Monday, April 15, 2013

Feline Arthritis Part 1: Three Approaches to Treatment


Lumbo-sacral spondylosis - OUCH!


 Have you noticed that your cat is having a hard time getting up and down the stairs? Maybe he’s not sleeping on the end of the bed anymore, or not hopping up into your lap as frequently? Perhaps your cat has a litterbox in the basement, but recently has started urinating upstairs where she spends most of her time? Is your cat’s coat looking scruffier than it has in the past – maybe because he or she is not spending as much time twisting around to groom? Is your cat grumpier than usual, or snappish when you pet certain areas? Maybe your cat just doesn’t like to play as much as in the past, or takes a long time to sit or lie down comfortably.

All of these things are clues to diagnosing feline arthritis. A 2002 study looking at x-rays of older cats showed that about 90% of cats over the age of 12 have evidence of degenerative joint disease (DJD), and a similar study determined that about 20% of those cats do not display any signs or symptoms of the arthritis changes to their bones. Rarely, if ever, do cats actually limp or cry out in pain when they have arthritis – it is usually much more subtle, and better discovered by cataloguing what the cat is NOT doing than by listing what the cat IS doing. Once you and your veterinarian have come to the conclusion that arthritis is a problem for your cat, there are several options for treatment.

Neutraceuticals

The first several options deal with rebuilding and protecting the joints. There are several products that help with this. 
  • Cosequin is a powder that can be mixed with canned food 1-2 times daily that supplies glucosamine and chondroitin to the cat. Glucosamine hydrochloride acts as a building block of cartilage by supplying a key nutrient that keeps cartilage cells healthy and functioning properly. The specific chondroitin sulfate, exclusive to Cosequin, is the most pure form available on the market. Manganese ascorbate is necessary to optimize the production of cartilage components. Glucosamine and chondroitin can take 6-8 weeks to reach full effect. 
  • Science Diet makes a therapeutic joint care diet called J/D that has shown definite benefits in studies – both for the treatment of arthritis and for the promotion of joint healing after orthopedic surgery in dogs and cats. This diet contains ingredients such as glucosamine and chondoitin and essential fatty acids that slow the degradation of cartilage, repair cartilage, and L-carnitine to encourage fat-burning while maintaining good muscle mass. J/D can take up to 28 days to show noticeable improvement.
     
  • The glycosaminoglycan Adequan is an injection that can be given at home weekly for 5 weeks and then once every other week for the rest of the cat’s life. Adequan shuts down enzymes which destroy collagen, joint proteins, and hyaluronic acid in degenerative joint disease and stimulate the production of protein, collagen, hyaluronic acid and other aspects of a fully functioning joint. While Adequan is marketed only to dogs, its use has safely been studied and tested in cats.
  •  Finally, omega-3 fatty acid supplements have been shown to help relieve joint inflammation, as well. Avoid fatty acid supplements that contain vitamin D, as they often contain a level of this vitamin that is higher than is safe for pets.


Pain Control

While cats cannot tolerate Tylenol as a medication, or most other non-steroidal anti-inflammatory (NSAIDS) medications that work so well in dogs, there are a few NSAIDS that can be used with care in cats, such as Metacam and Onsior. These medications aim to relieve joint inflammation to make the cat more comfortable. NSAIDS approved for cats do require close monitoring of the kidneys to ensure there are no contraindications – they should not be used in cats with chronic or acute renal disease, liver disease or used in debilitated or dehydrated cats. 
Other options for pain relief include Buprenorphine, Tramadol and Gabapentin.
  • Gabapentin is an anti-seizure medication that has been shown to provide pain relief, although the exact mechanism of action is not known. In humans, it has been used to treat restless leg syndrome, fibromyalgia and diabetic neuropathy. 
  • Tramadol is a mild opioid medication that acts similarly to codeine in relieving moderate to severe pain. 
  • Buprenorphine is another opioid drug that works well for relieving moderate chronic pain. Often, it is given orally into the cheek pouch rather than making the cat swallow the medication immediately, because it is absorbed better in the mouth than in the stomach.

Alternative Medicine

Finally, there are alternative medicine treatments that may help with arthritis. Our office carries a product called DevCor Mobility Pro that contains Corydalis Yanhuso Root, Devil’s Claw, and Boswellia serrata, which studies have shown to help support mobility and flexibility by decreasing inflammation. While neither laser therapy or acupuncture have had extensive effectiveness studies done, many people find that one 
treatment or the other help their pets. Laser therapy involves multiple ongoing treatments that help stimulate blood flow and cellular activity, interrupt transmission of pain impulses to the brain, and stimulates endorphin release. Acupuncture uses very thin needles to stimulate nerves and activate certain areas on the body to help relieve pain and decrease inflammation as well as stimulate healing. Hydrotherapy (swimming), if your cat will tolerate it, may also be beneficial, though it is more commonly used following orthopedic surgery or skeletal trauma. Some people have even reported positive response to chiropractic care or massage therapy.