Alternative therapies for managing osteoarthritis

The goals of osteoarthritis (OA) management in companion animals are aimed at improving quality of life by controlling pain and restoring mobility to the extent possible. Traditional modalities for accomplishing these goals include dietary manipulation, physical therapy, surgery, and pharmaceutical agents (nonsteroidal anti-inflammatory drugs, corticosteroids, disease-modifying osteoarthritic drugs, nutraceuticals).

But veterinary clients are inquiring with increasing frequency about alternative modalities for managing OA in their pets. As veterinarians, we hold the keys to safe and effective treatments for patients suffering from this debilitating disease. Here’s a brief overview of some alternative modalities that can be used for primary or adjunctive OA management.

Nutrition

The connection between OA and overweight/obesity is undeniable. According to Banfield’s 2019 State of Pet Health Report, 52% of dogs and 41% of cats with OA cared for in 2018 at Banfield practices were obese.¹ Overweight and obesity increase the load on joints, in turn increasing the development of OA, the speed of disease progression, and patient discomfort. Results of a lifelong study of 48 Labrador retrievers showed that restricted feeding (vs. feeding ad libitum) delayed or prevented the development of radiographic signs of hip OA.² With this in mind, evaluating a patient’s diet is an important first step in managing OA.

A number of therapeutic diets are available to aid in weight control and OA management. These diets are often lower in calories than typical diets and contain high levels of omega-3 fatty acids, which help support joint health and mobility by reducing inflammation, as well as glucosamine and chondroitin, which help slow cartilage deterioration.³ 

Acupuncture

The use of acupuncture for treating OA has become more common in general practice in recent years, as it is often requested by clients as an alternative to pharmaceuticals. Acupuncture is a form of traditional Chinese medicine that is performed by introducing thin, specialized needles into acupoints.

Multiple techniques, including dry needling, aquapuncture, moxibustion, electroacupuncture, and laser acupuncture, may be used either alone or in combination to stimulate acupoints. Aquapuncture is the introduction of sterile fluid into an acupoint as an alternative to setting dry needles. Moxibustion incorporates the burning of moxa (small cones of dried herbs) to apply heat safely to acupoints. Electroacupuncture, which combines mechanical and electrical effects, is commonly used to relieve pain associated with OA.⁴ Laser acupuncture involves the use of a low-intensity laser to stimulate acupoints. Laser acupuncture and aquapuncture are ideal for patients that cannot tolerate dry needling or electroacupuncture.

Herbal formulations

A number of Chinese herbal formulations containing boswellia and turmeric have been proven safe and effective for reducing OA pain and inflammation in dogs.^5,6 In my experience, Chinese herbal formulations are best used in combination with acupuncture to increase the effectiveness of treatment.

Stem cells

Commercially available autologous adipose-derived mesenchymal stem cells have been used by veterinarians since 2003 to treat joint disease as well as tendon and ligament injuries in horses.⁶ This modality is becoming more common in small animal medicine as well, particularly for improving mobility and quality of life in dogs with OA. In a 2007 study, dogs with hip OA treated with stem cells showed a significant improvement in mobility and pain scores.^7,8

Cannabinoids

Research on the use of cannabinoids in veterinary medicine—and the endocannabinoid system as a whole—is flourishing. One of the primary areas under study is the use of cannabinoids to treat pain and inflammation in OA patients. In a study published in April, cannabidiol (CBD) was shown to induce broad anti-inflammatory effects in vivo and to greatly reduce proinflammatory tumor necrosis factor-alpha in vitro.⁹ Legislation regarding cannabinoids varies widely, with restrictions in most states on discussing and prescribing cannabinoids for veterinary patients, but with further research cannabinoids could become a viable treatment option for animals.

Conclusion

The prevalence of OA, combined with a shift in client perceptions and the desire to treat with alternative modalities, pose a unique challenge to veterinarians. The good news is that safely and effectively improving quality of life in these patients is now possible when surgery and pharmaceuticals are not options. As always, the modalities selected should be tailored to the patient's specific needs and the owner's ability to remain consistent in their role as caregiver.

References

1. Osteoarthritis: When age is not to blame. Banfield Pet Hospital. Published January 2020. Accessed August 6, 2020. https://www.banfield.com/Banfield/media/PDF/Downloads/soph/2019-SOPH-Report.pdf
2. Smith GK, Paster ER, Powers MY, et al. Lifelong diet restriction and radiographic evidence of osteoarthritis of the hip joint in dogs. J Am Vet Med Assoc. 2006;229(5):690-693. doi: 10.2460/javma.229.5.690
3. Davies M. Practical management of canine osteoarthritis. Vet Times. Published January 19, 2015. Accessed August 1, 2020. https://www.vettimes.co.uk/app/uploads/wp-post-to-pdf-enhanced-cache/1/practical-management-of-canine-osteoarthritis.pdf
4. Zhang R, Lao L, Ren K, Berman BM. Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology. 2014;120(2):482-503. doi:10.1097/ALN.0000000000000101
5. Dejonckheere V. Turmeric for osteoarthritis in veterinary medicine: a review. (2016). Herbal Vets. Published 2016. Accessed August 1, 2020. http://www.herbalvets.org.uk/wp-content/uploads/2016/10/turmeric-dejonckheere.pdf
6. Miscioscia E, Shmalberg J,Scott KC. Measurement of 3-acetyl-11-keto-beta-boswellic acid and 11-keto-beta-boswellic acid in Boswellia serrata supplements administered to dogs. BMC Vet Res. 2019;15;270. https://doi.org/10.1186/s12917-019-2021-7
7. Black LL, Gaynor J, Gahring D, et al. Effect of adipose-derived mesenchymal stem and regenerative cells on lameness in dogs with chronic osteoarthritis of the coxofemoral joints: a randomized, double-blinded, multicenter, controlled trial. Vet Ther. 2007;8(4):272-284.
8. Shah K, Drury T, Roic I, et al. Outcome of allogeneic adult stem cell therapy in dogs suffering from osteoarthritis and other joint defects. Stem Cells Int. 2018;7309201. doi: 10.1155/2018/7309201
9. Verrico CD, Wesson S, Konduri V, et al. A randomized, double-blind, placebo-controlled study of daily cannabidiol for the treatment of canine osteoarthritis pain [published online ahead of print, 2020 Apr 24]. Pain. 2020;10.1097/j.pain.0000000000001896. doi:10.1097/j.pain.0000000000001896