Make a patient-specific plan for canine osteoarthritis

Osteoarthritis (OA) is a common condition seen in canine patients and management can be challenging. “We cannot take a cookbook approach,” David Dycus, DVM, MS, CCRP, DACVS-SA, founder and orthopedic surgeon at Fusion Veterinary Orthopedics, said during a recent session at the 2025 Fetch dvm360 Conference in Charlotte, North Carolina.¹ Instead, Dycus encourages veterinarians to obtain a definitive diagnosis of OA and create a management plan that is patient-specific.

Diagnosing osteoarthritis

Photo: Sabine Schönfeld/Adobe Stock

A senior dog rests in a bike trailer.

OA is the No. 1 cause of chronic pain in dogs and can have a large impact on both patient and owner quality of life. Dycus reminded veterinarians that, because it is an inflammatory disease that occurs secondary to other disease processes, it can occur in dogs of any age. A recent study of patients between 8 months and 4 years of age found that nearly 40% had radiographic evidence of OA.² Of these, 60% had concurrent clinical signs of OA.² As some clinical signs of OA can be subtle, it is essential to ask owners specific questions to determine the presence or absence of clinical signs.

The diagnosis of OA requires multiple pieces of information, including the following:

• Patient history. Most patients with OA have a chronic, slowly progressive history of lameness or alterations in their mobility. Patients presenting with a history of acute lameness often have some degree of injury, though they may be at risk of future development of OA.
• Physical examination. This includes objective gait evaluation (ideally using a numerical scale), assessing range of motion and presence or absence of pain in the joints, and comparing muscle mass in the limbs, which can indicate disuse.
• Diagnostic Imaging. Radiographs aid in the diagnosis of OA and are the minimum imaging technique needed for a diagnosis, but they should not be the only consideration. This is particularly important as some patients can have radiographic evidence of OA that is not yet causing clinical signs.

For some patients, the OA diagnosis may be speculative (based on history and physical examination alone) if the owner is unable or unwilling to pursue radiographs. Dycus encouraged veterinarians to carefully consider the potential adverse effects of any medications or treatments that are considered in these cases.

Finally, Dycus recommended using the Canine Osteoarthritis Staging Tool (COAST) to determine disease severity. This tool that takes input from the veterinarian and owner to determine the stage of OA for patients with clinical signs and helps to identify dogs with OA risk factors that could benefit from early intervention.³

Goals of Therapy

Ultimately, “OA is a total management disease,” Dycus said. “Our primary focus in patients with OA should be on modulating, mitigating, and/or eliminating inflammation.” By doing this, we can work to improve patient quality of life, improve pain, decrease the severity and frequency of flare ups, improve daily activity, and improve the human-animal bond.

Multimodal management is essential. OA affects the entire joint, not just a single part, so treatment should focus on the entire joint. Additionally, Dycus noted that many patients will present with flares of OA. Management of a patient during a flare is different than long-term management, particularly when it comes to exercise levels.

Treatment for COAST Stage 1

COAST stage 1 includes patients with risk factors but no clinical signs of osteoarthritis or pain on their examination. These patients are usually puppies or young adults. Radiographic changes may or may not be present.

For these patients, Dycus recommends establishing a baseline strategy to promote joint health and delay the onset of osteoarthritis. This strategy should include:

• Weight management. Preventing obesity is the ideal strategy. For patients who are already overweight, controlling pain is essential prior to starting a weight loss plan that includes exercise.
• Promote daily activity. While time running and playing in the yard can be helpful, clients should work with their pet to build up to 20-30 minutes of walking on flat ground twice daily.
• Make environmental changes. These may include non-slip flooring, adding rugs, or installing ramps to reduce strain on joints.
• Supplement omega-3 fatty acids, which have been shown to modulate inflammation. For joint health, the recommended dosage is higher than for other diseases (150-175 DHA/EPA mg/kg/day)
• Polysulfated glycosaminoglycan (Adequan Canine; American Regent Animal Health) has been proven to support joints in dogs. Dycus recommended administering the product at the label dose (2 mg/pound intramuscular injection twice weekly for 4 weeks). Once 8 injections have been administered, dosing can be discontinued.

Joint supplements can be considered as part of this strategy; however, Dycus cautioned veterinarians that supplements are not regulated by the FDA. He recommended looking for supplements that have quality control programs including third party testing, contain ingredients known to modulate inflammatory responses, and test those ingredients in vitro.

Treatment for COAST stage 2 to 3

As clinical signs of OA begin to develop in young to middle aged dogs, these patients may present with pain on examination and may have radiographic changes. At this stage, Dycus recommended continuing the baseline management strategy previously outlined but reducing daily exercise, especially during times of pain. Additionally, he added the following therapies to the management plan:

• Repeating the polysulfated glycosaminoglycantreatment at the label dose every 6 months. Dycus noted “this is not a loading dose. This is the dose,” and ongoing injections between the series are not necessary.
• Non-steroidal anti-inflammatory drugs (NSAID), which are the most effective oral pain reliever available. Dycus typically starts with 1 to 4 months of NSAID therapy.

For patients in this category, Dycus recommended rechecking 2 to 4 weeks after instituting therapy to ensure a positive response. As long as the patient is responding well, he rechecks every 6 weeks until the patient returns to their baseline management plan. Longterm management of these patients includes evaluating COAST and an orthopedic examination every 4 to 6 months.

For patients that are refractory to the initial treatment plan, additional options include short term addition of amantadine, formal rehabilitation therapy for 4 to 6 weeks, shockwave therapy and intra-articular injections with platelet rich plasma (PRP), steroids, or synthetics.

Treatment for COAST Stage 3 to 4

Middle-aged to older patients with consistent to worsening clinical signs, pain on their examination, decreased range of motion in their joints, and radiographic changes of osteoarthritis are typically COAST stage 3 to 4. These patients should still have a baseline plan, but it will likely need to be modified to account for mobility limitations that may interfere with daily exercise.

In addition to regular polysulfated glycosaminoglycanseries and daily NSAIDs, patients may need long term amantadine, intra-articular injections, and maintenance rehab. Dycus shared that the addition of gabapentin (>10 mg/kg TID) or pregabalin (2-4 mg/kg BID) may be helpful, though there is limited evidence for efficacy with regards to joint pain.

For these patients that are having significant pain flares or not improving, subcutaneous ketamine injections can be considered. Bedinvetmab (Librela; Zoetis) could also be considered to help break the pain cycle. One strategy is administering 2-3 injections then returning to maintenance NSAID use.

Client Communication

Dycus stressed the importance of setting appropriate expectations with owners of dogs with OA. This is a progressive disease that will worsen over time despite our best efforts. Owners should be prepared for this and understand that the management plan will evolve over time as the patient’s baseline changes.

Additionally, owners should be prepared for flare-ups of the disease process and be educated in how to recognize these events. The faster an owner recognizes a flare, the faster an intervention plan can be instituted.

“I’m a big fan of educating owners,” Dycus said, though he cautioned against giving too much information at once. Instead, he recommended providing owners with additional resources, such as websites like caninearthritis.org or caninearthritis.co.uk, that they can explore after the appointment.

Takeaway

“There’s never going to be only one thing to manage osteoarthritis,” Dycus stated. Canine patients can present with risk factors or clinical signs of osteoarthritis at any age. Using a tool like COAST can help to identify these patients and institute a patient specific management plan that can decrease inflammation within the joint and improve overall patient quality of life.

References

1. Dycus D. A patient specific approach to osteoarthritis management. Presented at Fetch dvm360 Conference; Charlotte, NC. March 14-16, 2025.
2. Enomoto M, de Castro N, Hash J, et al. Prevalence of radiographic appendicular osteoarthritis and associated clinical signs in young dogs. Sci Rep.2024;14:2827. doi:10.1038/s41598-024-52324-9
3. Cachon T, Frykman O, Innes JF. Face validity of a proposed tool for staging canine osteoarthritis: Canine OsteoArthritis Staging Tool (COAST). Vet J. 2018;235:1-8. doi:10.1016/j.tvjl.2018.02.017