Arthritis in dogs - signs, symptoms and treatment

Warning: At present it appears that Rimadyl will cause liver damage in some dogs. There have been some deaths in dogs with this reaction, although I think that the use of the word "many" is misleading. The predominant breed affected by this reaction has been the Labrador retriever but there are reports of other breeds being affected.

The following are real life cases of Arthritis in Dogs that have been treated by Dr. Mike Richards, DVM.

Arthritis pain control
Enteropathic arthritis - Enteritis and Limp
Arthritis and Heart Murmur in Older Dog
Systemic enzyme therapy for Arthritis
Arthritis treatment
Arthritis or Hip Dysplasia?
Immune mediated arthritis disorders
Medication for Dog with Arthritis
Advanced Arthritis - treatment and pain control options
Rimadyl and liver problems in Dogs
Interaction between Adequan and Glucosamine?

Arthritis pain control

Question:

My dog Tofu (11yr old female Dalmatian/terrier mix) has severe back and shoulder degenerative arthritic changes. Although she does not act like she`s in pain, her ambulation is getting much worse. We have been giving her 50mg Rimadyl BID & Cosequin DS BID. A few months ago I had taken her off Cosequin DS and put her on Glycoflex BID. I put her back on Cosequin to see if it would make a difference. It didn`t. Do you have any other thoughts about possible treatments/meds?

Answer:

Carprofen (Rimadyl Rx) is the best of the approved arthritic medications based on our clinical experience. When it doesn`t control pain well enough we usually add a narcotic because there isn`t much interaction between the medications and the additional pain relief afforded by the narcotics can be beneficial. We usually use hydrocodone or codeine in one of the combinations (like Vicodin Rx). We have used sustained relief morphine in a few patients and it helps a lot but we try to keep this as a short term treatment or to help patients whose owners simply will not consider euthanasia and there is significant suffering (which doesn`t sound like your situation). Sometimes Adequan (Rx) injections work better than oral glucosamine products but not enough better that we rush to try this frequently. Still, it is an option. Corticosteroids work really well to control the inflammation (and therefore the pain) associated with degenerative joint disease. We use these when a pet is in good shape otherwise but the owners are considering euthanasia due to pain or poor mobility. At that point, the side effects become much less of a concern, since they are always less severe than the euthanasia option. Sometimes a dog will have a year or 18 months of comparative comfort with very few side effects after we start using prednisone or one of the other corticosteroids. However, side effects will eventually occur and so it is important not to start these medications too soon. I know that there are veterinarians using Celebrex (Rx) for arthritis in dogs. Anecdotally it is reported to work well. I have not seen any sort of scientifically established dosage, though. I hate to use medications without a pretty firm idea of the effects and dosing information, so I have not attempted to use this medication. I have heard (but again no firm data) that Vioxx (Rx) is harmful to some dogs, so it isn`t used at the present time as far as I know. Stuff like regular moderate exercise, weight control, warmth when the joints are sore, icing when acutely inflamed and similar things that help people will help dogs. It is hard to overstate the importance of weight control. In at least one study in dogs weight control was more beneficial than any of the medications used in controlling disability and pain associated with degenerative joint disease. I hope that this help some.

Get more info on Over the Counter Pain Relief for Dogs with Arthritis

Enteropathic arthritis - Enteritis and Limp

Question:

I am a new subscriber but I already think this is a great web page and a great service. My question concerns my 6 year old mixed breed named Oba. About a month ago my Vet scoped and biopsied Oba and determined he is suffering from irritable bowel disease. She has prescribed Hill`s prescription diet w/d along with 500 mg of Flagyl (Metronidazole). Oba`s symptoms seem to be improving in that he suffers less from diarrhea but now seems somewhat constipated. Anyway I had a conversation with a nutritionist last week who told me the above condition could manifest arthritis type symptoms and Oba has been limping, progressively worse, for three or four months now. My Vet has x-rayed his hips, leg and back, as well as sedated him to perform ligament knee surgery. The surgery was not performed as the orthopedic Vet determined the leg was not "loose" enough to warrant surgery. I was told to leash walk him for a couple of weeks to see if the leg would heel, but the condition is getting progressively worse. Is there any way there could be a connection between the limping and the irritable bowel disease? The bowel symptoms started a little over six months ago and the limping a couple of months later. Thank you in advance for your input.

Answer:

There is a form of immune mediated arthritis that is called enteropathic arthritis and also called Type III non-erosive arthropathy. This affects approximately 15% of dogs who have non-erosive arthritis according to Hay and Mansley, writing in "Saunders Manual of Small Animal Practice". A connection between gastroenteritis from food allergies and arthritis is also made in an issue of the "Veterinary Clinics of North America", (Blakemore, July 1994). This condition is also discussed in the "Textbook of Veterinary Internal Medicine" by Ettinger and Feldman. There appear to be two theories for the simultaneous occurrence of enteritis and arthritis. The first theory is that the disorders are both caused by the same underlying immune system abnormality, which probably does occur in some cases. The second theory is that the body`s reaction to the chronic bowel disease and to immune complexes in the blood stream from this cause the arthritis. This probably also happens in some cases. Regardless of what the actual cause is, it does seem to help a great deal to successfully control the gastrointestinal disease so that should be the main thrust to the treatment effort. If the enteritis can be controlled then the arthritis should either resolve or require minimal treatment. In the meantime, if non-steroidal anti-inflammatory medications help with the arthritis and don`t make the gastrointestinal disease worse, they are probably the best medications to use. The other choice is to use corticosteroids. It is pretty important to be reasonably certain that this is an immune mediated arthritis and not osteoarthritis or infectious arthritis prior to using corticosteroids, though. On X-rays non-erosive arthritis usually causes very little changes to the bone so the joints look pretty normal except for soft tissue swelling. Aspirating fluid from the joint can also be helpful in making the diagnosis of immune mediated arthritis. It is hard to be sure that there is a connection between these two problems. The X-rays will help some and joint fluid aspiration might help, too. The best evidence would be if the arthritis clears up when the digestive problems are resolved. Good luck with this.

Get additional information on Irritable Bowel Syndrome in Dogs

Arthritis and Heart Murmur in Older Dog

Question:

I have a poodle mix, Bonni, that is 11 years old. She is my baby and I am very concerned about her. I adopted her (at 6-8 months) from the Humane Society in Texas, she had been abused and was aggressive towards men, but they were doing their best to find a suitable home for her. As a puppy she was diagnosed with a mild heart murmur and her only other problem until recently was skin allergies. Noticing that she hasn`t been feeling good lately (she had been really chewing on the same spot on her right hip and been hobbling a bit), I took her to my vet for a geriatric exam, where the vet did a series of tests. The blood tests revealed that all of her levels were within acceptable standards except for the LDH or LHD (?), the vet explained it as a "feel good" level. The norm, I believe, was 300 - 800, and she was at 1200. Her x-ray also showed mild enlargement of her heart, and he noticed that she was favoring her front legs. This led to a diagnosis of enlargement of the heart and osteoarthritis of the hip. The vet placed her on Rimadyl and Enacard, in addition to the Benedryl I give her occasionally for itchy skin.

Here are my questions: Is it safe to mix these medications? Is there anything I can do without medication to help her feel better? Can you estimate her life expectancy with these health problems? Would you recommend a different course of treatment? I think my vet is great, but am just interested in another opinion. Thanks for your service.

Answer:

I do not know of any reason not to use carprofen (Rimadyl Rx), diphenhydramine (Bendryl Rx) and enalapril (Enacard Rx) together. Weight control is the best non-medical treatment for both arthritis and heart disease. If Bonni is overweight, even a little, weight control would benefit her. We recommend trying glucosamine and chondroitin to see if they are helpful. These are available over the counter at most pharmacies and health food stores. We have lots of small poodles in our practice with heart murmurs that do not cause problems for years or even never cause problems, in some cases. I usually wait until there are clinical signs prior to using enalapril but many vets think it helps to use this as soon as a murmur is audible. If and when the heart disease gets worse there are other medications that may be helpful. Trying to keep extra salt out of the diet is helpful and I think that moderate exercise is beneficial, especially early in heart disease. All the things that help with arthritis such as massage, heat therapy, comfortable beds and adequate rest probably help dogs, too. Dogs don`t always like this kind of attention but you might find some aspect of this sort of nursing care that helps a lot.

Find out more about Dogs and Heart Murmurs

Systemic enzyme therapy for Arthritis

Question:

What do you know about systemic enzyme therapy? I subscribe to a publication for non-vets called the Whole Dog Journal (holistic veterinary publication) -- the January 2001 issue had an entire article devoted to the merits of systemic enzyme therapy, and in particular showcased a German product called Wobenzym N (made for people, but there is a canine version as well called Fido-Wobenzym). It contains, as you may have guessed, enzymes, as follows: pancreatin, papain, bromelain, trypsin, chymotrypsin, and rutosid. Given with meals it aids digestion, but given inbetween meals it`s supposed to be good for lots of things, including arthritis, both immune and non-immune in origin, and chronic UTIs. I am considering trying it with my severely arthritic 12 year old lab who has suffered from chronic UTIs as of late, who does not respond to NSAIDs and does not tolerate steroids well. The only pain reliever she is on now is a Chinese herbal supplement (OA Plus) that I told you about last year. While it still helps her get around a bit (big difference when I take her ff of it), I can see she is in pain when she tries to stand up. So I want to try this now. The article seemed to indicate that the medication was relatively safe, but did not mention interactions with other drugs (except to say that it improves absorption of antibiotics). I am of course concerned bout interactions with other drugs and vitamins as well as the herbs, even though I know that some of these enzymes are actually produced by the body. Right now the dogs is taking Pepcid AC, OA Plus, Pet Tabs Plus, calcium supplements, Cipro (prevent recurrence of UTI), metronidazole (for diarrhea from Cipro), Vitamin E, Lipiderm and bethanechol (for urinary retention). Any thoughts you may have would be appreciated.

Answer:

There are individual studies of enzyme use that show all the effects that you have listed according to Schoen and Wynn`s book "Complementary and Alternative Veterinary Medicine". If you search the PubMed site using Wobenzym as the search term, there are 33 articles on the various uses of this product. It appears to be very safe in humans based on looking through a few of these and it is used in some orthopedic conditions. One article mentioned that there was no interaction with the usual medications or hormones used to treat mastopathy in women and I suspect that holds true for the herbs and medications you might use to control arthritis. I could not find any references specifically for veterinary medicine but there is no reason to suspect that there would be much difference. I`d put this in the category of safe stuff to try that hasn`t been proven to work yet. I hope that helps in your decision making.

Question:

I have been reading about the various treatments for arthritis in dogs. We have an 11 yr old Goldren Ret. mixed, female, name Amber. She has been under treatment for 1 yr for arthritis. She has taken prednisone, Rimadyl and Adequan injections....all of which seem not to work after a while. We have decided to try Glucosamine Sulfate with aspirin. My question is....what dosage should I be giving her for Glucosamine and aspirin? Also, can i use Ibuprofen instead of aspirin? WE have given her Ibuprofen which seems to help. Although, I am worried about the dosage. She is a a restricted diet of Science Diet (RD) and she has lost weight. Originally, she weighed 78 lbs, but since her restricted diet and snacks of carrots, she has now weighs 66 lbs. The carrots are a great snack that once she got used to them, she now begs for them. I also find that warm baths make her feel better. I would really appreciate any input you may have.

Answer:

A lot of clients tell me they have given their dogs ibuprofen on an occasional basis and it has not seemed to harm most of them, but we have seen three or four dogs with gastric ulcers from this medication and it is reported to cause gastric ulcers in most dogs if it is given on a continuous basis for very long (in some dogs as short as two or three days). The most commonly prescribed dosage of glucosamine is 20mg/lb of body weight, or 1 of the standard 500mg tablets per 25 lbs. of body weight. There are several dose recommendations for aspirin but the one I like is 10mg/lb twice a day. We have a number of patients who use both glucosamine and aspirin. I like the glucosamine/chondroitin combination better than glucosamine alone. Aspirin causes GI upsets and ulcers in some dogs. If Amber stops eating while on aspirin it is imperative that you stop giving the aspirin and contact your vet if the loss of appetite lasts for more than one day. Hope this helps her.

If your dog has arthritis, look into the various treatment options available

Arthritis or Hip Dysplasia?

Question:

What would you recommend giving a 11 year old red hound for problems getting on her feet after laying down for a period due to i assume hip and joint problems.

Answer:

There are two things to consider. The first is that it really does help to know for sure if the problem is arthritis from wear and tear or conditions like hip dysplasia. In this case, there are a number of medications that might be helpful. If this is a condition other than arthritis, such as lumbosacral instability, pressure on the spinal cord from tumors or chronic disc disease, or degenerative myelopathy, then a different set of medications is necessary. It is usually safe to go ahead and try the medications for arthritis conditions for a short period of time to see if they help, though. I still prefer aspirin as a first choice because it is inexpensive, readily available and relatively safe. The usual dosage is 10mg/lb of body weight twice a day, for dogs. I think that it is worth trying glucosamine and chondroitin, at a dosage of one tablet of the 500mg glucosamine/400mg chondroitin tablets per 25 lbs. of body weight, if the cost is not a major factor. These are very safe medications but the degree of effectiveness you can expect using them is still not very clear. If these medications are not effective enough, then carprofen (Rimadyl Rx) and etodolac (Etogesic Rx, Lodine Rx) are very good medications for arthritis. It is best to monitor pets for liver and kidney damage prior to starting these medications and then to recheck these values two weeks to a month after starting the Rimadyl or Etogesic, if chronic use is anticipated. In severe cases, we add a narcotic medication, like hydrocodone, in addition to a non-steroidalanti-inflammatory like one of the previously mentioned medications. It is usually possible to improve the quality of life for arthritic pets a great deal. If there is not a quick response to these medications, looking for problems other than arthritis would be a best. Your vet can help you decide if this is necessary.

How to tell if you dog has Hip Dysplasia

Immune mediated arthritis disorders

Question:

Video: Treatment for Arthritis in Dogs - Causes, Symptoms, Signs, Prevention, Remedies

Lily, my 3 1/2 year old (DOB 3-31-97), red smooth haired dachshund suddenly started limping on her right rear leg on February 4, 2000 after a visit to the vet to have her anal glands expressed and her nails trimmed. Her nails had been cut extremely short, so I thought this might be the cause for her limp. But after a week or so went by and she continued to limp, I took her back to the vet. I was told it was probably just a sprain as they could not find anything wrong after physically examining her. Her limp continued to worsen but still no one found anything wrong on physical examination. Lily was also having some severe skin rash problems which had started about six months before the limp and had been on several different rounds of medications but with little success. The vet decided to refer us to a dermatologist in a specialty clinic three hours from our home. We visited the dermatologist in April and skin tests we done and we were told Lily was allergic to almost everything outside. One of the worst cases they had seen, and we started her on antigen shots. I also had an orthopedic surgeon at the clinic examine Lily`s right rear leg. He did not detect anything until he examined her while under sedation for the skin tests. He said she had a possible cranial cruciated ligament beginning in her right rear knee. He advised us to restrict her activities and since she was overweight at 20 pounds, he wanted her to lose 5 pounds before considering surgery. Six weeks later we returned for our follow-up visit with the dermatologist. Lily`s skin rash had improved greatly with the antigen therapy and the amitriptyline she was taking. We were to continue giving her the antigen injections. Lily`s limp had continued to worsen and she was walking very little.

The orthopedic surgeon arranged for our local vet to start Lily on Adequen injections, two injections per week for four weeks and then one every six weeks. Although Lily had been on a diet and had lost 2 pounds she still weighed 18 pounds and the doctor thought she would have a better recovery from cranial cruciated ligament repair if she could get down to her ideal weight of 15 pounds. It was on the return home that Lily first fell down while trying to urinate. Within the next day or two, she was not walking at all and was having trouble standing while urinating. I called the orthopedic surgeon and surgery was scheduled. On June 29th cranial cruciated ligament repair was done on her right rear knee. The doctor said the surgery went great and there were no signs of arthritis in the joint and she should have a full recovery within four months.

It was at our eight week check-up that the doctor was somewhat concerned that her leg was not as strong as it should be and she was still unable to walk on her own and we were still having to assist her while defecating and urinating. We decided to start doing some aqua therapy with her at home to try to build up her muscle strength. We began swimming with her in our spa everyday for about ten minutes each day. Her muscle strength did improve and she was standing on her leg but still not walking. I then noticed her front paws and ankles seemed very floppy and loose and mentioned it to my local vet who was administering the adequen injections. She immediately contacted the orthopedic surgeon and we scheduled another visit with him. On September 11th x-rays were taken of her front ankles and fluid was drawn from these joints. The test results are as follows - The joint fluid from her left carpus-consisted of 1 EDTA joint fluid sample. The smears have a high nuclear cellularity consistent with the total nucleated cell count of 13,500/ul. There is a moderate amount of fresh blood containing platelets often in clumps. A 200 cell differential count reveals 97% neutrophils, 1.5% lymphocytes, & 1.5% monocyte/macrophages. The majority of neutrophils are nondegenerate, few are degenerate. Neutrophils are increased over the amount of blood that is present. Few macrophages are mildly to moderately vacuolated. No microorganisms are noted. The joint fluid from her Right carpus-consisted of 2 unstained smears. The smears have a mild to moderate nuclear cellurarity consistent with an estimated cell count of <5000/ul. There is a mild amount of fresh blood containing few platlets. The leukocytes appear proportional to the amount of blood that is present. A 100 cell differential count reveals 93% neutrophils, 3% lymphocytes, & 4% monocytes. Occasional synovial lining cells are noted. The neutrophils are nondegenerative. No microorganisms are noted. I was only told the x-rays did not appear quite right. Lily started taking 15mg of prednisone per day and joint taps were repeated again on October 5th. The October 5th test results are as follows ;

A single direct smear of joint fluid from the right carpus - The nucleated cellularity is moderate with mild amount of red blood cells including occasional platelets. There is a moderate amount of granular eosinophilic background material (mucin), but lack of windrowing of the red blood cells (poor mucin clot?). A 200 cell differential count consists of 85% nongenereate neutrophils, 5% lymphocytes, and 10% monocyte/macrophages. Several macrophages are enlarged and contain moderate numbers of clear vacuoles. No cytophagia or erthrophagia is noted. Occasional binucleated cell (synovial lining cell?) and fibrocyte is noted. No microorganisms are seen.

Opinion: Although the presence of peripheral blood skews the differential count towards neutrophils, the neutrophils appear to be increased over that expected from blood contamination. The macrophages are activated and represent chroncity. Two direct smears of joint fluid from the left carpus - The nucleated cellularity is moderate (estimated <5,000) with mild amount of red blood cells including occasional platelets. A 200 cell differential count consists of 98% nongenereate neutrophils and 2% monocyte/macrophages. Few macrophages are mildly vacuolated without cytophagia or arythrophagia. Occasional stromal cell is noted. No microorganisms are noted.

Opinion: The proportion of neutrophils appear mildly increased over the amount of blood contamination. This is consistent with a mild nonseptic supportive process, which could be seen in resolving immune synovitis. Two direct smears of joint fluid from the left stifle - The nucleated cellularity is moderate (3000-5000/ul?) with moderate amounts of red blood cells including few platelets. Moderate amounts of granular eosinophilic background staining material is evident (mucin), without windrowing of the red blood cells suggesting a poor mucin clot. A 200 cell differential count consists of 89% nongenereate neutrophils, 7% small mature lymphocytes, and 4% monocyte/macrophages. Few synovial lining macrophages contain few cytoplasmic vacuoles. No cytophagia or erythrophagia is noted. No microorganisms are noted. Opinion: Neutrophils appear moderately increased over that expected for the degree of blood contamination. This would be consistent with nonseptic mild suppurative process, secondary to immune mediated disease. Lily`s prednisone was increased to 20mg per day. After she had been on this dosage for about five days, she had an accident in her crate. She was not able to hold her urine for an hour and 15 minutes. She was devastated over the accident she had made. The doctor said to decrease her dosage back to 15mg per day, especially since we were taking her on vacation with us and we would start her on Azathioprine when we returned. Lily had a CBC done and started taking 25mg of Azathioprine on October 25th. The prednisone was discontinued on October 24th. Another CBC was completed on November 2nd and I am told it appears okay. The doctor is watching for bone marrow problems, side effects of the medication. Lily had appeared to be hurting more since stopping the prednisone. I talked with the doctor today and we have started giving her 25mg of Rimadyl per day. She had taken Rimadyl at this same dosage when she had the cruciated ligament surgery in June but had been taken off it when the prednisone was started. We are scheduled to have joint taps done again on November 16th, after three weeks on Azathioprine, to see if the medication is going to be able to get her disease under control, before considering surgery to repair the damage which has occurred. We have been told she has rheumatoid arthritis and chances of recovery are not very good. We are devastated by the prognosis we have received and want to do all we can to make her an exception. I was also diagnosed with an auto immune disease, diffuse scleroderma, systemic sclerosis, in January 1996. I had to quit working and brought Lily into my life to fill my empty days with love and companionship. Little did I know she would become my dearest and closest friend. She gave me hope, love, and laughter through some of my most difficult days as I adjusted to being disabled. It`s almost ironic that now she is facing everything that I had to face with my own disease. I want to do everything I possibly can to help her as she has been a true blessing in my life. I am hoping that you will be able to shed some new light on our situation and help us in some way. I would truly appreciate your diagnosis on her case, on her treatment, and on her prognosis for recovery. I do not want to prolong Lily`s suffering but I do not want to give up on her either. Any insight you share will be greatly appreciated. P.S. Lily also has a Home Again ID chip which was inserted in April 1997 when she was spayed. Are you aware of any problems associated with these ID chips? Could they cause auto immune diseases in some animals?

Answer:

The answer to your last question is the easiest. There has been no apparent increase in cases of immune mediated hemolytic anemia (IMHA) or other immune mediated diseases since the introduction of microchip identification systems, so I think it is very unlikely that these chips cause immune system disease. Rheumatoid arthritis is considered to be an erosive, or damaging to the joint surface, form of arthritis in the dog. In this disease, the appearance of the X-rays and the examination of the joint that was done during surgery are as important, or more important, to the diagnosis than the joint fluid analysis. There should be damage to the joint surfaces visible on the X-rays if rheumatoid arthritis is present. It may be best to have a radiologist review the X-rays for evidence of rheumatoid arthritis, though, because it may be difficult to recognize joint destruction if complications like partial dislocations of the joints are present. Due to the possibility of other causes if non-erosive arthritis is present I would very strongly recommend having a radiologist look at X-rays, if your veterinarian or the orthopedic specialist is not absolutely certain that joint erosion is present -- or is not present. It is possible to test for rheumatoid factor in the blood, but this is not a very reliable test and some specialists avoid it, feeling that the results are more likely to be confusing rather than helpful. Rheumatoid arthritis is most common in adult small breed dogs. It usually causes systemic signs such as fever, depression, loss of appetite and pain that is hard to localize to one specific area of the body. It usually affects more than one joint and it usually starts in the joints farthest down the legs, with the carpus (wrist), tarsus (hock or rear ankle) and toes being commonly affected areas. It sometimes is very persistent, causing continuous pain, and other times follows a cyclic course, with waxing and waning bouts of pain and discomfort. Joints are usually swollen when rheumatoid arthritis is present. Rheumatoid arthritis does not respond well to treatment in many patients. Non-steroidal anti-inflammatory medications such as carprofen (Rimadyl Rx) or aspirin, seem to have variable success, with some authors reporting good success and others not much success using these medications. Prednisone in combination with azathioprine (Imuran Rx) has been recommended frequently. Methotrexate may work and leflunomide (Arava Rx) is also recommended, although it is reported to be very expensive. There is a condition referred to as canine idiopathic erosive polyarthritis, which causes signs pretty similar to rheumatoid arthritis. This condition doesn`t usually respond well to therapy. Since it resembles rheumatoid arthritis it has to be considered. I am under the impression that this condition might have to be identified through examination of the lining of the joint by a pathologist after surgical exploration of the joint --- which obviously has to be done very carefully to avoid making any existing condition worse. There may be some other way of diagnosing this condition at this time that I am unaware of. If the condition seems non-erosive, based on the stifle joint looking normal at the time of surgery and if the X-rays do not show erosion, then several other conditions have to be considered. One of the first things to come to mind is systemic lupus erythematosus (SLE), especially since this can also cause skin disease (although you do seem to have a diagnosis for the skin disease). Other possible problems include the tick borne diseases, such as ehrlichiosis, Lyme disease and infections. There would be a small chance of a link between allergic disease and an general immune response that could lead to joint pain, as well. If a radiologist reviews the X-rays and feels that the arthritis is erosive and is likely to be rheumatoid arthritis or canine idiopathic erosive arthritis, then I am not sure why surgery would be contemplated, unless it is surgery to stabilize the joint through arthrodesis (fusing the joint) --- which may be helpful in the case of idiopathic erosive polyarthritis. It may also help, in this case, to consider getting an opinion from an internal medicine specialist rather than an orthopedic surgeon. The immune mediated arthritis disorders are not really surgical diseases and I think that internal medicine specialists probably have more experience dealing with them due to this. I wish that I could give you some sort of specific advice other than to try really hard to establish whether there is erosion of the joint surfaces, or not, but this is the first step in the diagnostic process. Once that has been established (and it is possible it already has been), then it is possible to consider the major alternatives and to consider whether the newer therapies for immune mediated joint diseases might be helpful. I am nearly certain that this has been considered, but in a dachshund, it always seems necessary to me to look especially carefully for signs of spinal disc disease, even when there are lots of confusing signs that point in another direction.

Research other types of Immune Disorders in Dogs

Medication for Dog with Arthritis

Question:

I have a male, neutered, dalmation and he is 10 years old. A couple of years ago or so he developed arthritis and we started giving him aspirin. Then our vet recommended Rimadyl. We administered one pill with his food in the morning and in the evening and this worked well for him. Recently, he went to the vet for a checkup and our doctor did a blood test and informed us that his liver enzymes were slightly elevated. He said it wasn` t worrisome at this time, however, he would recommend changing Rimadyl to Etogesic. Within two days of taking Etogesic, Shelby developed gastrointestinal distress with bloating and diarrhea. I suspected the Etogesic which was the only change in his diet and we stopped the medication. It took several days for his bowels to get back to normal and that included a trip to the emergency animal clinic on a Saturday because of rectal bleeding from straining. He was miserable. It soon became apparent that he needed something for arthritic pain so we have resumed the Rimydal at half dose (the pills were scored in half) while we figure out what to do. One half pill in the morning and at night. What are the alternatives to Rimadyl and Etogesic? I may try Cosequin but I know that s not a pain reliever but rather a cartilage builder. What about prednisone and what are the side effects or problems with steroids? I have taken steroids myself prescribed by my ENT (ear, nose and throat doctor) for sinus problems on a very limited basis. I feel soooooo good on them. But my ENT says they are only for occasional use since there are problems with long term use. Is that the case in dogs and how long would it take to cause problems? I m told dalmations only live 10 12 years so maybe long term effects are not a worry? I would shy away from codeine since that may make him drowsy and he is still perky. What are your thoughts?

Answer:

I never know what to do when liver enzymes become elevated slightly and a dog is on carprofen (Rimadyl Rx). I have used this medication in several dogs that had elevated liver enzymes when we started the meds, without any apparent problems, so I think that this can be done. On the other hand, Rimadyl can cause severe liver damage in some dogs and so you have to be careful when liver enzymes start to rise, even though Rimadyl may not be the cause. Depending on the response to other medications, I think I would be willing to consider continuing the Rimadyl and monitoring the liver values closely. Etodolac (Etogesic Rx) and carprofen are the most potent non-steroidal anti-inflammatories (NSAIDs) approved for use in dogs at the current time. Meloxicam, approved for use in dogs in Canada, was just approved for use in humans in the United States and should be available in this country by May or June. It is reported to work well, too. In some cases, using a GI protectant, like cimetidine (Tagamet Rx) or misoprostol (Cytotec Rx) may be helpful in limiting the gastrointestinal problems if it seems necessary to go back to Etogesic, or if meloxicam causes the same problem. I like to use Rimadyl once a day at the full dose (1 mg/lb), instead of twice a day, when I cut back on it. This seems to work well enough for many dogs to remain comfortable. I think that supplementing the Rimadyl with Cosequin (tm) is a good idea. The recent Consumer`s Reports on alternative medicine said that chondroitin seemed to work better than glucosamine for arthritis in humans and Cosequin does contain both ingredients. I like hydrocodone for the pain of arthritis. It seems to work pretty well. Drowsiness is not usually a problem with it, although that effect can occur. I don`t usually use it unless the medications mentioned above don`t work, though. Corticosteroids are a true paradox for arthritis. No medications have stronger anti-inflammatory effects and the improvement on these medications can be astounding in some cases. They do have detrimental longer term effects, though. They promote weight gain and muscle loss, both of which are bad for arthritic pets. They tend to weaken articular cartilage, which is also bad. There is a saying in equine medicine "you can make a horse walk to its grave with corticosteroids". It is true. So we compromise on their use in this manner --- when anything else will work, we use other medications --- when nothing else is working well and people are considering euthanasia, we use corticosteroids. Our thinking is that the side effects can`t be worse than euthanasia, so why not use the these medications at that point? It is important to remember that corticosteroids can cause liver problems in a small number of patients, just like Rimadyl, too. Acupuncture is another option that appears to help some dogs. Hope this helps some. Pain relief is worth a lot. It is worth taking appropriate risks, in my opinion. Just give the safer approaches a chance and then, if necessary, use the medications with increasing risk as it seems appropriate to do so.

Compare various medications for the treatment of canine arthritis

Advanced Arthritis - treatment and pain control options

Question:

I have already tried acupuncture and homeopathy, too (Arth-Ease). I am going for one more consult with a new orthopedic specialist (tomorrow) just to make sure there isn`t some other problem before we start the corticosteroids. One more quick question -- do you recommend Pepcid AC for your patients who are on long-term corticosteroid therapy for arthritis? My other dog is on long-term therapy (prednisone) for chronic active hepatitis (10 mg. every other day for 60 lb. dog) and I have been giving her a 10 mg. Pepcid AC daily to prevent stomach problems on the instruction of her internal medicine specialist. So far, so good.

Answer:

I have not used Pepcid AC concurrently with corticosteroids, mostly because we don`t seem to have significant gastrointestinal problems with its use, except when using very high dosages. In those cases we have used cimetidine (Tagamet Rx) in the past but at the present time there seems to be a move towards using famotidine (Pepcid AC Rx) because it may be able to suppress acid production longer and also has less interactions with other medications (information from Plumb`s Veterinary Drug Handbook). So I don`t see any reason not to continue to use it but we have not had significant ulcer problems with corticosteroids in most instances without using any medications to avoid them. You have tried hard to resolve this problem. I hope that the orthopedist has good suggestions or that the use of corticosteroids does prove to be beneficial.

Question:

I am writing again about my Labrador Retriever with the severe arthritis (see earlier attached messages). I`ve tried nearly everything you suggested (narcotics, Adequan did not work), and am now ready to turn to steroids for pain relief. I know there are a number of different steroids out there -- when you get to this point with your patients, what steroids and dosages do you use for an 80 lb. dog? Do you start with higher dosages at the beginning and gradually reduce over time? FYI -- I have provided copies of some of your e-mails to my vet, and he likes having your input!

Answer:

It is depressing when arthritis doesn`t respond well to medications. But there is still some hope with the corticosteroids. I use prednisone almost exclusively in my practice. There are a lot of suggested dosing schemes for prednisone and various arthritic conditions but we usually start with .25mg/lb of body weight once a day for five days and then use 0.25mg to 0.5mg/lb of body weight every other day after that. If necessary we will increase the dosage to as high as 1mg/lb every other day but we are reluctant to go any higher than that. Many times we are able to get by with 0.25mg/kg every 48 hours. It is sometimes necessary to use an non-steroidal anti-inflammatory on the off days (aspirin, etodolac, carprofen) or to use a narcotic pain reliever in addition to corticosteroids. I haven`t used much in the way of alternative therapies but I know a vet who does acupuncture who is really convinced it is helpful in chronic arthritis. I can`t speak from personal experience on this but don`t see much reason not to consider it, too. Good luck with this.

Follow Up Question:

I have a few quick follow-up questions. My vet and I are now trying a combination of Rimadyl (100 mg. 2x/day) and hydrocodone (5 mg. 2x/day) on my lab, who weighs 80 lbs. She has been on it for almost 2 weeks now -- there has been some marginal improvement, but it does not seem to be enough to justify continuing it. But before we try something else (Adequan is probably next): 1) should the Rimadyl be given at the same time as the hydrocodone (right now I am giving her the hydrocodone in the morning and evening and the Rimadyl at noon and before bedtime)? 2) is 5 mg. twice per day the right dosage of hydrocodone (my vet has never used it before for arthritis, so I want to make sure)? 3) is 2 weeks long enough to determine that the hydrocodone is not sufficiently effective? 4) if she`s not responsive to hydrocodone, would it still be worth trying oxycodone and/or fentanyl patches? 5) if the answer to 4) is yes -- if you were treating my dog, would you try Adequan next or the other narcotics? 6) when using Adequan, how quickly can I expect to see a response (if there is going to be one)? if a dog does not seem to be responding to Adequan, how long do you continue using it before you determine there probably will be no response? (again, my vet hasn`t used it before so he doesn`t know) T

Answer:

1) I usually give hydrocodone two or three times a day and have never actually stopped to figure out if it should be given at the same time as Rimadyl or aspirin, or not. I am presuming that most of my clients give these medications at the same time. I think either way should be OK. A week or so should be long enough to see if it is worthwhile, though --- so it probably isn`t. 2) I will use 10mg of hydrocodone three times a day in large dogs and am reasonably certain a higher dosage could be used. The actual recommended dosage is about 1mg/10 lbs of body weight two to four times a day, but that is the recommendation for coughing, which is the most common usage for hydrocodone. My thinking is that it works well in some patients at the lower end of the dose range and they are the patients who benefit most, so I just don`t push the dosage. 3) Two weeks is plenty of time to see if this helps. It doesn`t in all cases, so you have probably gone far enough with it. 4) Fentanyl patches are very effective pain relief but probably aren`t suitable for long term use since they do seem to have more effect on a dog`s outlook on life than hydrocodone (we see some dogs that get overly mellow on fentanyl -- OK post-surgically but probably not a good long term thing). I have used Tylenol3 in some dogs. Tylenol is a compromise because acetaminophen is a little more likely to cause liver problems in a dog than in a human but I really think pain relief is worth this risk when it is really necessary. It may work a little better than hydrocodone or Vicodin (Rx), which we more commonly use (again, knowing that Vicodin has acetaminophen and thus a little more risk). People I talk to seem to think so when comparing the use of these medications for their own problems, at least. Of course, Rimadyl (Rx) also sometimes causes liver problems but it also seems worth trying, to me, as long as this risk is acceptable to the pet`s owner. 5) I would probably try Adequan first, or even try adding oral glucosamine/chondroitin products. 6) Adequan is hard for me to assess. We have had dogs get up and walk within a few days that weren`t even ambulatory and have had other dogs that seemed to respond only after 5 or 6 weeks of treatment. I suspect that dogs at both ends of this spectrum may be having coincidental remissions in symptoms but can`t be sure. We stop using it after 6 weeks if there is not a good response to it. Hope this helps.

Follow Up Question 2:

I have more questions -- this time about my 10-1/2 year old spayed female Chocolate Lab. She has had arthritis since age 8-1/2, but is otherwise healthy. She has been on Rimadyl (100 mg. twice a day) for about 2 years and on a glucosamine/chondroitin sulfate (GCS) supplement for about a year. She weighs about 80 lbs. now, and I am trying to get her down another 10 lbs. using a homemade diet, but it is difficult because she pretty much refuses to exercise. The medication is no longer working well enough to control the pain, and she has a great deal of difficulty climbing stairs. I took her to an orthopedic specialist, who basically told me that she has arthritis in every one of her joints and is not a good surgical candidate. He suggested acupuncture, which did not work. I need to figure out where to go from here, as last night I had to call a friend to help me carry her up a flight of stairs. 1. I asked my vet about Adequan, but he has never used it before and wary of starting now. I know you have used it in your practice from your web site. What kind of success rate do you have using it? Can it be used in combination with Rimadyl and GCS? How do I convince my vet it is worth trying? 2. Also, is there really a significant difference between Cosequin DS and other GCS products? I am now using the Foster-Smith Joint Care product, and it was suggested to me by a holistic vet that the difference in the Cosequin formulation might yield improved results. 3. Although I am not opposed to using steroid therapy as a last resort, I wondered if a different NSAID or a higher dose of Rimadyl might be worthwhile first. From the product literature, I know that Pfizer tested 3X and 5X the recommended dose of Rimadyl without too many problems in the dogs tested. I`d be interested in your comparative risk analysis of steroid therapy vs. increasing the dosage of Rimadyl. By the way, I have tried aspirin and Etogesic, but neither worked as well as Rimadyl. 4. Is there anything else I should be trying? I already have her on Lipiderm, Vitamin E (400 IU/day) and Vitamin C with bioflavenoids (1000 mg/day). Thanks again for your helpful advice on my Springer Spaniel.

Video: Elbow Dysplasia Diagnosis In Young Dogs to Avoid Dog Arthritis

Answer:

Adequan (Rx) is relatively easy to use. It is very safe and it can be used in combination with Rimadyl (Rx) and glucosamine/chondroitin. There may not be a need to use it AND the glucosamine, since it is a similar product, just in injectable form. The dosage recommendation varies a lot from vet to vet, but in general it is used at about 3 to 5 mg/kg (so about 120 to 200mg for an 88 lb. dog) and used frequently for three to five weeks (once every 3 to 7 days) and then used at whatever interval seems to work after that - usually one to three weeks. It is expensive and the injections sting but those are the only drawbacks that I know of. I have wondered if using glucosamine orally might extend the time between injections but in the limited experience we have had, I don`t think this is the case. How do I know it stings? I was at a veterinary seminar on blood disorders. The topic of conversation at the dinner table turned to whether or not it was safe to use Adequan when a bleeding disorder was present, because it is related to heparin. The specialist`s answer was yes. Someone at the table asked if the medication worked well. Out of eight vets, three or four had used it, but one vet was adamant that it worked really well. He said the only drawback was that the injections really stung. I said, "My patients don`t seem to complain much," to which he replied, "It stings!". To which I said, "I don`t see that effect," at which time he pounded his leg in the way a large animal vet pounds a horse`s neck prior to giving an injection and said "It stings!" Still being dense, I said, "well, I don`t see it" and to which he replied, "It stings, but I can ski again!". At that point, I understood that he KNEW it stung. And that he really really believed it worked. I don`t know the answer to your question about Cosequin (TM). They are the only company that has actually paid for research on their product, so they definitely believe in it. I have a hard time believing there is a huge difference between glucosamine/chondroitin products if the dosage of the medications is similar, though. I don`t know of a more effective NSAID than Rimadyl. One of the problems in dogs is that many of the NSAIDs are REALLY likely to cause ulcers, including indomethocin and ibuprofen, which might be effective if they could be used. (please note information about liver damage problems in Labs and some other dogs with Rimadyl) I do like to use hydrocodone in combination with Rimadyl in patients that appear to need additional pain relief. This combination seems to help some patients a lot. It is better if the hydrocodone is used intermittently, since it is addictive, but it can be very helpful. I have used Vicodin (Rx), which is acetominophen and hydrocodone, but I would be reluctant to use acetominophen and Rimadyl at the same time since both can cause idiopathic liver problems in a small number of dogs. Other narcotic pain relievers may be worth considering, such as oxycodone or even fentanyl patches, as well. Sometimes, a few days of pain relief can make a huge difference. When you reach the point that your Lab`s quality of life just isn`t good enough with NSAIDs and pain relievers, corticosteroids are a good choice. At that point you have nothing to lose and a lot to gain.

Find out the different options you have for pain medication for dogs with arthritis

Rimadyl and liver problems in Dogs

Question:

You might want to add to the "Rimadyl" section that liver tests and enzyme panels should be done prior to this administration. Many dogs, especially labs, have died from Rimadyl. You should probably speak to Pfizer about this as it has appeared in many newsgroups for the past several months. Apparently, many vets aren`t aware of its life-threatening effect to labrador retrievers.

Answer:

We have received a couple of emails recently regarding liver disorders following the use of carprofen (Rimadyl Rx). This is reported on our site under side effects of medications but we will add this note to the Rimadyl page. At present it appears that Rimadyl will cause liver damage in some dogs. There have been some deaths in dogs with this reaction, although I think that the use of the word "many" is misleading. The predominant breed affected by this reaction has been the Labrador retriever but there are reports of other breeds being affected. Rimadyl benefits a large number of dogs. It harms a small number of dogs. The harm appears to be reversible by withdrawal of the drug. With all medications it is extremely important to pay attention to any potential side effects. With Rimadyl it is very important to discontinue use of the medication if a dog exhibits a decrease in appetite, lethargy, depression or any other signs of illness after administration of the medication. This is not a medication like insulin, in which withdrawal is dangerous to the pet. If there is evidence of any undesirable side effects the best course of action is to stop administering Rimadyl and to contact your vet. It is hard to argue against drawing blood and checking serum chemistry levels to check for pre-existing liver or kidney problems prior to using a new medication in any pet and especially in older pets. However, I think it is important to point out that the predictive value of this testing is not established and that if the reaction to Rimadyl is similar to reactions to other medications there will not be much predictive value in the lab work. Most of the reactions to other medications do not occur as the result of pre-existing liver disease but as the result of an inability of a particular dog`s liver to process the medication. The lab work protects the pharmaceutical company against claims that the medication caused conditions that already existed, which is one of the reasons the tests are promoted. Diagnosing a pre-existing condition may also help prevent further damage to an already damaged organ by allowing appropriate adjustments in medication dosage or prompting a decision to use a different medication. These are the other reasons testing is suggested Still, there is a good chance that dogs who will react to Rimadyl will have normal serum chemistry values prior to treatment and lab work should not be viewed as a guarantee that problems will not occur. Ideally, lab work should be done prior to administration of the medication and one month afterwards. For families on a budget trying to help their pets the additional expense of lab work may be inhibiting. If I had to chose between checking lab values before administration and after one month, I`d chose the later time. If the cost of lab work will keep an owner from using Rimadyl then I feel comfortable pointing out that it must be discontinued if signs of illness after its use occur and not running lab tests prior to use or after use. Would I use Rimadyl in my own dogs? Yes. In fact, I have done so. Do I worry about toxic effects? Of course I do. I watch my dogs carefully when administering any medication to see if there are changes that might be associated with the medication. Every dog owner should do this. Every vet should listen to dog owners and take their worries seriously after administration of a new medication. In many cases there are alternative medications that can be used or it may be reasonable to discontinue a medication for a condition that does not absolutely require it. Rimadyl is a very effective medication for dogs with debilitating joint disease. It provides a measure of comfort to these pets that is worth taking some risk to provide, because it is more effective than any other non-steroidal medication I am aware of. It can cause liver damage in a small percentage of the dogs it is given to. It is important to be aware of this problem and I am glad that people are aware of it. But it is just a risk to be considered, not a reason not to use Rimadyl when there is justification to do so.

Get an overview of Rimadyl and it`s use in treating arthritis in dogs

Interaction between Adequan and Glucosamine?

Question:

I have a fourteen year old Afghan who has arthritis. He is currently receiving Adequan shots approximately every ten days to two weeks. I would like to know if I can give him Glucosamine sulphate tablets which I can buy at a pharmacy in addition to these shots. Is Glucosamine sulphate the same thing that is in the adequan shot?

Answer:

Adequan (rx) is a glucosamine so you would be giving similar products. While this would probably be safe there was recently an article in which overdosage of these products in cats led to bleeding disorders, if I remember it correctly. It is conceivable that problem could occur in dogs as well since the glucosamines are related to heparin which does interfere with blood clotting. All in all, I`d probably depend on the Adequan for this mode of therapy and consider adding an additional product with a different effect, such as a non-steroidal anti-inflammatory (NSAID) or a narcotic pain reliever. Carprofen (Rimadyl Rx) has been pretty effective in our practice and we have used it at the same time as Adequan in a few patients without problems, so far. We have used hydrocodone in a number of arthritic patients in combination with an NSAID or Adequan and it has sometimes made a significant difference in the patient`s overall attitude. Pain relief can be very beneficial.

Get more in-depth information on the use of glucosamine for Dogs

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