Arthritis and Joint Disease

Normal Joint Structure

The body contains several different types of joints. Some of these joints are very specialized like the fibrous discs between the vertebrae of the back. There are also “synovial” joints that consist of two bones and a fibrous capsule that holds those two bones together. These joints are the most common concern in degenerative arthritis. The surfaces of these two bones are covered with slippery cartilage that allows these bones to glide across each other with little to no friction. These bones need to able to glide freely repeatedly over the course of the pet’s life for comfortable range of motion in these joints. The idea in preventing the progression of arthritis is to maintain the normal structures of the joint. In many cases of arthritis prevention our first step is to provide the biochemical components of these structures by using nutritional supplements. The following is to review what these biochemical structures are and how supplements work.

Chondrocytes

These are the cells that secrete the “matrix”. The matrix is the soft material that represents 95% of the cartilage. These cells must remain healthy in order to produce new matrix when the old matrix is damaged.

Matrix

Matrix consists of collagen and proteoglycans. We have all heard of collagen which is the tough support proteins that act as the “steel girders” of the body. They hold everything from bone to skin in the shape it is meant to be in. Proteoglycan is not a very familiar word to most people however it is very important to understand when choosing a joint supplement. These are the material that surrounds the collagen fibers. It consists of a long protein molecule with strands of what is called glycosaminoglycans or GAGs growing off its sides like bristles on a hairbrush. These GAG bristles allow the proteoglycan molecule to soak up water like a sponge. This absorbent characteristic allows the cartilage to be soft like a mattress and yet slippery when the two bones of the joint move across each other. The three GAGs that make up a proteoglycan molecule are Chondroitin sulfate, Keratin sulfate (which is made in the body from a biochemical called glucosamine), and Dermatan sulfate. This is why many joint supplements contain glucosamine and chondroitin sulfate.

The Joint Capsule

The joint capsule is the capsule that encloses the joint creating a “hinge” structure. This capsule has a tough outer layer, a fibrous layer, and then an inner layer that secretes joint fluid. Joint fluid provides both nutrition and lubrication to the enclosed joint. This joint capsule also works as a filter by keeping unwanted proteins and biochemicals out and only letting the desired nutrients inside. The joint capsule is made of two types of cells Type A Synviocytes which remove impurities and clean out debris. Type B Synviocytes are important in lubricating the joint.

Degenerative Arthritis

When either an injury has occurs or in cases of poor conformation, the cartilage becomes roughened and can chip or wear down. This causes the joint capsule to become inflamed and prevents it from functioning normally. With this inflammation impurities are allowed to enter the joint, the lubricating fluid loses many of its natural properties, and a painful abnormally functioning joint is created. The goal in treatment is to alleviate both the pain and inflammation as well as to provide the biochemical building blocks that allow the joint to heal itself.

Treatment and Preventing the Progression of Arthritis

Unfortunately, many cases of arthritis involve a heavy pet. Since extra weight puts more strain on joints weight loss is often very important in keeping an arthritic pet comfortable. Thinner pets can be kept more comfortable for a longer period of time with fewer medications. Thinner pets also tend to have a lesser risk and slower progression of many arthritic conditions. Weight loss is an important step in treating any obese pet and although it may seem difficult your veterinary staff can help give suggestions that make this process easier for your particular situation. The next step with arthritis especially in the early stages is to begin a joint supplement. One important thing to know is that not all joint supplements are created equal. Since these are nutritional supplements and not medications there is no regulatory body overseeing their production. This means that for many of these products not only have little to no research to back them up but there is no one to make sure that what the label says is in the product is really there. There are many trusted companies that make glucosamine/chondroitin supplements in many different forms from tablets, capsules, chewy treats, and even flavored gels for cats. Talk to your veterinarian to help decide on what the best supplement may be for your specific pet’s needs.

As arthritis progresses, pain and inflammation begin to appear as stiffness, lameness, and weakness. At this point there is another option to medication available. Laser Therapy consists of using infrared light to assist in controlling these symptoms. The infrared laser uses light to stimulate the cells both in and surrounding the joint. The stimulation results in a decrease of inflammation and swelling, a decrease in the pain, an increase in blood flow to the area which brings in many cells important to healing, and an increase in range of motion. For more information on laser therapy please feel free to read the articles located in the laser therapy section of our website bardstownvet.com.

Physical therapy can also be an important link in aiding mobility in the arthritic dog. Arthritic joints rely on strong muscles for support however the arthritis often leads to disuse and poor muscle conditioning. Regular low impact exercises for a short period of time such as short walks or swimming can aid in the mobility of these pets. It is important to not overdo these exercises and prevent the pet from sore the next day. Also avoid sudden spurts of speed and keep a steady pace. This can help keep the joints flexible and reduce excess weight. If the pet is sore do not exercise until the pain resolves and then begin the exercise again about half as long as the previous session. Ice can help with acute pain but only for about fifteen minutes. A warm up and cool down routine should also be implemented when exercising the arthritic pet. The pre exercise warm up should consist of warming up the muscles for at least five minutes prior to exercising. A warm compress can be applied to aid in this processes, joints should also be flexed and extended through passive range on motion. Muscles should also be gently massaged to increase blood flow. The cool down process is ideally 5 minutes of exercise at a slower pace followed by 5 minutes of gentle massage.

Passive range of motion exercises consist of laying the pet on its side and gently flexing and extending all of the pets joints starting at the foot and working up to the shoulder or hip. If this causes the pet discomfort do not continue to the painful point. Ideally 15-20 flex/extensions are performed on each joint. To perform a gentle massage there are many hand motions that can be used. Stroking can be done using the palm of the hand moving from head to tail or from hip or shoulder to toe. Efleurage is a stroking motion but performed in the opposite direction beginning at the toe. Friction is performed by using the tips of the fingers to make small rotary motions. With all of these techniques some pressure should be applied but it is important to not apply to much pressure. To get an idea of proper pressure using a scale press down with your hand until 5 pounds is reached. Your massage should never contain more than this much pressure. Massage can help with increased circulation, increased lymphatic flow, improved mobility, and relaxation. If physical therapy is something that interests you but you are not entirely comfortable in completing a routine yourself there is also a center in Louisville that specializes in physical therapy for pets. For more information please feel free to speak to your veterinarian about your interest.

The final step in controlling pain and inflammation for the arthritic pet consist of using medications. Often NSAIDs are used to keep the pet comfortable as the arthritis progresses. There are many choices and combinations that can be used and it is very important to speak to your veterinarian to decide what medication might work best for your pet. It is also important to realize that the use of these anti-inflammatories can come along with complications and side effects these medicines are filters through the liver and can cause problems with dogs whose liver is not functioning properly. It is necessary to have your pet’s risk evaluated through a physical exam and possibly a blood screening. Also when using these medications it is important to maintain the previous courses of action listed above in the hopes that we can maintain the comfort of the pet on the lowest dose of medication possible in order to try to avoid future complications.