An Intro to My Multimodal Management Plan for Arthritis

This is the 3rd post in a multi-part series covering my elbow dysplasia journey. Part 1 covered how it was diagnosed and the specifics of my case. Part 2 covered my surgery and rehab protocol. This post will introduce my ongoing my ongoing multimodal management plan, and we'll dive into in greater detail about each modality in the next several posts.

Living my best snowdog life despite my elbow dysplasia

When a pup has dysplasia in any joint, or if a pup suffers a major injury to a joint, arthritis inevitably develops even if you pursue corrective surgery. But even in orthopedically sound animals arthritis is very common with age - 80% of dogs have arthritis by the time they are 8 years old with most cases being diagnosed between the ages of 5 and 8.

Unfortunately, arthritis is becoming increasingly common in younger dogs too - it's now estimated that up to 20% of dogs will show radiological signs of osteoarthritis by the age of just one year old.

I am kind of in both boats - I've had arthritis in my elbows since puppyhood due to elbow dysplasia, and as a large breed, highly active 5 year old dog my hips - though not dysplastic - are likely to start showing wear and tear too.

Note: Throughout this blog series, I am using the term "arthritis" to mean osteoarthritis. There are several other types of arthritis which are beyond the scope of this discussion. There are also non-arthritic conditions which present similarly but are not in fact osteoarthritis. Before pursuing any treatment plan it is critical to work with your vet(s) to reach an accurate diagnosis, confirmed by imaging.

Arthritis is a progressive condition. Although it can't be cured, its progression can be slowed. In some cases where arthritis is due to a joint abnormality or injury, surgical intervention to reduce pain near term and slow progression longer term may be an appropriate first step. I've already discussed my bilateral elbow surgery in the previous post so I won't repeat that info here.

Arthritis is also an individualized condition with symptom severity that can vary day by day. There is no "one size fits all" treatment. Different dogs will respond differently to any given intervention depending on the stage of their progression as well as their individual biology and comorbidities. Successful management strategies are fluid - they must adapt both long-term as the disease progresses and as the dog's overall health changes, and short-term to address acute flare-ups of pain. Monitoring the condition both daily and over time is critical. There are several standardized questionnaires that vets use to monitor or "score" pain levels, so you could choose one of these. But for me, my pawrents are usually assessing the following:

• Is my gait balanced and smooth with full range of motion?

• Does my posture look even and straight, or do any limbs appear to be rotated or offloaded?

• During post-walk paw cleaning, do I offer all paws easily, or do I resist picking up a certain paw?

• During passive range of motion stretches, do I feel stiff or resist any of the movements?

• Do I move freely any when standing up from a down position and vice versa?

• Do I alternate which leg I lift when I pee, and do I lift as high as usual?

• Do I hold my squat normally when I poop?

• Do I show my usual enthusiasm for activity, or do I shy away from things I normally enjoy?

• Do I show any signs of sensitivity to being touched? Do any joints feel "hot" or swollen?

• Do my muscles feel symmetrical, or does one side feel more atrophied than the other?

• Am I generally carrying my tail in its typical curly position, or is it down more than usual?

If any of these signals seem "off" I might be having an acute flare-up of pain and my pawrents know that I need pain control, rest, and continued monitoring. So far I've had remarkably few flare ups and they've always resolved within a couple of days. But if ever the pain persists for a longer time, or if acute pain episodes become more frequent, my pawrents would return to the vet for updated imaging to determine if there are new or worsening concerns. Again, it is critical to have an accurate and up-to-date diagnosis.

Specialists agree that managing arthritis is best accomplished using a multimodal plan that combines several different interventions to both slow disease progression as well as to treat/control/prevent acute pain and flare-ups.

Over the next several posts I'm going to detail all of the many adaptations and modalities I currently use with success, as well as several additional options that I'm keeping in mind for the future if needed. For any of you dealing with arthritis I hope you will find this series helpful; and I'd like it to start a dialogue - I'm very keen to hear from you in the comments to learn what interventions have (or haven't) worked for you!

Below is a teaser outline of the different topics for the next several posts. I'll come back and link each post here as it is published:

• Weight Control, Physical Therapy, and Body Conditioning

• Home Environment and Activity Adaptations

• Diet and Supplements

• Complementary Therapies

• Medications

• Joint Injections and Regenerative Medicine

  
  

The Evidence Hierarchy as detailed at https://openmd.com/guide/levels-of-evidence

But before we dig in, a little philosophy: my pawrents favor an evidence-based approach. They like to understand the "how" and "why" behind my treatments, and for those of you who feel the same way I'll link relevant studies and resources along the way.

It would be amazing to have conclusive evidence of efficacy for every treatment. However, the truth is that more often than not unbiased, well-controlled, large scale, peer-reviewed, repeatable studies and comparisons simply don't exist yet - especially for new and emerging treatments. And my pawrents don't want to skip anything that could help me, so they are willing to try treatments based on lesser evidence provided there's a reasonable likelihood of benefit and little likelihood of harm.

Therefore a number of interventions I currently use would be considered "promising" rather than "proven". They are often based on "best available evidence" in the form of smaller studies and clinical reports. Sometimes not even that level of data exists, and we may try a therapy based on "best guess" opinion from our vets, guided by logic and experience.

So stay tuned and we'll start diving into specifics! Meanwhile for any of you who are dealing with canine arthritis I'd love to hear from you - what resources have you found helpful? What therapies have you found helpful? Are there any specific topics or questions you want me to address with respect to my own case as I work on this series?

Finally, though I've mentioned these additional online resources before, I wanted to link them again here. These are all sites mom has found helpful as she's tried to learn more and become a better advocate for me and I trust you'll find them informative as well!

Canine Arthritis Management (CAM) - lots of free introductory resources are available at this website, and the corresponding Facebook group and Instagram deserve a follow as well. But IMHO it's well worth the modest fee to get access to their Member Zone, where you'll find a huge set of topic-focused webinars and articles from leading veterinary experts worldwide. They also have a handful of reasonably priced online courses (some for laypeople, some for veterinary professionals). The "Canine Arthritis Essentials" course is a great foundation for pet parents that will track well with the approach I'll detail throughout this post series.

Canine Arthritis Resources & Education (CARE) - another great all around resource (also on Facebook and Instagram) where you'll find a number of topic-specific articles, videos, and links to available studies. They also host some online courses (though some of them are actually the ones produced by CAM).

Association for Pet Obesity Prevention (APOP) - not about arthritis per se, but given that maintaining a healthy weight is the single most important thing you can do for your pup's arthritis and overall health, it merits inclusion in this list. This site has information on assessing your pup's body condition, as well as tools to help you understand their caloric needs and promote weight loss if necessary. You can follow APOP on Facebook or Instagram as well.

Research paper: A proposed framework for practical multimodal management of osteoarthritis in growing dogs