Veterinarians see benefit to canine OA management protocols

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A majority of veterinarians want structured protocol for managing canine osteoarthritis (OA), according to results of a survey conducted by the American Animal Hospital Association (AAHA). The survey also revealed that demand for such protocol is especially needed for detecting OA early in younger dogs.¹

The survey was conducted by AAHA in partnership with veterinary orthopedist Denis Marcellin-Little, DEDV, DACVS, DACVSMR, CCAT, a professor at the University of California, Davis, School of Veterinary Medicine, and American Regent Animal Health, maker of Adequan Canine polysulfated glycosaminoglycan (PSGAG), which is indicated for control of arthritis signs in dogs’ synovial joints. Results of the survey relied on responses collected from nearly 800 veterinarians, of which approximately 95% agreed that a canine OA protocol is needed. “This consensus is a cry for help—a clear demand for more structure in managing osteoarthritis,” said Marcellin-Little, in a news release.1

A recent study led by a team of investigators at North Carolina State University, College of Veterinary Medicine in Raleigh, investigated the prevalence of OA and clinical signs of the condition in 123 dogs, ages 8 months to 4 years, and found that radiographically visible OA (rOA) is common in young dogs. Approximately 60% of dogs in this study with rOA were also determined to have clinical OA as well as pain. These investigators found that pain associated with OA “appears to be undiagnosed and undertreated in young dogs.”²

A self-assessment by AAHA survey respondents revealed a confidence level of 7 of 10 for their understanding of canine OA onset and 8 of 10 for managing the disease. “There’s a bit more confidence in management than in detection, which shows that we should be focusing on early onset,” Marcellin-Little noted.¹

Diagnosing OA

AAHA survey respondents indicated they generally rely on physical examinations, patient health histories, and radiographs to diagnose OA. However, the survey also found that fewer than 1 in 7 respondents use a client questionnaire to help OA detection.³

During a presentation of the study results at the 2024 Veterinary Meeting and Expo (VMX) in Orlando, Florida, Marcellin-Little addressed the low usage of a baseline OA questionnaire with event attendees.³ “It’s free, it’s simple, and it can be done before your visit. [There’s] no work [involved]. You have zero reason not to do it and yet very few people do it,” he said.

Managing OA

What treatment methods do veterinary professionals use to manage OA? The AAHA survey found respondents relying on therapies and resources as follows³:

• Weight loss or optimization of body condition (98%)
• Joint supplements (97%)
• Walking or exercise with the owner (82%)
• Drug addressing the underlying disease, such as PSGAG (71%)
• NSAIDS (68%)
• Pain control drugs (57%)
• Nonpharmaceutical modalities (50%)
• In-clinic therapeutic exercises (11%)
• Other (7.9%)

In his talk, a session that was sponsored by American Regent, Marcellin-Little expressed opinion that joint supplements may be overused for managing OA, based on the high percentage of those who reported relying on them. “I love joint supplements, but we can’t just say this is the foundation. It’s an adjunctive strategy. I like the affordability, simplicity and safety…but there’s a risk of over relying on something that is not going to have a big, strong impact,” he said.

Conversely, the UC-Davis professor expressed concern that some other treatment methods, including NSAIDS, pain control drugs, and nonpharmaceutical modalities are being underused by veterinary professionals.³ “NSAIDS have a robust effect size but there is a safety concern and 3% of the dogs are going to identified with an adverse effect,” he said.

Marcellin-Little also urged VMX attendees to consider PSGAG more widely than 71% for OA prevention.³ “We have to remind ourselves to use it early…Controlling inflammation is critically important,” he said.

OA management protocols

Citing the “overwhelming” majority of veterinarians who indicated organized protocols dictating OA management are necessary, Marcellin-Little also discussed the reasoning for these protocols. “We want to improve the logistics of managing OA, make it less random, make it more standardized, more efficient. We want better science,” he said.

AAHA survey respondents indicated that OA protocols should include elements of management, education and science. Top responses included early disease management such as repairing cartilage health or slowing degradation, mid-stage management, disease prevention and understanding OA management products and strategies including when to implement them. Providing client education guidelines and resources was also highly sought-after by survey respondents.

Four in 10 veterinarians surveyed agreed that their practice currently has an OA protocol in place, while 7 in 10 survey respondents said they have an OA protocol for senior dogs.³ “Most agree that a protocol is realistic,” said Marcellin-Little.

However, veterinarians were less in agreement about when an OA protocol should be implemented. Only 9.5% said an OA protocol should be implemented on the first visit for all dogs while 35% agreed the protocol should be implemented on the first visit for dogs at risk.³ In his talk, Marcellin-Little expressed a need for more focus on preventing OA. “Let’s make things better here. Let’s move that [35%] up to 95%,” he said.

Other veterinarians surveyed expressed an OA protocol starting at points beyond a fist visit such as post-surgery, when a dog reaches a certain age, or if the patient has an injury, while 89% agreed disease management protocols should be used when a canine shows signs of OA.³

Current management of canine OA is largely focused on relieving pain, but optimal management should include an understanding of joint degeneration and inflammation. Treatment should begin early and be proactive with steps that include nutrition, joint protection and health, and an established routine exercise, according to Marcellin-Little.³

Takeaways

Survey respondents reported an estimated 45% of their patients living with OA and 26% have early-onset disease. Additionally, 47% of respondents’ patients are predisposed to the condition.¹ According to Marcellin-Little, the data justify the need for stronger emphasis on early detection.

However, 75% of veterinarians who responded the study’s survey reported knowing only “a little bit” about canine OA, and fewer than 10% initiate discussions about the condition when beginning a relationship with a patient and client. Based on these findings, investigators concluded that there is opportunity to improve education and resources about the condition and to help increase practitioners’ understanding about what clients need to know about canine OA.¹

Overall, the study’s findings are a call to action for veterinary professionals to prioritize OA management and detection, according to American Regent. “We should be talking about OA when it’s a nonissue, before it becomes a problem,” added Marcellin-Little.

References

1. Survey highlights substantial need for canine osteoarthritis management protocol for veterinarians. News release. American Regen Animal Health. December 7, 2023. Accessed February 8, 2024. https://www.aranimalhealth.com/News
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. Marcellin-Little D. OA management protocol—time for a reset? Presented at: Veterinary Meeting and Expo; Orlando, Florida; January 13-17, 2024.