Joint health: A roundtable discussion (Sponsored by Nutramax Laboratories)


Joint health: A roundtable discussion (Sponsored by Nutramax Laboratories)

The clinical signs

Sherman O. Canapp, Jr., DVM, MS, CCRT, DACVS, DACVSMR, Veterinary Orthopedic and Sports Medicine Group, Annapolis Junction, Md.
Dr. Sherman O. Canapp: What are the classic signs of joint health problems in dogs and cats, and what is your take on this issue?

Darryl L. Millis, DVM, MS, DACVS, College of Veterinary Medicine, The University of Tennessee, Knoxville, Tenn.
Dr. Darryl L. Millis: In the past, a lot of us have waited for animals to come in with a lameness problem or for an owner complaint of a pet's having difficulty rising or going up and down stairs. Certainly those things are still important, but it has become evident that we need to address the joint before it becomes clinically affected.

What that means for veterinarians is that we have to be more proactive, especially with examination of young dogs, focusing on hips and elbows. Then as the animals reach middle age, particularly in large and giant breeds, paying close attention to those joints but also the knees. The key to maintaining good joint health is early diagnosis and recognition of a problem before it becomes a bone-on-bone and a pain management issue. We need to do some detective work before it gets to that point to try to salvage the joint as best we can.

Paul Fox, DVM, Mount Carmel Animal Hospital, Monkton, Md.
Dr. Paul Fox: In a general practice, one needs to be aware of the animals that are at risk for having joint problems, as puppies or later in life, especially large-breed dogs and overweight dogs. Some of Dr. Lascelles' research shows that of cats over 12 years of age, 90% have arthritic changes in their joints. These changes don't necessarily mean that the cats will be lame or even in pain, but it bears to question the under-diagnosis of arthritis in cats. The discussion of osteoarthritis with clients needs to happen much earlier in pets' lives than I think we are accustomed.

Dana K. Juillerat, DVM, MS, Tri-County Animal Hospital, Fort Pierce, Fla.
Dr. Dana K. Juillerat: In younger animals, it is important to notice different stances and standing positions. The animals will often stand with their knees turned outward, kind of bowlegged. Also, recognize soft tissue injuries. It is not always an orthopedic problem that is going on. Of course, lameness, changes in behavior, and a decreased willingness to jump up on the sofa are more classic signs. Clients often say, "My cat used to jump up on the top of the fridge, and it's never on top of the fridge anymore." A lot of behavioral changes go along with joint disease.

Duncan X. Lascelles, BSc, BVSc, PhD, CertVA, DSAS(ST), DECVS, DACVS, College of Veterinary Medicine, North Carolina State University, Raleigh, N.C.
Dr. Duncan X. Lascelles: We realize that joint disease is common and that it impacts quality of life. We need to broaden our outlook and not just use a fire brigade of analgesics, but think about a multimodality approach. It is all about lifestyle decisions, and that takes it back to the early ages.

We need to educate our clients as to what decisions to make to provide the best lifestyle for their pets. These early decisions will impact joint health in the long run. Starting from an early age, everything, including nutrition, supplementation, exercise, and surgical decisions, can impact joint health. The field has changed a lot. In just the past fourteen years we have made a dramatic move from a reactive approach to a more proactive, preventive approach.

Canapp: With more dogs at a younger age becoming active in sporting type activities, such as agility events, hunt tests, and field trials, owners are starting these dogs earlier and earlier in training. We are seeing some joint conditions earlier in life in the canine athlete not seen before simply because the sporting industry has become so huge. We need to educate and encourage owners to take a prophylactic, or preventive, approach and possibly start their dogs on supplements at an earlier stage, before there are signs of joint disease.

Dr. Lascelles, you have done so much work with the feline patient. Do you see a big difference between what you commonly find as far as history, physical size, or differences in joint problems with cats than you see with dogs?

Lascelles: There is a big difference. We are at the early stages of understanding what joint disease in cats is all about. The biggest difference at the moment is in the way we are diagnosing it. Dogs are taken for walks, and owners have a fairly good idea of what lameness or a mobility abnormality is. Then there are the other mobility activity perturbations that are seen: not jumping into the car, not wanting to climb up or down steps or stairs.

In cats, it is a very different scenario. Owners are not evaluating limbs. We, as veterinarians, can't even evaluate limbs and gait very well in cats. We need to look at behaviors that we haven't looked at before, such as changes in the level of engagement with family members and other pets as well as spontaneous activities that may be more easily defined, such as jumping up and jumping down. These less-defined behaviors are going to be a very important part of leading us to a possible diagnosis of painful joints and degenerative joint disease-associated pain. With cats, we have to rely even more on owners. We have to figure out what signs to direct the owners to, what activities, what behaviors to get them thinking about.