2 increasing up to d28. When comparing the muscle strength between all CCLR cases treated with NSAIDs and treated with PRP, there was a significant difference between those groups on d28 (p = 0.007). In conclusion, a single intra-articular injection of PRP has a superior effect on management of inflammatory processes, has better clinical outcomes, and longer duration of action than oral NSAIDs, in the treatment of canine CCRL or PL.

A prospective, randomized, double-blind, placebo-controlled multisite, parallel-group field study in dogs with osteoarthritis conducted in the United States of America evaluating bedinvetmab, a canine anti-nerve growth factor monoclonal antibody

OBJECTIVE

Bedinvetmab, a fully canine anti-nerve growth factor monoclonal antibody, was evaluated in dogs for control of osteoarthritis-related pain in a study conducted to support registration in the USA.

STUDY DESIGN

Randomized, double-blind, placebo-controlled, multicenter, parallel-group study.

ANIMALS

General practice client-owned dogs with osteoarthritis (n = 272).

METHODS

Dogs were block randomized 1:1 to placebo (saline, n = 137) or bedinvetmab (n = 135; 0.5-1.0 mg kg-1) administered subcutaneously, once monthly. The primary end point, day 28 Canine Brief Pain Inventory (CBPI) treatment success (TS), required pain severity score (PSS; 0-10) decrease ≥1 and pain interference score (PIS; 0-10) decrease ≥ 2. CBPI TS rates [and number needed to treat (NNT)], change in scores [and standardized effect size (ES)], change in quality of life (QoL) and bedinvetmab half-life were calculated.

RESULTS

Significant (p < 0.05) improvement with bedinvetmab over placebo occurred (days 28, 42, 56, 84) for CBPI TS. Of cases evaluable for day 28 CBPI TS (placebo, n = 131; bedinvetmab, n = 128), success rates were 36.6% and 47.4%, respectively (p = 0.0410) (NNT, 9.3; PSS and PIS ES, 0.3). CBPI TS increased after the second dose in both groups, plateaued for bedinvetmab at day 42 and decreased for placebo beginning day 84. Day 84 NNT (4.3), PSS (0.4) and PIS (0.5) showed continued improvement with monthly dosing. After the first dose, mean (± standard deviation) bedinvetmab half-life was 19.1 (8.3) days. Adverse events were similar between groups and not considered treatment-related. There was a significant effect of bedinvetmab versus placebo on all CBPI components (PIS, PSS, QoL).

CONCLUSIONS AND CLINICAL RELEVANCE

These results corroborated those previously reported and provide further support of safety and effectiveness of bedinvetmab (0.5-1.0 mg kg-1) administered subcutaneously at monthly intervals to dogs for control of osteoarthritis-related pain.

Two Amnion-Derived Mesenchymal Stem-Cells Injections to Osteoarthritic Elbows in Dogs-Pilot Study

The aim of the study was to investigate the potential of cell-based regenerative therapy for elbow joints affected by osteoarthritis. Interest was focused on two intra-articular applications of amnion-derived mesenchymal stem cells (A-MSCs) to a group of different breeds of dogs with elbow osteoarthritis (13 joints). Two injections were performed 14 days apart. We evaluated synovial fluid biomarkers, such as IFN-γ, IL-6, IL-15, IL-10, MCP-1, TNF-α, and GM-CSF, by multiplex fluorescent micro-bead immunoassay in the treated group of elbows (n = 13) (day 0, day 14, and day 28) and in the control group of elbows (n = 9). Kinematic gait analysis determined the joint range of motion (ROM) before and after each A-MSCs application. Kinematic gait analysis was performed on day 0, day 14, and day 28. Kinematic gait analysis pointed out improvement in the average range of motion of elbow joints from day 0 (38.45 ± 5.74°), day 14 (41.7 ± 6.04°), and day 28 (44.78 ± 4.69°) with statistical significance (p < 0.05) in nine elbows. Correlation analyses proved statistical significance (p < 0.05) in associations between ROM (day 0, day 14, and day 28) and IFN-γ, IL-6, IL-15, MCP-1, TNF-α, and GM-CSF concentrations (day 0, day 14, and day 28). IFN-γ, IL-6, IL-15, MCP-1, GM-CSF, and TNF- α showed negative correlation with ROM at day 0, day 14, and day 28, while IL-10 demonstrated positive correlation with ROM. As a consequence of A-MSC application to the elbow joint, we detected a statistically significant (p < 0.05) decrease in concentration levels between day 0 and day 28 for IFN-γ, IL-6, and TNF-α and statistically significant increase for IL-10. Statistical significance (p < 0.05) was detected in TNF-α, IFN-γ, and GM-CSF concentrations between day 14 and the control group as well as at day 28 and the control group. IL-6 concentrations showed statistical significance (p < 0.05) between day 14 and the control group.

Physiotherapeutic Strategies and Their Current Evidence for Canine Osteoarthritis

Osteoarthritis (OA) is a common and debilitating condition in domestic dogs. Alongside pharmaceutical interventions and weight loss, exercise and physiotherapy (PT) are important measures in maintaining patient mobility and quality of life. Physiotherapy for OA aims to reduce pain, optimize muscular function and maintain joint function. Physiotherapeutic plans typically include PT exercises combined with therapeutic modalities, lifestyle and environmental modifications to improve the patient's overall quality of life and function. Information on therapeutic clinical efficacy of physiotherapeutic measures for canine OA is still very limited. Thus, physiotherapeutic strategies are still primarily based on evidence extrapolated from human protocols tailored to people with OA. The authors propose a simple systematic PT approach for canine OA, prioritizing measures according to simplicity, cost effectiveness and practicality. This guide (the "Physiotherapy Pyramid") aims to provide a clear stratified approach to simplify decision making and planning for owners, veterinarians and veterinary physiotherapists, leading to more straightforward design and implementation of treatment plans. Measures are implemented starting at the base of the pyramid, subsequently progressing to the top, allowing effective and practical interventions to be prioritized. The levels of the pyramid are in ascending order: environmental modification, exercise plan, OA-specific home exercises and treatment by a veterinary physiotherapist.

Evaluation of clinical efficacy of undenatured type II collagen supplementation compared to cimicoxib and their association in dogs affected by natural occurring osteoarthritis

The aim of the study was to evaluate the clinical efficacy of 30 days treatment of undenatured type II collagen(UC-II®), compared to cimicoxib and to their combination, in osteoarthritic dogs. Client-owned dogs were enrolled in a clinical, randomized, controlled and prospective study. Posture, lameness, pain, range of motion and x-ray of affected joint(s) were evaluated and scored based on severity (CLINICAL score). The Liverpool Osteoarthritis in Dogs survey was used to score the owner evaluation of dog's mobility (LOAD score and MOBILITY score). Osteoarthritis (OA) stage was defined through the Canine Osteoarthritis Staging tool (COAST). After diagnosis (T0), all patients were randomly assigned to different treatment groups: C group = cimicoxib 2 mg/kg/day orally OS, F group = UC-II® 1 tablet per day OS; C + F group = cimicoxib-UC-II® at the same previous dosages; CTR group = dogs who didn't received any treatment. All treatments were administered for 30 days. Seventy-six dogs completed the study. LOAD score was recorded significant lower after treatment for each group, with a reduction in percentage of 29.5% for C, 31.4% for F, 21.1% for C + F. LOAD score was lower in C(P = 0.04), F(P = 0.001) and C + F(P = 0.009) group at T30 than CTR group. MOBILITY and CLINICAL scores were significantly lower in all groups at T30, when compared to T0. MOBILITY score was lower than CTR in C(P = 0.02) and F(P = 0.01); CLINICAL score was lower in C + F(P = 0.016). The present findings prove that the treatment with UC-II®, cimicoxib and their combination provide significant reduction in clinical signs associated with OA.

Observational study of the clinical value of the Canine Osteoarthritis Staging Tool

The aim of this multi-centred, cohort, prospective, observational study was to evaluate the clinical application of the canine osteoarthritis staging tool (COAST), in dogs affected by osteoarthritis (OA). In all dogs, a COAST stage was obtained based on the Liverpool Osteoarthritis in Dogs (LOAD) score and a complete orthopaedic and radiographic examination. The severity of OA (COAST stage) was scored as 1 (preclinical), 2 (mild), 3 (moderate), and 4 (severe). These scores were compared with the overall subjective opinion of experienced orthopedic surgeons who examined the dogs (Clinical Opinion). Data were analysed with descriptive statistic, multiple regression analysis, chi-square and Bland-Altman tests (P < 0.05). In total, 362 evaluations were performed in 202 dogs. Clinical Opinion had a greater proportion of stage 1 and 2 cases compared to COAST (P < 0.0001). The proportion of stage 4 cases was higher in COAST compared to Clinical Opinion (P < 0.0001). The proportions of Stage 3 cases were similar in the two evaluation systems. COAST had a strong correlation (r = 0.79; P < 0.01) with Clinical Opinion. Overall, the two evaluation systems exhibited strong agreement (mean bias 0.51). Stages 1 and 2 had weaker agreement (mean bias 1.04 and 0.75, respectively), than stage 3 and stage 4 (mean bias 0.46 and 0.0, respectively).

Identification of canine osteoarthritis using an owner-reported questionnaire and treatment monitoring using functional mobility tests

Objectives

To investigate the diagnostic value of an owner‐completed canine osteoarthritis screening checklist to help identify previously undiagnosed osteoarthritis cases, and assess their response to carprofen treatment by monitoring pain and functional mobility.

Materials and Methods

Dogs (n=500) whose owners reported ≥1 positive response to the osteoarthritis checklist were examined to identify dogs with previously undiagnosed osteoarthritis. Eligible dogs (n=133) were evaluated for pain and video mobility analysis by Helsinki Chronic Pain Index and visual analogue scale scores, respectively, following carprofen treatment, administered for 30 days (n=95) or up to 120 days (n=38). Dogs were filmed at clinics performing activities (walking, jogging, sitting/lying, walking up and down stairs), and scored at days 0, 30 and 120 using visual analogue scale by an independent blinded expert.

Results

A diagnosis of osteoarthritis was confirmed by a veterinarian in 38% (188 of 500) of dogs. Balance of sensitivity and specificity across the original group of nine screening questions was optimised to approximately 88 and 71%, respectively, after elimination of three questions. Pain measured by Helsinki Chronic Pain Index and functional mobility improved over time in response to treatment with carprofen. Mean ability scores for activities significantly improved between days 0 and 30 for walking, jogging, sitting/lying and walking down stairs, and days 0 and 120 for sitting/lying and walking up stairs.

Clinical Significance

More osteoarthritis cases were identified in study dogs than previous prevalence estimates, indicating the screening checklist's potential to help identify for further evaluation cases that could otherwise remain undiagnosed. Improvements in function were demonstrated after carprofen treatment.

Characterization of weight-bearing compensation in dogs with bilateral hip osteoarthritis

To describe the weight-bearing compensation in working dogs with bilateral hip osteoarthritis (OA), fifty police working dogs were evaluated with a weight distribution platform at the initial evaluation and after intra-articular treatment (a negative control - 0.9% sodium chloride (NaCl), a platelet concentrate, Hylan G-F 20, triamcinolone hexacetonide or stanozolol). Six evaluation sessions were performed, over a 180-day period. Results were compared by breed, age, sex, weight and Orthopedic Foundation for Animals hip grade scores with the Independent Samples T-Test, repeated samples Analysis of variance and Pearson correlation coefficient, p<0.05. Animals had a mean age of 6.5±2.4 years and a bodyweight of 26.7±5.2kg. No significant differences were observed when comparing weight-bearing for different breeds, sex, hip grades or weight during the initial evaluation. Significant differences were observed in deviation (p<0.01) and symmetry index (p<0.01) between the control and treatment groups during the follow-up period. A weight shift from pelvic to thoracic limbs was observed, with a weak, although significant, correlation between a pelvic limb and the opposing contralateral thoracic limb. Labrador Retrievers showed higher symmetry index and deviation from normal values during the follow-up period than German Shepherd Dogs and Dutch Shepherd Dogs. Male dogs also showed higher symmetry index and deviation comparing with females. At this period, the symmetry index showed a weak, although significant, correlation with body weight. Weight-bearing of all limbs correlated with the remaining limbs, reflecting a more balanced weight distribution than the initial evaluation. The weight distribution platform can be used to evaluate patients, at the initial presentation and during the assessment of response to treatment.

Effects of a flotation vest and water flow rate on limb kinematics of Siberian Huskies swimming against a current

OBJECTIVE

To evaluate the effects of a flotation vest (FV) and water flow rate (WFR) on limb kinematics of dogs swimming against a current.

ANIMALS

7 (1 male and 6 female) healthy adult Siberian Huskies.

PROCEDURES

Dogs were habituated to swim with and without an FV beside an investigator in a continuous-flow pool against WFRs up to 2.9 km/h. During each of 4 experimental sessions in a repeated-measures study, markers were wrapped around the right carpus and tarsus, and a video was recorded while each dog swam with or without an FV for about 2 minutes at each of 7 WFRs between 0 and 2.9 km/h when the WFR was incrementally decreased or increased. Motion tracking software was used to measure stroke excursion and frequency.

RESULTS

Stroke excursion varied more than frequency among all dogs and in response to changes in experimental conditions. The male dog and 1 female dog were unable to complete the study. For the remaining 5 dogs across all experimental conditions, mean tarsus excursion was 30% that of the carpus. Mean total excursion (sum of the excursion-frequency products for the carpus and tarsus) decreased when an FV was worn and increased with WFR by 69% and 19% when WFR was incrementally increased and decreased, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

In dogs, range of motion during swimming was greater for the carpus than tarsus, when an FV was not worn, and increased more with WFR when WFR was incrementally increased. Those factors should be considered during swimming-based rehabilitation.

Orthotic Device Use in Canine Patients: Owner Perception of Quality of Life for Owners and Patients

Orthotic devices are an established treatment for neuromusculoskeletal disease in the human population. Orthoses are an emerging veterinary therapy due to limited practitioner experience, availability of devices, and published data from veterinary patient outcomes. Expanding client education and veterinary expertise in the application of orthoses may allow greater access and successful utilization of these devices to treat appendicular disease. While orthoses have the potential to improve quality of life for veterinary patients, consideration needs to be made for owner related factors with device use. Owner satisfaction and experience may greatly impact compliance with treatment recommendations; therefore, it is crucial that owner expectations are met. The purpose of the present study was to evaluate owner-reported outcomes of orthosis for canine patients and their owner's subjective responses about the shared pet/owner experience utilizing a promoter score. It was hypothesized that owner's impressions of their pet's experience with the orthotic device would influence owner perceptions of quality of life for both the owner and the pet, and these factors would impact the likelihood of the owner to recommend a veterinary orthosis to a friend. An anonymous online survey was sent to 136 clients of a single veterinary orthoses manufacturer. Fifty-six surveys were completed and included for analysis. The owner's reported quality of life was in agreement (P = 0.02) with reported pet quality of life. There was also a higher likelihood (P = 0.02) for the owner to recommend a veterinary orthotic device to a friend when owner perceptions of pet quality of life were positive as compared to negative or neutral. Willingness to recommend an experience to a friend is a reflection of satisfaction with the experience. The dependence of owner and pet quality of life should therefore guide therapeutic decisions for patient management and client communication to ensure that the orthosis experience is positive for both patient and owner.

Evidence of acrolein in synovial fluid of dogs with osteoarthritis as a potential inflammatory biomarker

BACKGROUND

Acrolein is a known pro-inflammatory toxic aldehyde, propagating cellular damage and tissue inflammation in humans and animal models of various diseases. Osteoarthritis (OA) has a significant inflammatory component; however, presence of acrolein in synovial fluid of joints with OA has not been previously reported. The first aim of this study was to evaluate evidence of acrolein in the synovial fluid of dogs with OA as well as in Control joints. The second aim was to determine if evidence of acrolein can be detected in synovial fluid samples that have been in a frozen state for long periods of time.

METHODS

In this pilot clinical study, synovial fluid samples were prospectively collected (i.e., New samples) from a single joint of both clinically healthy (New Control, n = 5) and dogs with OA (New OA, n = 16) and frozen until the time of analysis. Additionally, frozen synovial fluid samples from a biobank (i.e., Old samples) were used to evaluate ability to detect evidence of acrolein in long-term stored samples (median of 4.89 years) in Old Control (n = 5) and Old OA (n = 5) samples. Measurements of acrolein in all synovial fluid samples was based on detection of its major protein adduct, N ε - (3-formyl-3, 4-dehydropiperidino)lysine (FDP-lysine), using the western blot method. Synovial fluid matrix metalloproteinase 2 (MMP2) was measured in all samples using the western blot method as a positive control of OA inflammation.

RESULTS

Acrolein-lysine adduct was detected in both Control (n = 10) and OA (n = 21) groups in both Old and New samples. Acrolein-lysine adduct and MMP2 were detectable at a lower level in the Old compared to New synovial fluid samples; however, the differences were not statistically significant (p > 0.1). The measured MMP2 levels were significantly higher in the OA compared to Control group samples (p = 0.033), but not for acrolein-lysine adduct (p = 0.30).

CONCLUSIONS

This study confirmed evidence of acrolein in canine synovial fluid of both OA and Control groups. Freezing of synovial fluid for up to 5 years does not appear to significantly affect the ability to detect acrolein-lysine adduct and MMP2 in these samples.

Unlocking the Real Potential of Black Soldier Fly (Hermetia illucens) Larvae Protein Derivatives in Pet Diets

Black soldier fly larvae (BSFL)-derived proteins are gaining popularity as sustainable pet food ingredients. According to the literature, these ingredients have strong antioxidant and antimicrobial activities. Due to the ability of BSFL protein derivatives to donate hydrogen atoms and/or electrons to counterpoise unstable molecules, they could possibly help in the prevention of osteoarthritis. During this study, the antiarthritic potential of BSFL protein derivatives was evaluated using the following assays: (1) proteinase inhibition, (2) erythrocyte membrane stability, (3) reactive oxygen species (ROS) production by activated macrophages, (4) ROS production by monocytes, and (5) cellular toxicity. Additionally, the glucosamine content of these ingredients was also evaluated. Chicken meal is commonly used in pet food formulations and was used as an industrial benchmark. The results obtained during this study demonstrated the strong antiarthritic potential of BSFL protein derivatives. We found that BSFL protein derivatives are not only useful in preventing the development of arthritis but could also help to cure it due to the presence of glucosamine. We also found that chicken meal could contribute to the development of arthritis by increasing ROS production by monocytes.

Grapiprant: A snapshot of the current knowledge

Grapiprant is the pioneer member of the novel piprant class, a potent and specific antagonist of the prostaglandin E2 receptor 4. It has been approved in veterinary medicine for the control of pain and inflammation associated with osteoarthritis in dogs at the dose regimen of 2 mg/kg once a day by the FDA and EMA (for pain only) in 2016 and 2018, respectively. The aim of this narrative review was to report the analytical methods, pharmacokinetics, pharmacodynamics and safety of grapiprant in several animal species using the best available published scientific evidence. In conclusion, most of the analytical methods proposed for grapiprant detection are simple, reliable, sensitive and validated. The pharmacokinetics show discrepancies between animal species. The therapeutic efficacy seems more suited to chronic rather than acute pain.

Intra-articular Injections With Either Triamcinolone Hexacetonide, Stanozolol, Hylan G-F 20, or a Platelet Concentrate Improve Clinical Signs in Police Working Dogs With Bilateral Hip Osteoarthritis

Objectives: To compare the effect of intra-articular treatment with triamcinolone hexacetonide (TH), stanozolol, hyaluronan, and a platelet concentrate in police working dogs with bilateral hip osteoarthritis (OA). Study Design: Prospective, longitudinal, double-blinded, negative controlled study. Sample Population: Fifty police working dogs with naturally occurring hip OA. Methods: Animals were randomly assigned to a control group (CG, n = 10), TH group (THG, n = 10), platelet concentrate group (PCG, n = 10), stanozolol group (SG, n = 10), and Hylan G-F 20 group (HG). On days 0 (T0), 8, 15, 30, 90, and 180 days post-treatment, weight-bearing distribution was evaluated. In those days, and on days 60, 120, and 150, four clinical metrology instruments were completed. Kaplan-Meier estimators were conducted and compared with the log-rank test. Cox proportional hazard regression analysis was performed to determine treatment survival. Significance was set at p < 0.05. Results: Patients had a mean age of 6.5 ± 2.4 years and body weight of 26.7 ± 5.2 kg. At T0, hips were classified as mild (n = 35), moderate (n = 10), and severe (n = 5), according to the Orthopedic Foundation for Animals grading scheme. No differences were found between groups at that moment considering age, body weight, OFA hip score, and all assessments performed. All treatments improved clinical signs in various OA dimensions in some groups, with a broad effect interval. PCG showed a lower range of variation while maintaining a positive result for more extended periods (p < 0.01 for symmetry index and 0.01 < p < 0.04 in the majority of scores). Breed, age, sex, and OFA grade did not significantly influence response to treatment. Conclusions and Clinical Relevance: This is the first prospective, negative controlled, double-blinded study to compare the effect of a single administration of these IA treatments in dogs with hip OA. HG and PCG recorded more significant improvements throughout the 180-day follow-up. In particular, PCG also registered a lower variation in results, seemingly the best therapeutic option. Nevertheless, improvements were still observed in THG and SG, and these treatment options can be considered, mainly when the first two treatments are not available.

Oral Transmucosal Cannabidiol Oil Formulation as Part of a Multimodal Analgesic Regimen: Effects on Pain Relief and Quality of Life Improvement in Dogs Affected by Spontaneous Osteoarthritis

Simple Summary

Osteoarthritis is a progressive and degenerative condition that affects dog populations, causing pain. The pain associated with osteoarthritis is considered to be chronic, owing to both active inflammation and to a maladaptive component caused by central sensitization. Chronic pain in dogs is being increasingly recognised as a significant problem, and finding successful treatments against canine osteoarthritis-related pain is challenging. The aim of this study was to assess the efficacy in pain management over a twelve-week period of oral transmucosal cannabidiol, in combination with a multimodal pharmacological protocol, in dogs affected by spontaneous osteoarthritis. Dogs receiving oral transmucosal cannabidiol in addition to an anti-inflammatory drug, gabapentin and amitriptyline showed a meaningful improvement in Canine Brief Pain Inventory scores, in comparison with dogs that did not receive cannabidiol. The present study suggests that the addition of oral transmucosal cannabidiol to a multimodal pharmacological treatment for canine osteoarthritis improves owner reported pain scores and quality of life of dogs, without severe adverse effects.

Abstract

The aim of this study was to evaluate the efficacy of oral transmucosal (OTM) cannabidiol (CBD), in addition to a multimodal pharmacological treatment for chronic osteoarthritis-related pain in dogs. Twenty-one dogs were randomly divided into two groups: in group CBD (n = 9), OTM CBD (2 mg kg⁻¹ every 12 h) was included in the therapeutic protocol (anti-inflammatory drug, gabapentin, amitriptyline), while in group C (n = 12), CBD was not administered. Dogs were evaluated by owners based on the Canine Brief Pain Inventory scoring system before treatment initiation (T0), and one (T1), two (T2), four (T3) and twelve (T4) weeks thereafter. Pain Severity Score was significantly lower in CBD than in C group at T1 (p = 0.0002), T2 (p = 0.0043) and T3 (p = 0.016). Pain Interference Score was significantly lower in CBD than in C group at T1 (p = 0.0002), T2 (p = 0.0007) and T4 (p = 0.004). Quality of Life Index was significantly higher in CBD group at T1 (p = 0.003). The addition of OTM CBD showed promising results. Further pharmacokinetics and long-term studies in larger populations are needed to encourage its inclusion into a multimodal pharmacological approach for canine osteoarthritis-related pain.

Comparison of canine stifle kinematic analysis after two types of total knee arthroplasty: A cadaveric study

Background and Aim:

Osteoarthritis is a common consequence of cranial cruciate ligament rupture (CCLR) in the canine stifle. Total knee replacement is a valuable method for managing end-stage osteoarthritis.

Materials and Methods:

Two new designs of total knee replacement implants were fabricated with information from computed tomography scans. Canine hind limbs of cadavers were tested with a biomechanical testing machine with C-arm fluoroscopy. The four groups tested were as follows: Intact stifles (INTACT), CCLR, total knee arthroplasty (TKA) with a peg on top of the tibial component (TKAP), and TKA with no peg on top of the tibial component (TKAN). Extension, flexion, adduction, abduction, internal rotation, external rotation, cranial translation, caudal translation, and range of motion were measured.

Results:

The cranial translation of the tibia relative to the femur increased significantly after cutting off the cranial cruciate ligament. After arthroplasty, adduction/abduction and cranial/caudal translation within the TKAN group was increased compared with the intact stifle group. In the TKAP group, only adduction was greater than it was in the intact stifle group.

Conclusion:

The design of the prosthesis used for the TKAP group was more appropriate for total knee replacement in dogs than the design of the prosthesis for the TKAN group.

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.

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.

Evaluation of the clinical effects of diet and physical rehabilitation in dogs following tibial plateau leveling osteotomy

OBJECTIVE To assess clinical effects of an omega-3 fatty acid and protein-enriched diet, physical rehabilitation, or both in dogs following tibial plateau leveling osteotomy (TPLO) and arthroscopic surgery for cranial cruciate ligament (CCL) disease. DESIGN Randomized, prospective clinical trial. ANIMALS 48 dogs with unilateral CCL disease. PROCEDURES Dogs were randomly assigned to receive a dry omega-3 fatty acid and protein-enriched dog food formulated to support joint health (test food [TF]), a dry food formulated for maintenance of adult dogs (control food [CF]), TF plus rehabilitation (TF-R), or CF plus rehabilitation (CF-R). Data collected over 6 months included body weight, body condition score, ground reaction force data, tibial plateau angle, limb circumference measurements, subjective pain and lameness scores assigned by surgeons and dog owners, and daily activity measured by accelerometry. RESULTS Peak vertical force and vertical impulse were greater after surgery for dogs in the TF groups than in the CF groups; peak vertical force was greater after surgery in dogs that underwent rehabilitation than in those that did not. Owner scores indicated lower frequencies of lameness and signs of pain during some activities for the TF group, compared with other groups, and for the TF-R and CF-R groups, compared with the CF group. Sedentary time decreased and time spent in light-to-moderate or vigorous activity increased in all groups over time. Rehabilitation was significantly associated with greater time spent in light-to-moderate activity, regardless of diet. CONCLUSIONS AND CLINICAL RELEVANCE Feeding the TF and providing physical rehabilitation during the first 6 months after TPLO were associated with improvements in some indices of clinical outcome and function in dogs. Significant interactions between time and some outcome variables were observed, indicating further research is warranted.

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.

Intra-Articular Administration of Autologous Micro-Fragmented Adipose Tissue in Dogs with Spontaneous Osteoarthritis: Safety, Feasibility, and Clinical Outcomes

Similar to the disease affecting humans, osteoarthritis (OA) is a painful musculoskeletal condition affecting 20% of the adult canine population. Several solutions have been proposed, but the results achieved to date are far from being satisfactory. New approaches, such as intra-articular delivery of cells (including mesenchymal stromal cells), have been proposed. Among the many sources, the adipose tissue is considered very promising. We evaluated the safety, feasibility, and efficacy of a single intra-articular injection of autologous and micro-fragmented adipose tissue (MFAT) in 130 dogs with spontaneous OA. MFAT was obtained using a minimally invasive technique in a closed system and injected in the intra- and/or peri-articular space. Clinical outcomes were determined using orthopedic examination and owners' scores for up to 6 months. In 78% of the dogs, improvement in the orthopedic score was registered 1 month after treatment and continued gradually up to 6 months when 88% of the dogs improved, 11% did not change, and 1% worsened compared with baseline. Considering the owners' scores at 6 months, 92% of the dogs significantly improved, 6% improved only slightly, and 2% worsened compared with baseline. No local or systemic major adverse effects were recorded. The results of this study suggest that MFAT injection in dogs with OA is safe, feasible, and beneficial. The procedure is time sparing and cost-effective. Post injection cytological investigation, together with the clinical evidence, suggests a long-term pain control role of this treatment. The spontaneous OA dog model has a key role in developing successful treatments for translational medicine. Stem Cells Translational Medicine 2018;7:819-828.

Effect of an Oral Joint Supplement When Compared to Carprofen in the Management of Hip Osteoarthritis in Working Dogs

The goal of this study was to evaluate the effectiveness of an oral joint supplement in working dogs with hip osteoarthritis compared with a positive control group (CG). Fifteen animals were divided in treatment group (TG, n = 10) and CG (n = 5). To TG a commercially available joint supplement, containing glucosamine HCl, chondroitin sulphate, and hyaluronic acid was given for 40 days and a 70-day course of a placebo, to be administered as if it was carprofen. The CG received carprofen for 70 days, and a placebo to be administered as the joint supplement. Response to treatment, measured by the canine brief pain inventory (CBPI) and the Hudson visual analog scale, was evaluated before treatment (T0), after 15 days (T1) and 1 (T2), 2 (T3), 3 (T4), 4 (T5), and 5 (T6) months. With CBPI, no differences were found in pain interference score and pain severity score between TG and CG throughout or when comparing results within groups. Individual results were considered successful in a maximal of three dogs of the TG by T3 (30%) and 1 in CG (25%). With Hudson visual analog scale, improvements where registered with individual results, for 40%-50% of the animals in TG and 60%-80% of cases in CG. The oral joint supplement and carprofen produced some improvements in individual scores but where unable to do so when overall results were considered. Each of these options may not be able, by itself, to fully address the demands of a working dog with joint disease and related pain.

Efficacy of an oral nutraceutical for the treatment of canine osteoarthritis. A double-blind, randomized, placebo-controlled prospective clinical trial

OBJECTIVES

To assess the safety and efficacy of an orally administered nutraceutical (Glu/CS+; + for additional ingredient) for the treatment of clinical osteoarthritis (OA) in dogs.

METHODS

In this double-blind, randomized, placebo-controlled clinical trial, client-owned dogs with clinical signs of OA in one or more joints were assigned to a Glu/CS+ (n = 30) or placebo (n = 30) group. Dogs were administered Glu/CS+ or placebo orally and wore an activity monitor (AM) continuously throughout a 97 day study period. Prior to the initiation of the treatment, seven days of baseline activity was collected. On days -7, 30, 60 and 90 of the study, owners completed a patient assessment form (Canine Brief Pain Inventory). Data between groups were compared.

RESULTS

No serious adverse events were reported. No difference was found between groups when evaluating daily activity counts during the seven-day pre-treatment period and the 90-day treatment period. Owner assessment (pain interference and pain severity scores) improved over the 90-day treatment period for both groups, however no difference was found between treatment groups.

CONCLUSIONS

Treatment with oral Glu/CS+ for a 90 day treatment period when compared to placebo treatment did not result in a significant increase in activity counts in dogs with clinical OA. However, owner assessment scores similarly improved throughout the study period for dogs in both groups, suggesting a caregiver placebo effect in this outcome measure.

Evaluation of the Effect of Mesotherapy in the Management of Osteoarthritis-Related Pain in a Police Working Dog Using the Canine Brief Pain Inventory

CASE DESCRIPTON

A 9-year-old, 33.4kg (73.63Lb) male entire drug detection Labrador Retriever Dog was presented with an history of constant lameness from the right thoracic limb, aggravated with exercise and work.

CLINICAL FIDINGS

Clinical examination revealed mild signs of pain on the manipulation of the elbow joint, with reduced range of motion on the end feel of joint flexion and extension and crepitation. Radiographic examination of the right elbow joint revealed severe, chronic osteoarthritis, with osteophyte formation on the humeral epicondyles and articular margin of the distomedial humerus, with a narrowed joint space, and osteophytes on the proximal radius, proximomedial ulna, and anconeal process.

TREATMENT AND OUTCOME

A solution comprised of a combination of lidocaine, thiocolchicoside, and piroxicam was prepared and applied around the right elbow joint. The animal was rested for 3 days and normal work load was introduced over a 5-day period. The CPBI was completed by the trainer before treatment (T0), 14 days (T1), 1 (T2), 2 (T3), 3 (T4), 4 (T5), 5 (T6), and 6 (T7) months after treatment. Following the mesotherapy session, pain score results consistently declined until the 3-month evaluation moment. At the 6-month follow-up evaluation, values have risen to near baseline values. No side effects were recorded.

CLINICAL RELEVANCE

Mesotherapy produced significant reduction of pain score results, as measure by the CBPI, and may be a promising treatment option for canine osteoarthritis-related pain. Further studies are required.

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.

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.

Intra-Articular Hyaluronic Acid Compared to Traditional Conservative Treatment in Dogs with Osteoarthritis Associated with Hip Dysplasia

The purpose of this study was to compare the efficacy of the intra-articular (IA) hyaluronic acid injection to traditional conservative treatment (TCT) in dogs with osteoarthritis (OA) induced by hip dysplasia. Sixteen dogs were distributed into two groups: Hyal: IA injection of hyaluronic acid (5-10 mg), and Control: IA injection with saline solution (0.5-1.0 mL) in combination with a TCT using an oral nutraceutical (750-1000 mg every 12 h for 90 days) and carprofen (2.2 mg/kg every 12 h for 15 days). All dogs were assessed by a veterinarian on five occasions and the owner completed an assessment form (HCPI and CPBI) at the same time. The data were analyzed using unpaired t test, ANOVA, and Tukey's test (P < 0.05). Compared with baseline, lower scores were observed in both groups over the 90 days in the veterinarian evaluation, HCPI, and CPBI (P < 0.001). The Hyal group exhibited lower scores from 15 to 90 and 60 to 90 days, in the CBPI and in the veterinarian evaluation, respectively, compared to the Control group. Both treatments reduced the clinical signs associated with hip OA. However, more significant results were achieved with intra-articular hyaluronic acid injection.

Characterisation of tramadol, morphine and tapentadol in an acute pain model in Beagle dogs

OBJECTIVE

To evaluate the analgesic potential of the centrally acting analgesics tramadol, morphine and the novel analgesic tapentadol in a pre-clinical research model of acute nociceptive pain, the tail-flick model in dogs.

STUDY DESIGN

Prospective part-randomized pre-clinical research trial.

ANIMALS

Fifteen male Beagle dogs (HsdCpb:DOBE), aged 12-15 months.

METHODS

On different occasions separated by at least 1 week, dogs received intravenous (IV) administrations of tramadol (6.81, 10.0 mg kg(-1) ), tapentadol (2.15, 4.64, 6.81 mg kg(-1) ) or morphine (0.464, 0.681, 1.0 mg kg(-1) ) with subsequent measurement of tail withdrawal latencies from a thermal stimulus (for each treatment n = 5). Blood samples were collected immediately after the pharmacodynamic measurements of tramadol to determine pharmacokinetics and the active metabolite O-demethyltramadol (M1).

RESULTS

Tapentadol and morphine induced dose-dependent antinociception with ED50-values of 4.3 mg kg(-1) and 0.71 mg kg(-1) , respectively. In contrast, tramadol did not induce antinociception at any dose tested. Measurements of the serum levels of tramadol and the M1 metabolite revealed only marginal amounts of the M1 metabolite, which explains the absence of the antinociceptive effect of tramadol in this experimental pain model in dogs.

CONCLUSIONS AND CLINICAL RELEVANCE

Different breeds of dogs might not or only poorly respond to treatment with tramadol due to low metabolism of the drug. Tapentadol and morphine which act directly on μ-opioid receptors without the need for metabolic activation are demonstrated to induce potent antinociception in the experimental model used and should also provide a reliable pain management in the clinical situation. The non-opioid mechanisms of tramadol do not provide antinociception in this experimental setting. This contrasts to many clinical situations described in the literature, where tramadol appears to provide useful analgesia in dogs for post-operative pain relief and in more chronically pain states.

Feasibility and repeatability of thermal quantitative sensory testing in normal dogs and dogs with hind limb osteoarthritis-associated pain

The objectives of this study were to determine whether thermal quantitative sensory testing (QST) can be performed in client-owned dogs, is repeatable and whether QST differs between normal dogs and dogs with hind limb osteoarthritis (OA). This clinical, prospective, observational study used clinically normal dogs (n=23) and dogs with OA-associated hind limb pain (n=9). Thermal QST was performed in standing dogs using a high-powered light source delivered by a previously validated system. Dogs were tested on two occasions, 2 weeks apart. Five tests were performed on each hind limb at each time point. Repeated measures analysis of variance was used to evaluate the effects of leg, time point and OA/normal status on thermal threshold latencies (TTL). Additionally, paired t tests were used to compare the TTL of left and right limbs within groups and between time points. Thermal thresholds were successfully measured in 32 client-owned dogs without prior training. TTL were significantly different between normal and OA dogs (P=0.012). There was no difference between limbs (P=0.744) or time periods (P=0.572), when analyzed by repeated measures analysis of variance, and no interactions between group and limb, visit and limb, or visit and group. In conclusion, thermal thresholds can be measured in client owned dogs with no prior training and are repeatable from week to week. Further data are required to determine if OA results in thermal hypoalgesia as measured at the distal hind limb and whether this is an indication of central sensitization.

Biceps femoris muscle transposition for treatment of cranial cruciate ligament rupture in small breed dogs

The purpose of this study was to evaluate a new extracapsular surgical technique for the treatment of cranial cruciate ligament rupture in small breed dogs. Nine small breed dogs (seven females and two males) weighing ≤ 15 kg were treated with biceps femoris muscle transposition (BFT). The duration of the BFT procedure was 20 min. Each patient underwent a standard clinical protocol and a questionnaire for the owners. Follow-up (at 1, 3, and 12 months postoperative) confirmed significant improvement in all patients, especially at 1 month postoperatively (p < 0.01) and again after complete stifle joint assessment at 3 months postoperatively. After 12 months, only two patients showed a slight increase in osteoarthritis. According to our results, BFT is a simple extracapsular surgical technique that can be used for the treatment of cranial cruciate ligament rupture in small breed dogs.

Clinical pharmacology of nonsteroidal anti-inflammatory drugs in dogs

OBJECTIVES

To discuss the clinical pharmacology of currently licensed veterinary NSAIDs and to review gastrointestinal and renal adverse effects as well as drug-drug interactions that have been reported with these drugs. To review the use of NSAIDs in the peri-operative setting and their use in patients with osteoarthritis. To further review the reported effects of NSAIDs on canine articular cartilage and liver as well as the clinical relevance of a washout period.

DATABASES USED

PubMed, CAB abstracts and Google Scholar using dog, dogs, nonsteroidal anti-inflammatory drugs and NSAID(s) as keywords.

CONCLUSIONS

A good understanding of the mechanisms by which NSAIDs elicit their analgesic effect is essential in order to minimize adverse effects and drug-drug interactions. Cyclooxygenase (COX) is present in at least two active isoforms in the body and is the primary pharmacologic target of NSAIDs. Inhibition of COX is associated with the analgesic effects of NSAIDs. COX is present in the gastrointestinal tract and kidneys, along with other areas of the body, and is also the likely reason for many adverse effects including gastrointestinal and renal adverse effects. The newer veterinary approved NSAIDs have a lower frequency of gastrointestinal adverse effects in dogs compared to drugs such as aspirin, ketoprofen and flunixin, which may be due to differential effects on the COX isoforms. There are currently no published reports demonstrating that the newer NSAIDs are associated with fewer renal or hepatic adverse effects in dogs. NSAIDs remain the cornerstone of oral therapy for osteoarthritis unless contraindicated by intolerance, concurrent therapies or underlying medical conditions. NSAIDs are also effective and frequently used for the management of post-operative pain.

Assessment of veterinary practitioners in the British Isles' approaches towards the management of canine osteoarthritis

The aim of this questionnaire-based retrospective study was to ascertain veterinary practitioners in the British Isles' approaches to osteoarthritis in dogs. The Mann-Whitney U test, Kruskal-Wallis test and multiple ordinal logistic regression were used to compare demographic data with treatment options. Questionnaires were returned by 228 practitioners (a response rate of 22.8 per cent). The majority of responses were from males (70 per cent). Eighty-six per cent (188 of 220) of the respondents had graduated from veterinary schools in the UK and Ireland. Veterinarians who had graduated less recently used exercise modulation less frequently (P<0.004, odds ratio [OR]=1.06) and ranked exercise modulation as less important (P=0.008, OR=1.04). Veterinarians who had graduated outside the UK or Ireland were less likely (P=0.033, OR=0.46) to use exercise modulation than those who had graduated in the UK or Ireland. Veterinarians who had graduated more recently were less likely (P=0.008, OR=0.95) to use medications. Female veterinary surgeons were less likely to rank medications as important (P<0.0001, OR=0.29) and less likely to rank corticosteroids as important (P=0.046, OR=0.42) than male veterinary surgeons. Practitioners who had graduated outside the UK or Ireland were less likely (P=0.01, OR=0.30) to rank corticosteroids as important. There was a significant mild negative correlation between the frequency of use of structure-modifying osteoarthritis drugs (SMOADs) and practitioners' opinions on rank importance (-0.32, P<0.0001). Medications such as SMOADs and nutraceuticals were ranked as not important but were used frequently. Overall, age, sex, the university of graduation and the number of canine consultations per day had an impact on the practitioners' treatment protocols.

Elbow denervation in dogs: development of an in vivo surgical procedure and pilot testing

The objective of this study was to develop a surgical technique for sensory denervation of the canine elbow joint and to assess the effects of denervation on limb function in normal dogs. Twenty cadavers (40 elbows) were used to characterize innervation and design the surgical protocol which was tested in 13 cadavers (26 normal elbows). The effect of denervation on limb function was assessed in vivo in four dogs with the elbow randomly selected for the procedure. Primary outcome measures were static bodyweight distribution and distal limb mechanical sensory thresholds; secondary outcome measures were subjectively scored lameness, neurological function and pain on manipulation. Histology was performed on all resected tissues to determine whether nerves had been resected. Denervation was achieved by separate medial and lateral surgical approaches. In testing the developed surgical protocol, 111/130 resected samples contained nerve tissue in the healthy cadaveric elbows and 18/20 in the in vivo study. Limb function and sensation were not altered by elbow joint denervation. The protocol developed for denervation of the canine elbow appears feasible and does not result in any sensory or motor deficits of the forelimb.

Where do we go from here? Future treatment strategies for chronic pain

Many of the tools that can be used to alleviate chronic pain in our patients are readily available to all practitioners, but they are not used with appropriate frequency. Thus, the immediate future of chronic pain therapy is simply to do more of what we are already doing. There are also drugs and techniques currently used in human medicine that may be available to us in the near future and many drugs and techniques on the research bench that might make it to our patients in the more distant future. Because of the magnitude of the chronic pain problem in human medicine, research on the treatment of chronic pain is intense, and the hope is that both human and veterinary patients will eventually benefit.

Diagnosis and treatment of osteoarthritis

Osteoarthritis (OA) is a common disease in aging dogs and cats but frequently goes undiagnosed and untreated. Although OA cannot be cured, long-term management of the disease can be very rewarding for the veterinary medical team as well as pet owners. Managing pain with pain medications is an essential first step. There are a wealth of pain medications available, including nonsteroidal antiinflammatory drugs, gabapentin, amantadine, and tramadol. There are also physical modalities available for pain reduction. Weight management and nutritional joint support are also important in aspects of managing OA in dogs and cats. Finally, physical rehabilitation is a great way to improve mobility and keep pets active as they age.