Rebecca Barr, BVMS MRCVS MSc
Osteoarthritis (OA) is a disease commonly seen in pet dogs. It has been found that 80% of dogs over the age of 8, and 20% of dogs over the age of 1 have osteoarthritis to some degree, with complications of arthritis being one of the leading causes of euthanasia in older pets.
Osteoarthritis is typically thought of as a disease of the joint; however, what starts in the joint usually leads to adverse effects on muscle, connective tissue, and skin. The initial damage to the joint is caused by the degeneration of normal joint structure — including problems with the cartilage and thickening of the fluid in the joint, which is involved with joint movement. This degeneration often leads to formation of small pieces of new bone and pain within the joint. Over time, many animals then go on to experience muscle pain as a result of compensating for a sore joint. We often see referred pain in different areas of the dog’s body, for example, back pain as a result of hip OA, or neck pain secondary to elbow OA.
Unfortunately, there is no cure for arthritis. However there are many things we can do to help keep them as comfortable as possible and ensure they maintain good quality of life.
The clinical signs of OA are many and varied. They are often poorly recognised by owners, and the severity of the impact on their pet frequently underestimated. As a result, many dogs spend months and even years suffering as a result of poorly managed, painful conditions. Often during veterinary clinic visits and behaviour consults, owners mention changes in their dog’s behaviour that may suggest underlying pain. It has been found in the leading behaviour clinics in the U.K. that up to 70% of cases have an underlying or contributing medical or pain issue, with pain being one of the leading causes of aggressive or avoidant behaviour. The signs most commonly noticed by owners may be physical, behavioural, or have components of both. The stopping or starting of a behaviour, particularly one that involves a reasonable degree of movement, is a warning sign that pain may be present in the patient. Any pet that starts to show aggressive behaviours should have a clinical exam by a veterinarian to assess for pain.
Signs that owners may notice can include:
- Slowing down, either on walks or generally
- Reluctance to jump (e.g., onto the sofa or into the car)
- Not playing with toys
- Not stretching
- Showing new or an increasing frequency of distance-increasing or aggressive behaviors
- Not wanting to be groomed
- Excessive panting
- Restlessness/can’t settle
- Not wagging their tail
- Shifting weight
- Gait changes
- Hunched position
There are numerous factors that can predispose an individual to developing OA; certain breeds are prone due to genetics and conformation, environmental factors (particularly for young animals), obesity, previous injury or surgery to a joint or bone, and the type and intensity of exercise.
A diagnosis of OA may be made based on clinical exam along with clinical signs, or imaging in conjunction with the above. Imaging of choice is typically radiography, but in some cases CT may be more appropriate; certain joints (e.g., elbows) can be difficult to fully examine via radiography, and CT scans are likely to allow a more definitive diagnosis.
Improving outcomes for dogs with osteoarthritis
Although OA is not a disease that can be cured, there are many things we can do to help keep our pets comfortable and ensure good quality of life.
Weight management is a hugely important part of managing arthritis — weight reduction in an overweight animal can result in substantial improvements in demeanour and behaviour in affected dogs. As well as extra weight putting additional pressure on sore joints, fat cells promote inflammation in the body, which results in increased pain. If a dog is sore and not wanting to exercise, it can be tricky to get them to lose weight. When they aren’t exercising as much, they don’t need the same amount of calories, so food intake (including treats) should be decreased. When looking at food enrichment activities for dogs that have reduced or altered mobility, it is important to ensure the dog is not consuming more calories than required over the course of the day.
Changing the environment
Environmental modification is one of the first things we think about for humans with mobility problems or chronic pain; stair lifts, single-level dwellings, orthopaedic mattresses and walking aids are all things that people regularly obtain to make things safer and more comfortable for them in the environment. The same applies to arthritic pets; slippery floors, loose rugs, stairs, and door thresholds are all hazards that can lead to trips and falls, as well as the pet becoming less confident about moving around in their environment. Encouraging clients to assess their environments for potential hazards can make a huge difference to the individual dog. Ensuring rugs are taped to the floor, the dog’s bed is at a low level, and food bowls are at an appropriate height are just a few measures that can be enormously beneficial.
Jumping in and out of cars can cause additional problems. Increased pressure on painful joints can lead to a reluctance to jump in the car and may even lead to aggressive behaviour if the owner tries to pick up a painful or nervous dog. Teaching the dog to use a ramp with a gradual slope, always ensuring the ramp is an appropriate gradient and with sufficient grip for the individual, will prevent such events.
Exercise modification is another area that can be very easy for clients to change whilst having a markedly beneficial impact on the dog. The common belief that dogs wouldn’t run around or chase a ball if they were sore simply isn’t the case, with many dogs overexerting themselves on walks only to feel extremely painful later that evening. The effects often aren’t seen by the owner immediately; as the dog is enjoying the experience they are getting while they are out, it may be perceived by the owner that modifying the exercise would be detrimental to the dog. Fortunately, there are many ways of modifying exercise so that the dog’s needs are met, both physically and emotionally.
Shorter and more frequent walks are better than one long one, because the muscles don’t experience the same fatigue and don’t become as stiff afterwards. It is important that the dog is allowed to go at their pace, since walking faster than they feel able may cause pain afterwards. Additionally, walking at a steady pace will help ensure more accurate and stable limb placement. Gradual slopes will put less pressure on joints and muscles than steep ones. Grass will be less painful than hard surfaces, so spending as little time on pavements as possible can help keep arthritic pets comfortable while they are walking.
We know lots of people enjoy playing long games of fetch with their dogs, but repetitive and high-intensity activities can cause problems with joints and muscles, especially if there is existing disease. Fast turns and skidding to a stop can make sore joints and muscles hurt more. The neurochemicals involved in these high-arousal activities can mask pain for the duration that the levels are increased. The emotional association with such activities will also result in an animal that will continue to play even if there is active inflammation and pain.
There are numerous alternative activities to encourage owners to engage in with their pets; looking at the original function of the breed of dog may help owners to find games and activities their pet will enjoy. Sniffing and searching for food or toys in the grass, exploring new places, allowing the dog to sniff out their own route for a walk, training in different places, enjoying an interactive food toy in a cafe — there are many inventive ways to keep our dogs entertained. In addition, there are now lots of social media pages dedicated to enrichment for dogs, many of which are suitable for dogs with mobility issues; directing clients to these, with guidance as to what types of activities are suitable for their individual pet will help ensure the dog receives adequate stimulation and can help strengthen the dog-owner bond.
There are many drugs now available to help manage arthritis, including those designed to reduce inflammation and relieve pain associated with inflammation. Depending on the extent and severity of the disease, a veterinarian may find it appropriate to manage a dog with two or more types of medication; different drugs act on different areas and stages of the pain pathway, and using a combination of drugs can help improve comfort. In some cases it may allow lower doses of individual drugs to be used. Some animals need to be on long-term or lifelong medication, while others may only need a few weeks at a time to help manage flare-ups.
Hydrotherapy and physiotherapy can be enormously helpful for pets with arthritis. Qualified practitioners will be able to assist with exercises to help strengthen muscles and support the joints and connective tissue. Hydrotherapy and swimming can also be a good form of exercise. There is less pressure put on joints, and the limb movements are slower than when dogs run. As well as the physical benefits of these types of therapy, they also offer mental stimulation for the dog, and a degree of training can be incorporated into such activities.
How behaviour and training professionals can help?
Behaviour professionals can play a key role in helping pets that are in pain. It is important o ensure every animal you see with a behaviour problem has been recently checked by a vet. Encourage clients to video any abnormal behaviour to show to their vet to assess for pain. Remember, pain is responsible for, or involved in, a large proportion of cases referred for behavioural assessment. If the animal is left untreated, not only do we have a welfare issue, but it will decrease the efficacy of the training or behaviour modification protocols implemented.
If there is a diagnosis of pain or arthritis, speak to the dog’s vet to discuss what types of activities may or may not be suitable for the dog.
Discuss with owners what constitutes appropriate exercise; this is important in dogs of all ages, whether or not there are any existing medical problems. If a young dog suffers from a bad muscle strain as a result of repetitive, high-intensity exercise, it may take weeks to months to heal. If the dog is in pain during that time, their behaviour is likely to change.
Ask owners to keep a diary of behaviours and activities their dog has been engaging in. This will help to identify patterns that may give indications of pain or arthritis, e.g., “I took dog for a two-hour walk yesterday afternoon, and today she growled at me when I tried to get her to come out of bed.” Ensure the owner has a good understanding of body language; this is crucial for all dogs but especially those that suffer from chronic pain. An early understanding of how the dog is feeling about a situation can help to prevent stress on the dog’s part and reduce the risk of aggressive behaviour developing.
Although increased exercise is often advised for dogs that are experiencing a variety of behaviour problems, it is important to ensure that this is not at the expense of their physical health. Discourage activities such as repetitive ball-chasing and encourage activities such as scent work, problem-solving games, or food toys. As well as being safer physically, these types of activities are thought to improve the human-animal bond, and provide opportunities to reduce stress and promote a positive emotional state. Considering the surfaces dogs walk on and the exercise they do, and monitoring their weight will also help minimize a young dog’s risk of developing OA later in life.
Work with the owners on getting the dog used to, and comfortable with, being handled. Teaching consensual handling is invaluable, because it gives the dog some control over what is happening to them and often makes handling much less stressful. This is useful for vet exams, but also for the owners at home. Don’t start handling work until the dog’s pain is well controlled where possible — if handling is painful or stressful, it is more likely that the dog will struggle to accept it, and learning good associations will be harder.
Encouraging the use of snuffle mats and toys designed to be licked, appropriate chews, scent games, and appropriate training. Licking, chewing, and sniffing all help to reduce stress in dogs and may have benefits in terms of perception and experience of pain. Owners can be inventive with ways to do this and often find it very enjoyable.
As OA progresses, dogs start to lose mobility and need additional support to move around. Helping the owners to teach their dog to use equipment they may need in the future, such as harnesses, ramps, and buggies, is a good way to get ahead of any potential stress for both the owners and the dog. If an owner tries to use a piece of equipment when the dog is painful (e.g., walking up a ramp), the dog may become avoidant of it. Correctly conditioning these pets to new equipment as soon as possible is vital to the success of the intervention, and can result in huge improvements in the dog’s quality of life.
It is worth mentioning that many dogs with sound sensitivities or phobias may also be experiencing pain; many studies have discussed the link between the two, with they hypothesis that muscle and joint pain results from or is exacerbated by startling at a sudden noise. Again, any dog that has developed sensitivity to noises should be thoroughly assessed for pain.
Whilst addressing chronic pain in a dog is not going to miraculously cure any associated behaviour problems, it will certainly improve the quality of life for the dog, and in many cases will result in some positive behaviour changes. A dog that is in pain may not sleep well due to needing to shift position regularly, struggling to find a comfortable position, or waking up regularly due to experiencing pain. This in turn will affect the dog’s cognitive ability, mood, and therefore behaviour. If by allowing the dog to sleep better we can improve these things, then we are likely to see positive changes in the dog’s behavior. Pain that has been left unmanaged for long periods of time may result in well-practiced unwanted behaviours that can be challenging to overcome. With appropriate pain management, environmental and exercise modifications, and sympathetic training and behaviour modification, many of these cases can have very rewarding outcomes.