Non-steroidal medications are another group
of medications commonly prescribed for arthritic dogs. There
are a number of these products, including aspirin, ibuprofen,
naproxen, phenylbutazone, piroxicam, carprofen (RimadylR,)
Etodolac (EctoGesicR,) and acetominophen (TyelenolR.)
Note: acetominphen is not technically a non-steroidal
medication even though it is often and incorrectly prescribed
for this purpose; acetominophen has no anti-inflammatory properties.
Since dogs have shown greater toxicity (usually
increased GI side effects) with most of the human NSAID medications,
it is questionable if they should be used in dogs for any
reason. As a result of this increased sensitivity towards
NSAID side effects, the pharmaceutical companies are developing
products which are safer for our canine patients.
Like corticosteroids, the NSAIDS work by
inhibiting the chemicals (prostaglandins) that cause pain
and inflammation. While they can be very useful in controlling
pain and inflammation, like corticosteroids they too have
side effects, some more serious and dangerous than others
(see below.)
Non-steroidal medications work in something
called the COX pathway. COX stands for cyclooxygenase, which
is another enzyme in the pathway that break down the arachidonic
acid in the cell membranes of the joint into chemicals such
as free radicals and various prostaglandins that damage the
articular cartilage.
There are 2 COX enzymes that have been discovered
to date: COX-1 and COX-2. COX- 1 is found in various tissues
such as the stomach, intestines, and kidneys and serves an
important role in maintaining health. When arachidonic acid
is broken down by COX-1, good, anti-inflammatory prostaglandins
are produced. These prostaglandins keep the kidneys functioning
normally and help protect the stomach and intestinal tract
against ulcers.
When arachidonic acid is broken down by COX-2,
bad, pro-inflammatory prostaglandins are produced. These prostaglandins
(and other chemicals) are harmful and contribute to the side
effects seen in some patients taking NSAID medications, such
as GI ulcers and kidney disease. Drugs that selectively inhibit
COX-2 but not COX-1 are most likely to result in fewer side
effects and be safer for our patients. Right now the move
is on in human medicine to find NSAIDS that inhibit COX-2
but not COX-1; hopefully our veterinary patients will benefit
from this research as well.
Current NSAID medications available for veterinary
patients inhibit both COX-1 and COX-2 to various degrees.
Indomethacin and piroxicam have high COX-2/COX-1 ratios, and
result in high incidences of GI problems (bleeding, ulcers).
Naproxen, ibuprofen, carprofen (Rimadyl) and etodolac (EctoGesic)
have lower COX-2/COX-1 ratios, and as a result have fewer
incidences of GI problems. Aspirin has a higher ratio but
an intermediate incidence of GI problems, indicating that
other mechanisms are involved in causing some of the side
effects we may see in patients taking NSAIDS.
As mentioned, the NSAIDS have the potential
to produce a number of undesirable and potentially fatal side
effects. One side effect is gastrointestinal bleeding that
occurs because of prostaglandin inhibition. Other side effects
include kidney disease (also due to prostaglandin inhibition,)
liver disease (mild cases display elevated liver enzymes whereas
more serious cases can show liver failure,) immune diseases
(anemia, low platelet count, skin diseases,) neurologic signs
(seizures, paralysis, unsteadiness,) behavioral problems (hyperactivity,
aggression, depression, or sedation,) drug interactions (NSAIDS
should not usually be used when corticosteroids are used as
the potential for side effects increases,) and even death.
Finally, and perhaps most importantly, as with steroids, many
of the non-steroidal medications destroy cartilage, although
the popular NSAIDS Rimadyl and EctoGesic appear to cause less
cartilage destruction than other NSAIDS.
Can NSAIDS be safely used in the treatment
of arthritis? I believe NSAIDS can be safely and effectively
used short-term (5-7 days) in pets not taking any other medications
and in pets without other diseases. This means a careful history,
examination, and laboratory testing will be needed in most
pets. For long-term use (which is rarely necessary as most
pets do very well on complementary therapies as discussed
in Part III,) I only use NSAIDS if ALL OTHER TREATMENTS HAVE
FAILED, AND IF THE OWNER HAS BEEN WARNED OF POTENTIAL SIDE
EFFECTS. These patients are frequently (every 2-3 months)
monitored for side effects, and GI protective medications
(see below) may be used to decrease GI side effects. In effect,
we try to make the patient comfortable and have a good quality
of life at the risk of causing side effects and even death
in that pet.
As I mention in The Arthritis Solution for
Dogs (Prima Publishing) "Blanket therapy with anti-inflammatory
drugs is a poor substitute for a well-designed program of
management."
Complementary Therapies for Pets
with Arthritis
While conventional therapies can be useful
for short-term pain relief in pets with arthritis, most dogs
and cats will improve significantly when treated with complementary
therapies. This final article will provide a brief overview
of the most popular complementary therapies available for
treating arthritis.
Homeopathy
Homeopathy uses diluted substances to help
the body heal itself. Individual remedies are selected based
upon a careful history and physical examination of the arthritic
pet. Several remedies can be combined in solutions such as
those made by HomeoPet that are available for short-term use
of mild lameness. Common individual remedies include: Caulophyllum,
Lithium Carb., Rhus Tox., Bryonia, Hecla Lava, and Actaea
Rac.
Acupuncture
Traditional acupuncture involves the placement
of tiny needles into various parts of a pet's body. These
needles stimulate acupuncture points which can effect a resolution
of the clinical signs. Other forms of acupuncture involve
laser therapy, aquapuncture (tiny amounts of vitamins are
injected at the acupuncture site for a more prolonged effect,)
and electroacupuncture (a small amount of non-painful electricity
stimulates the acupuncture site for a more intense effect.)
As a rule, results from acupuncture compares
quite favorably with traditional therapies. Side effects from
acupuncture are rare. Accidental puncture of a vital organ
can occur. Infection can occur at the site of needle insertion.
Occasionally, the needle can break and surgery may be needed
to remove it. Some pets require sedation in order to allow
insertion of the acupuncture needles. In some animals, signs
may worsen for a few days before they improve.
Many owners worry that acupuncture is painful
and that their pets will suffer. Usually acupuncture is not
painful. Occasionally, the animal will experience some sensation
as the needle passes through the skin. Once in place, most
animals will relax and some may become sleepy. Fractious animals
may require mild sedation for treatment.
The number of acupuncture treatments that
a pet will require varies from pet to pet. Usually, we try
at least 8 treatments (2-3/wk) to assess if acupuncture will
work. On average, treatments last about 15-30 minutes for
needle acupuncture, and 5-10 minutes for aquapuncture or electroacupuncture.
If the pet improves, acupuncture is done "as needed"
to control the pet's signs.
Magnetic Therapy
In recent years, therapy using magnets has
gained a following among some doctors and pet owners. It is
seen as a safe a simple method of treating various disorders,
often producing positive results without side effects or much
expense.
Doctors theorize that magnets work by means
of magnetic lines of force; units called gauss measure the
strength of the magnetic field. The higher the gauss number
the stronger the magnet (a 1000 gauss magnet is stronger than
a 100 gauss magnet.) Magnets are used either as permanent
magnets, also called static magnets, or as pulsed electromagnetic
field magnets (PEMF). Static magnets come in bars, beads,
or strips. PEMF uses pulsing current flow through a wire coil
to create a magnetic field around the wire: the greater the
amount of current flow, and the greater the number of turns
of the wire, the greater the magnetic field that forms. In
people PEMF is approved for treating nonunion fractures (fractures
that have failed to heal) by the FDA. Other uses include avascular
necrosis of the hip, osteoarthritis, and rotator cuff injuries.
No toxic effects have been reported using magnetic therapy.
In our Western view of healing, magnets appear
to heal the body by removing inflammation and restoring circulation.
By increasing blood flow to a diseased site, increased nutrients
are available for healing. In the Eastern view of healing,
magnets help restore the energy flow of the body to allow
healing and proper metabolism. This is similar to one of the
theories used to explain the positive effects of acupuncture
as well.
While usually safe, magnets should not be
used in acute infectious conditions, on cancerous growths
(although some doctors do find them useful in treating cancerous
tumors), in acute injuries, pregnant animals, or in dogs with
cardiac pacemakers.
Continue
to Nutritional Supplementation
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Be sure to visit the Glucosamine Product Guide for a review of commercially available glucosamine products broken down by 9 different categories such as price per month, quality and type. Learn what the best products out there are and what criteria was used to ranked each.
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