Canine OsteoArthritis Staging Tool Now Available

UPDATE (January 23, 2019) — The Canine OsteoArthritis Staging Tool (COAST), introduced last year, is now available. Devised by the COAST Development Group and funded by Elanco Animal Health, this new tool could prove to be an essential weapon in the canine OA arsenal.

“Until now, a standardized way hasn’t existed to diagnose and stage OA with risk factor analysis in subclinical dogs,” said pain management expert Mark Epstein, DVM, DABVP, CVPP, senior partner and medical director of TotalBond Veterinary Hospitals and Carolinas Animal Pain Management in North Caolina. “This tool...will revolutionize the way we approach OA, with a goal of better outcomes for dogs with this debilitating disease.”

Click here to access the COAST tool.

Canine osteoarthritis (OA) is primarily a developmental disease, but more than 50% of canine cases are not diagnosed until dogs are between 8 and 13 years of age. To combat this discrepancy, early intervention is critical to providing the most effective management of canine OA.

Recognizing the deficiency in timely diagnosis, Elanco Animal Health and the COAST Development Group—comprised of international medical specialists—partnered to develop a standardized staging system for canine OA that provides guidance on how to assess and monitor dogs that are “at risk” or display clinical signs of the disease.

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The Canine OsteoArthritis Staging Tool (COAST) is expected to “improve the diagnosis and monitoring of dogs with osteoarthritis with the potential to guide disease management plans.”

In an article published in The Veterinary Journal, researchers from the COAST Development Group explained the validity of this new diagnostic aid.

COAST Assessment Criteria

In designing the staging system, the development team established key objectives COAST needed to fulfill:

• Procedures had to be relatively cost-effective and easily implementable for primary care practices.
• Encourages a “team approach” by taking into consideration both veterinarian and pet owner evaluations.
• Evaluates multiple aspects of canine OA, including joint mobility, level of discomfort, and overall health.

“We have seen the successful implementation of standardized staging systems for other companion animal diseases,” Nichola Archer Thompson, DVM, global technical marketer for the orthopedic health category at Elanco, said. “So, the possibility of a similar approach for canine OA is particularly exciting.”

COAST is broken down into 2 processes that can be repeated at different intervals depending on disease progression.

COAST Grading

Grading is achieved through a combined score between the pet owner and veterinarian to assess the dog as a whole. Pet owner information is obtained through the completion of a clinical metrology instrument and their opinion of the dog’s discomfort level over the previous month. Although not a scientific measurement, the developers contend that pet owner perception is important for case management.

In addition to the owner’s evaluation, the veterinarian determines a grade for both the dog overall and its joints based on findings from a thorough orthopedic examination that includes manipulation and radiographs.

COAST Staging

Using the combined grading results, the patient is classified into 1 of 5 COAST stages:

• Preclinical—0: Clinically Normal (no OA risk factors);
• Preclinical—1: Clinically Normal (OA risk)
• 2: Mild Clinical Signs
• 3: Moderate Clinical Signs
• 4: Severe Clinical Signs

Based on where the dog falls on the scale, the veterinarian can determine the appropriate treatment or monitoring protocol for the patient and adjust treatment as required through subsequent COAST evaluations. “If OA is confirmed, determining the COAST stage of OA could facilitate long-term care plan discussions and support treatment decisions,” the developers wrote.

Conclusions

Dogs brought to the veterinary clinic because of owner-perceived signs are obvious candidates for a full COAST evaluation, but this process should also be used for pet owner education when OA signs may be intermittent, subtle, or unrecognized. The staging tool also provides the advantage of consistency in multi-clinician practices where dogs are not necessarily assessed by the same veterinarian at each visit.

“By implementing a standardized in-clinic COAST assessment approach at key points of contact with ":at-risk groups," grades or staging outcomes that are higher than expected could prompt targeted questions, help improve owner understanding and encourage further investigations if required,” the authors said.