1 In Practice FOCUS November 2015 Investigation and management of canine osteoarthritis Rob A. Pettitt, Alexander J. German CANINE MOBILITY Lameness in dogs will be a familiar part of any small animal practitioner’s caseload. Osteoarthritis is a common cause for this lameness, although it is often secondary to a primary inciting cause; so treatment and management may need to address the primary inciting cause as well as the pain associated with the arthritis. Management of the condition involves a combination of medical and surgical options, and weight management can often be crucial in reducing pain and improving patient mobility. In this article, Rob Pettitt and Alex German explore the multifactorial elements in both investigating and managing this condition in dogs. OSTEOARTHRITIS is the most common cause of arthritis in the dog and affects up to 20 per cent of the adult canine population. Other causes of arthritis include, for example, immune-mediated disease and sepsis. In dogs both primary and secondary forms of osteoarthritis occur although the secondary form is far more common. This form occurs following injury or insult to the affected joint, for example, cranial cruciate ligament rupture, articular fracture or osteochondrosis, which initiates the biochemical cascade leading to a common pathway of arthritis. The susceptibility of any individual to osteoarthritis is related to factors such as genetics, age and systemic factors such as obesity. Superimposed on this inherent susceptibility are local factors such as instability and injury to the joint itself. Models of osteoarthritis are well documented in the literature (for example, Dieppe and Lohmander 2005) but are not within the scope of this article. Clinically, the major presenting signs are lameness, stiffness, exercise intolerance or an unwillingness/inability to climb or jump. The signs can be attributed to the primary inciting cause, pain associated with arthritis or a combination of both. Rob A. Pettitt, Alexander J. German, Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE, UK e-mail: r.a.pettitt@liverpool.ac.uk Investigating osteoarthritis History It is important to start with an accurate and complete history when assessing patients with osteoarthritis (Box 1). In dogs, osteoarthritis has specifc breed and age predilections so the signalment of an animal may help the clinician in reaching a diagnosis. For example, hip dysplasia is present in very young medium- to large-breed dogs and the secondary radiographic changes are evident from a very early age. The most common manifestation of osteoarthritis is so-called ‘inactivity stiffness’. Owners report that their pet’s lameness seems to resolve during exercise but then worsens after periods of rest following these bouts of activity. Other common presentations include a change in the animal’s ability to climb, for example, the stairs, or jump, such as into the back of the car. As part of the history taking and ongoing management of osteoarthritis there have been recent efforts to design and validate client-based questionnaires that provide a summative score and can be used to assess the severity of the disease at the outset and the response to any treatment. Although these questionnaires have not been fully validated, they provide a useful tool in the management of osteoarthritis and are available either as downloads or under licence (Brown and others 2008, Walton and others 2013). Physical examination Osteoarthritis is usually secondary to a primary inciting cause so a diagnosis of osteoarthritis alone is usually insuf fcient and the clinician needs to identify the primary cause. A physical examination should be systematic and complete. It is useful to compare the contralateral limb when assessing the range of motion, and also when looking for soft tissue swelling and muscle atrophy. However, since the most common forms of orthopaedic disease (eg, cruciate disease, elbow dysplasia and hip dysplasia) can frequently present bilaterally, this is not always useful. A complete analysis of the gait should be performed. This is most commonly done in two ways: n The patient can be examined while in the consultation room during the history taking. This can often reveal very subtle lameness and allows the clinician to monitor the animal lying down and standing up, as well when walking around the consultation room. n Further analysis of the gait should be made in an area that allows the animal to be walked and trotted in a straight line. The animal should be observed walking away from and back towards the clinician, as pelvic limb lameness is often more obvious when walking away and thoracic limb lameness more obvious when walking back towards the clinician. This gait analysis is usually performed before the physical examination as the lameness may be worsened by the examination, although repeated single joint examination followed by immediate gait analysis may help to localise lesions, especially in the more subtle cases. Box 1: History taking for suspected osteoarthritis More specific questions that need to be asked when taking a history for a suspected case of osteoarthritis include: n duration of lameness; n clinical progression; n response to any treatment; n any history of trauma or other inciting causes; n behavioural changes; n response to amount of exercise performed; and n effects of weather. This supplement is sponsored by Royal Canin. In Practice commissioned the article, which was peer-reviewed and assessed for relevance. It also provided copy editing, production and distribution services. ©British Veterinary Association 2015. All rights reserved. on May 20, 2020 by guest. Protected by copyright. http://inpractice.bmj.com/ In Practice: first published as 10.1136/inp.h5763 on 11 November 2015. Downloaded from