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Medical Therapy for Stifle

Osteoarthritis

Steven C. Budsberg

Introduction

Osteoarthritis (OA) of the stifle joint is a pro-
gressive degenerative disease in dogs, which
can have a profound impact on quality of life
(Vasseur & Berry 1992; Lazaret al. 2005; Hielm-
Bjorkmanet al. 2011). The clinical signs of sti-
fle OA include discomfort, limited joint range
of motion, loss of muscle mass and muscle tone,
and decreased overall limb use. The pain can be
difficult to control. One of the primary reasons
hindering successful management may be the
presence of central nervous system plasticity
(Knazovickyet al. 2016). Additionally, while OA
is considered a chronic progressive disease, the
clinical picture may be quite dynamic with both
intermittent periods of acute signs, or ‘flare-
ups,’ and periods of clinical quiescence. Given
all of these cofactors, it is not surprising that
there is variation in the clinical impact between
individual dogs.
The goals of medical management are to
minimize the clinical signs of OA, maintain
or improve limb use and, if possible, slow the
progression of the disease. Remember, OA
of the joint is an end-stage process; current
medical management protocols are directed at
ameliorating those clinical signs. It has been
proposed that multimodal therapy can yield a

better response in the treatment of OA through

the synergism of various therapies acting in

non-competing modes of action. This allows

for the administration of collectively lower

doses of medication, decreasing the potential

side effects of any one treatment prescribed

(Altmanet al. 2000). In addition to nonsteroidal

anti-inflammatory drugs (NSAIDs), multi-

modal therapy for the treatment of OA also

incorporates weight loss, exercise modifica-

tion, rehabilitation, and diet supplementation

(Argoff 2002; Budsberg & Bartges 2006; Aragon

et al. 2007; Johnstonet al. 2008; Vandeweerdet al.

2012; Monterio-Steagallet al. 2013; Comblain

et al. 2016).

In the last few years, a plethora of new inter-

ventions have been introduced as adjunctive

therapies for OA. These include, but are not

limited to, non-NSAID analgesics, purposed

disease-modulating agents, biological products

(e.g., autologous protein products, stem cell

products, monoclonal antibodies), other oral

supplements, and physical modalities such

as acupuncture and light therapy. Most of

these therapies have been employed without

extensive clinical trials to assess efficacy. It is

important to remember the need for blinded,

randomized, clinical trials to assess efficacy

of new treatments. A care-giver placebo effect

Advances in the Canine Cranial Cruciate Ligament, Second Edition. Edited by Peter Muir. © 2018 ACVS Foundation.
This Work is a co-publication between the American College of Veterinary Surgeons Foundation and Wiley-Blackwell.

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