There are many conventional treatments
for arthritis including corticosteroids and non- steroidal
anti-inflammatory medications (NSAIDS.) Is any one treatment
preferred or better for the pet with arthritis? There is no
perfect treatment. However, the "most perfect" treatment
for arthritis should meet the following criteria:
1. The therapy should be cost-effective.
2. The therapy should be easy for the owner
to administer.
3. The therapy must be safe for the pet.
4. The therapy must have minimal or no short
and long term side effects.
5. The therapy should help the joint heal
itself, as well as relieve inflammation and pain.
No matter what treatment is chosen for the
pet with arthritis, it should meet as many of these conditions
as possible to be of most benefit to the pet.
Conventional Treatments
There are numerous conventional treatments
for pets with degenerative joint disease (arthritis). Unfortunately,
some of these treatments have sought to relieve the effects
of the arthritis without actually doing anything to help the
pet's joints heal.
Remember that arthritis is an inflammatory,
painful condition. While the treatment treatment selected
must relieve the inflammation and pain, it is important to
keep in mind that long term therapy with conventional medications
are actually harmful to the joint cartilage. Most of these
drugs actually prevent healing of the cartilage, further destroying
the cartilage and joint components. So even though the pets
will feel better for a while, we're actually making their
condition worse. And because many pets taking corticosteroids
for prolonged periods of time gain weight as a side effect
of this class of medication, this excess weight puts further
stress on already damaged joints, adding more insult to injury.
Since most therapies for pets with arthritis
seek to relieve inflammation, it's important to understand
just what inflammation is and how our therapies help relieve
this side effect of arthritis.
Inflammation is caused by damage to the tissues
and cells of the affected body part. When a tissue is inflamed
it exhibits any or all of the following signs: redness, pain,
tenderness, swelling, and loss of function.
Cell membranes contain chemicals called phospholipids.
When the cell membrane is injured, as in the arthritic pet,
an enzyme acts on the phospholipids to produce fatty acids
including arachidonic acid (an omega-6 fatty acid) and eicosapentanoic
acid (an omega-3 fatty acid). Further metabolism of the arachidonic
acid and eicosapentanoic acid by additional enzymes yields
the production of chemicals called eicosanoids. The eicosanoids
produced by metabolism of arachidonic acid (the omega-6 fatty
acids) are pro-inflammatory and cause inflammation, suppress
the immune system, and cause platelets to aggregate and clot;
the eicosanoids produced by metabolism of eicosapentanoic
acid (the omega-3 fatty acids) are non-inflammatory, not immunosuppressive,
and help inhibit platelets from clotting.
Various drugs work at different stages to
help decrease the production of the pro- inflammatory compounds.
For example, corticosteroids such as prednisone work at 2
places in this biochemical pathway: they help inhibit the
enzyme which is responsible for metabolizing the membrane
phospholipids into arachidonic and eicosapentanoic acids,
and they inhibit the enzyme responsible for breaking down
arachidonic acid into pro- inflammatory compounds. Non-steroidal
anti-inflammatory medications such as aspirin and ibuprofen
work at another step in the pathway called the COX pathway,
discussed below, that is responsible for metabolizing arachidonic
acid into pro-inflammatory compounds.
Corticosteroids
Corticosteroids ("steroids",) are
commonly used for treating the arthritic dog. Steroids are
one of the most frequently used and abused drugs in veterinary
and probably human medicine. It's just too easy for doctors
to reach for the magic "steroid shot" to treat symptoms
without really diagnosing and treating the disease.
Many of my holistic clients think that corticosteroids
are horrible drugs that are to be avoided at all costs. However,
that is far from the truth. Corticosteroids are actually wonderful
drugs that can be life-saving when used correctly at the right
dose, for the proper length of time, and in the right patient.
So often though, they are often not used at the right dose,
for the proper length of time, and in the right patient. Because
they can aggravate existing arthritis by inhibiting the synthesis
of proteoglycans and collagen, the molecules that make up
cartilage, there is rarely if ever a need for their long-term
use in the treatment of patients with arthritis.
I believe the best use of corticosteroids
is for short term, infrequent use to control pain in pets
with mild arthritis. I prefer an initial short-acting injection
followed by a 5-7 daily oral dosing. Unless absolutely necessary,
depot injections of methylprednisolone which can last in the
pet's body for 30-60 days should be avoided.
The negative side effects of long-term use
of steroids is that they can decrease the ability of wounds
to heal, they increase the chance of infection, they may also
actually contribute to further destruction of arthritic joints
by decreasing collagen and proteoglycan synthesis, and they
can suppress the body's immune system.
Milder short-term side effects seen in most
dogs treated with corticosteroids include an increase in appetite,
an increase in water intake, and an increase in urine output.
Continue
to Non-Steroidal Anti-Inflammatory Medications (NSAIDS)
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