The Earlier, 
the Better: Preventative OA Care for Aging Pets

Regular – and early – preventive osteoarthritis care for aging pets can address things like activity, mobility, comfort, and quality of life.

In recent years, the industry has seen stronger partnerships between veterinary professionals and pet owners, which can help to improve their engagement and commitment to their pet’s life-long health, said Emi Saito, DVM, Banfield Pet Hospital.

“The human-animal bond is stronger than ever before, and pet owners are more aware of and committed to the care of their pets,” she said. “We have also seen a better understanding among pet owners of the importance of regular preventive care for their pet to address things like activity, mobility, comfort, and quality of life for their pet as they age.”

One health issue related to mobility that veterinarians are on the lookout for is osteoarthritis (OA), a form of arthritis caused by inflammation and damage to joint tissue that can affect both dogs and cats. Factors such as age, genetics, injury, and joint abnormalities can cause OA, but a common contributor to this painful and degenerative disease is excess weight and fat. Over the past 10 years, Saito said Banfield veterinarians have witnessed a 66% increase of OA in dogs and 150% increase in cats.

Banfield Pet Hospital’s 2019 State of Pet Health Report focused on the prevalence of OA in cats and dogs and discussed how this irreversible, progressive condition is associated with excess weight. According to the report, 52% of dogs and 41% of cats with osteoarthritis are overweight or obese. “Discomfort from OA can keep pets from being active, which can lead to weight gain and fat deposition, both of which can then worsen the joint condition,” said Saito. “It is also likely that it can go the other way – excess weight and fat can contribute to the development of OA. OA can begin to develop at any age but is more likely to be found in older pets. As such, keeping pets at a healthy weight – especially as they age – and regular veterinary examinations are a critical part of early detection and management of OA.”

Other medical issues seen in senior pets include age-related vision loss, Saito said. Pet owners may start to notice their pet having difficulty navigating nighttime walks or finding them in a dark room. If pet owners notice any vision changes, their pet should be examined by a veterinarian to rule out underlying diseases that could be treated, she said. If the pet is vision-impaired, furniture placement should be considered to prevent them from running into objects or sharp corners, and some extra light may be helpful when going up and down stairs or on walks in the evenings.

“Some older pets may also develop urinary incontinence,” Saito said. “The use of absorptive bedding or diapers in conjunction with more frequent opportunities to use the restroom can help keep pets dry. Depending on the cause of the urinary incontinence, their veterinarian may also be able to recommend medications that can help control accidents.”

There are a number of other conditions that may be seen in older pets, and sometimes the first signs are not blatantly obvious. Any time pet owners see any changes in their pet’s behavior or activity levels, they should consult with their veterinarian to determine the cause. “Just like the examples mentioned above, the earlier we can diagnose conditions and get the pet managed, the greater chance we have of helping to slow disease progression and most importantly, improve the pet’s quality of life,” Saito said.

OA: No ‘one-size fits all’ approach

“When we say OA requires a multimodal approach, we mean we need to think beyond just treating with pain/anti-inflammatory medications and joint supplements, and include working with owners to detect OA before the pet becomes lame or has noticeably reduced mobility,” said Saito.

There is no one-size-fits-all plan for treating OA, Saito said, so every diagnostic and treatment plan should be tailored to each pet. But in general, there are different components that should be considered as a veterinarian and client develop a plan for an OA pet:

• The earlier we detect and start managing OA, the better. “By early detection and initiation of OA management at an earlier stage of joint disease, we may be able to reduce the time (and perhaps dosage) the pet will need anti-inflammatory and pain management in its life,” Saito said. This means having conversations with pet owners to find out how the pet is doing at home, going beyond baseline questions about whether a pet is limping or having problems walking to asking specific questions related to a pet’s willingness and ability to do normal activities. Some people may attribute certain changes in behavior as normal for aging pets, when in reality, they can be attributed to OA (or another condition).
• A thorough examination routinely performed by a veterinarian can also help identify changes early. Diagnostics such as radiographs are recommended to screen for OA, particularly in higher-risk pets (based on factors such as breed, genetics, activities, etc.) and in pets that are lame or showing decreased mobility. “This can help rule out other diseases that might cause a pet to present similarly, and as a result, we can be more confident that we are properly managing care for the pet,” Saito said. “For instance, we don’t want to treat a pet like it has OA when diagnostics would have shown that it instead has osteosarcoma or another joint condition that could be surgically repaired.”
• As it relates to treatment, it’s important to pair anti-inflammatory or analgesic medications with proper nutritional support. This may be in the form of a veterinary diet or dietary supplements that support joint health.
• Another critical component is weight management. “We found 41% of cats and 51% of dogs newly diagnosed with OA are overweight or obese,” Saito said. “The excess weight and fat contribute to the inflammation in the joint, which contributes to reduced mobility and exercise, which can lead to weight gain and more fat accumulation. Research has shown obese pets that lose as little as 6.1% of their weight showed improvement in clinical signs of OA.”
• In addition, exercise or some level of activity is helpful in managing these pets, not only by burning more calories but by building and maintaining muscle mass, which helps the arthritic joints. There are options, such as veterinary physical rehabilitation and dog swim pools, more readily available today than even 5-10 years ago for helping these pets regain some mobility and improving their quality of life.

Compliance

Why wouldn’t a pet owner comply with a treatment plan? Sometimes the signs aren’t as obvious to them. One of the key barriers with compliance of treatment plans is that many times, the first signs of OA and other conditions are very subtle or mild and therefore attributed to “my pet is just getting older,” Saito said. Thus, it can be challenging to convince pet owners that there is a problem. “Particularly relating to OA, the most common sign owners recognize is limping, but sadly, some of our veterinarians have reported that a pet owner may not appreciate their lame pet is in pain or recognized improvement after treatment has been started,” said Saito.

There are tools available that enable clients to report or monitor pet behavior at home, particularly those they might think are ‘normal’ for their aging pet but are actually due to OA. Use of these kinds of tools can help facilitate the conversation of what is really normal, and after the pet is started on a management plan, while the owner may not see the recovery they anticipate (e.g., full recovery), such a tool may help them appreciate what improvements have been achieved as a result of treatment.

“And, conversely, perhaps if the treatment isn’t leading to notable improvement – such a tool may also help the veterinarian have an objective measure that indicates the treatment plan may need to be adjusted,” said Saito. “So, it can be a win-win situation for the veterinarian and the owner, all to benefit the pet and to assess response to treatment – all leading ultimately to improvement in patient outcome (such as quality of life).”

Joint supplements: A good first step

How can veterinary practices increase their revenues via supplements? And where can distributor reps help? Shelly Derks, marketing manager – Equine and Specialty Products, Dechra Veterinary Products, provided Veterinary Advantage with some insights.

Show vs. tell. “Veterinarians like scientific evidence to show these ingredients are actually beneficial for the pet at the levels contained in the product,” she said.

Use their strengths. Veterinarians must prioritize their veterinary-exclusive products. “They need to recommend products, like Phycox® Canine Joint Supplements, which are only sold to veterinarians. They also need to understand the importance of the NASC seal and that a company must complete a facility audit and implement specific quality standards to carry it on their products. Dechra also provides technical and veterinary support which you don’t get from an online retailer. We don’t sell directly to anyone except licensed veterinarians. And Dechra cannot guarantee the stability or safety of our products purchased through online channels nor will we stand by our 100% palatability guarantee.”

Start early. A joint supplement is the best first step to helping maintain healthy joint function and should be considered before many drug therapies since those have risks and side effects associated with them, Derks said. “The vets who have been the most successful are those that start the dog early on a joint supplement versus waiting until the owner complains the pet ‘doesn’t get up from lying down’ as easily as it used to. This complaint can stem from a variety of issues such as poor conformation, being overweight, injury to a joint or limb, surgery on a joint or limb, or even an infectious disease like Lyme disease.”

Multimodal works best. Osteoarthritis is a multifaceted disease and research has shown that several inflammatory mediators are involved in the underlying process. Anti-inflammatories help to reduce inflammation, but supplements are complementary and work in a different way, said Derks. “For example, Phycox contains phycocyanin and several different antioxidants. Powerful antioxidants can act as free radical scavengers and help to reduce the inflammatory mediators affecting joint health. Research has shown that having a multimodal approach – including diet, supplements, weight loss, and anti-inflammatories – is the best way to treat dogs with osteoarthritis.”

Supplement sales

Distributor reps play a significant role in helping educate veterinary clinics on
the differences in the quality of supplements.

The supplement industry has shown rapid growth in recent years, with no signs of slowing down. “I feel this is attributed to veterinarians and their clients becoming aware of and fully embracing the benefits quality supplements can provide as part of a multimodal approach to pets’ health management,” said Eric Shreves, DVM.

In the last decade, supplements, especially those manufactured by larger established companies, are being supported by increasingly more advanced scientific research and development. The advanced research provides veterinarians with a better understanding of the mechanism of action of the ingredients. This research also leads to the development of more advanced supplements with improved bioavailability and easier administration, said Shreves.

“Supplements work perfectly as part of a multimodal approach as they may often help reduce the number of pharmaceuticals required, such as NSAIDs, which can be more expensive or prone to unwanted side effects,” he said. “With less severe joint issues, nutraceuticals, in conjunction with other adjunct modalities, such as acupuncture, laser management, and/or physical therapy, provides enough support to keep pets comfortable without having to rely on pharmaceuticals. “

Competing for supplement sales

In order to compete with online and retail outlets for supplement sales, Shreves said veterinary clinics must do two things. First, veterinary clinics must ensure they carry and recommend quality supplements backed by science from a manufacturer the clinic can trust. Second, clinics should also carry quality supplements from manufacturers who support veterinarians through advanced packaging and keeping these supplements offline, refusing to sell their advanced lines in retail settings.

As the supplement industry is not well regulated, distributor reps play a significant role in helping educate veterinary clinics on the considerable differences in the quality of supplements in the veterinary discipline, Shreves said. Because of this, distributor reps need to be aware of and promote the manufacturers that follow Current Good Manufacturing Practices (cGMPs) and provide exceptional quality control and assurance, while routinely conducting scientific research on their products. These processes help ensure the supplements are safe, bioavailable, and accurately reflect label claims.

“The best distributor reps should have a finger on the pulse of their clinics and tailor their interaction to each clinic,” he said. “For example, you know a clinic in your territory has arrangements with local shelters and adoption facilities, and they receive a lot of first-time clients from them. I would be asking the clinic what they recommend for all those recently adopted patients they see. For example, their immune systems may be weakened from stress, malnutrition, or infections from being in the shelters or streets. The situation offers a perfect opportunity to discuss bringing in a supplement that modulates the immune system and helps the clinic provide support to all these new patients and develop client-clinic trust and, subsequently, retain the client.”

1-Photo credit – istockphoto.com/Calysta Phalen

2-Photo credit: istockphoto.com/Dejchai Kulawong

3-Photo credit: istockphoto.com/Lightspruch