Arthritis

Arthritis in any species is an almost identical disease. The technical term is osteoarthritis and has to do with the breakdown of the cartilage in the joint. This causes inflammation leading to pain and stiffness and eventually bone rubbing on bone. It also affects the normal function of the entire joint capsule. It's not a "curable" disease process. However, we have numerous treatments that can help slow down the progression as well as treat the pain and inflammation it causes, keeping your dog's quality of life high even through their "golden years." 

First, note that we often recommend a senior workup when discussing arthritis. This may include some x-rays to evaluate the bones and degree of visible arthritis within the joints to help us tailor an appropriate treatment regimen for your pet. The second is often bloodwork to ensure their organs are functioning well and can tolerate some of the medications we may be recommending. 

SUPPLEMENTS (aka nutraceuticals):
Man, there are a LOT of joint support supplements on the market for both people and dogs. I know just walking into the pet store can be overwhelming! How do you know which ones to pick? Is it worth a name brand vs generic? Well, if you want to know just about everything, please keep reading below for the ins, outs, and details of the supplements for dogs.

First, the word ‘supplement.’ In dogs, this is the place where a lot of people start. The trickiest part with supplements is that there is NO regulation. Any person can make a supplement (or dog food), slap a label on it, spend tons in advertising and BOOM make a lot of money. That does not mean it legitimately works. However, there are some companies that have been around for a while and have actually spent the money doing research studies showing the effects their supplement ingredients make an actual difference. These companies will be GMP-certified companies – this means the FDA has been to their facilities and verified their products. There should be a stamp on their products to indicate this. In recent studies 90% of products tested over the counter did NOT have the labeled ingredients at the appropriate doses marked in the bottles – yikes! Therefore, I always recommend doing your research with any supplements first.

Second is manufacturing. Some of the ingredients within supplements must be derived carefully or can degrade very quickly if handled improperly during the creation process. Therefore, you also have to know how these companies function and if they handle the ingredients in a way to get the full benefits out of them. 

Finally, the other important thing to know is that there is not ONE supplement out there that covers every base. There are way more than I'm going to list here, but I wanted to cover the most common ones we get asked about. Here we go!

• Fish Oil/Omega Fatty Acids: Well, I bet you didn’t expect this one first! Stick with me. First, fish oil helps with everything! Joints, skin, heart, immune system, liver, kidneys, etc. This is actually the ONLY product that has studies to support a statistical response in helping our canine patients. The biggest mistake people make that I see is that they aren't giving enough of it. There are 2 ingredients that are the most important in dogs and these are 'EPA' and 'DHA'. If these are not listed on the label, don't purchase that product. When determining an appropriate dose in dogs I want you to add together these 2 numbers. For proper joint penetration, they need approximately 50mg per pound total per day (EPA + DHA) which is often much higher than what may be on the bottle. I do recommend slowing working up to this amount as it can cause diarrhea if you jump straight to the high doses. A lot of joint supplements may contain some of this, but I have yet to find one as the appropriate dose for full joint support, so commonly you need to add this on in addition to other joint supplements. Recommended products typically include: Wellactin, Eicosa, Vetriscience or Vetoquinol. I personally really like Nordic Naturals. For the big dogs, Nordic Naturals has an Ultimate Omega (human formulation) that has about 1480mg in two capsules. So if you gave 2 capsules twice a day, you’re hitting about what a 60lb dog needs.
   
• Glucosamine/Chondroitin: Now this I bet you’ve heard of. These naturally occurring ingredients aim at decreasing inflammation in the joints and encourage healthy cartilage regrowth. While very commonly recommended, there are actually no studies to statistically prove this works. That being said, it is still very strongly recommended and readily available in many joint supplements. These need to be given at double the maintenance dose for the first 4 weeks to build them up in the system and then maintenance dose long-term. This is the most common ingredient found in almost any joint supplement, but the amounts can vary widely so make sure to compare apples to apples!  Recommended products include: Cosequin, Dasuquin, Glycoflex and Flexadin (all of these have multiple varieties, keep reading!)
   
• Polysulfated Glycosaminoglycans (PSGAGs): This is actually a very concentrated injectable form of chondroitin sulfate. It penetrates the joint better than the oral forms and is strongly recommended as being more beneficial compared to the oral formulations. The current recommendation is to do an intense regimen for 1 month (twice weekly injections for 4 weeks). There are some patients that benefit from a monthly maintenance injection after that, though the company said they have no clinically proven this. You can repeat the 8-injection protocol as needed to help with clinical signs. Being an injection, this is something you can either get done at the clinic OR is something we can teach you to give at home. Recommended products include: Adequan or Chondroprotect
   
• Methylsulfonylmethane (aka MSM): This is another naturally occurring supplement that aims at decreasing inflammation and also serves as an antioxidant. This has been used for quite a few years now as an addition to the glucosamine/chondroitin. Recommended products include: Cosequin with MSM, Dasuquin Advanced with MSM, Glycoflex, and Flexadin Plus
   
• EggShell Membrane (ESM): This derives from the lining of the egg shell that comes from chickens (the thin membrane part that stays with the egg after the yolk is gone). It contains very high levels of collagen, elastin, and glucosamine which has been shown to help regenerate and preserve cartilage within joints as well as decrease inflammation. Recommended products include: Movoflex and Dasuquin Advanced with Egg Shell Membrane.
   
• Hyaluronic Acid/Boswellia/Vitamin D3: These are additional ingredients that are becoming more popular within joint supplements. Once again naturally occurring, these all work in different ways to increase joint fluid, decrease inflammation, and support any remaining cartilage. It also starts working quickly, compared to the products above as those take a few weeks to build up in the system. These can be found in a number of supplements as additional things to help. Recommended products include: Movoflex, Dasuquin products.
   
• Green-Lipped Mussels: Derived from a mussel found near New Zealand, these aquatic creatures contain very high amounts of eicosatetraenoic acid (ETA), omega fatty acids, and vitamins. These ingredients have been found to work to again block inflammation and encourage cartilage regeneration at a different level. Being newer, it is not found in as many products but is growing in popularity. Recommended products include: Dasuquin Advanced with ESM, GlycoFlex, and Flexadin Plus
   
• Hemp/CBD Oil: Legally I cannot say whether this actually works or not and what medical applications it has. There are some studies on the dog side that are set to come out soon but due to the legality, it is still very controversial. That being said, it’s probably one of the most common things I get asked about in our pets. It's definitely a "use with caution" thing that in my opinion should fall under the medication umbrella. If you are interested in this product, a few things to note. Hemp Oil is the WORST as far as false products with zero guarantees and risks of making animals extremely sick. There are only a few companies that I would recommend. In addition, the oil disintegrates very quickly when baked in a treat form, so the oil is MUCH more effective if you are going to try this. The concentration is also extremely important as this widely varies among markets. If you are interested in more information, please contact me.
   
• Diet: there are some prescription-level diets out there that you can feed your dog (or cat) that are specifically formulated to have extra ingredients that consist of a lot of these supplements discussed in the food. Often we still have to add a bit more, but maybe not as much as with them just being on the supplements alone. Examples of these diets are: Purina JM (this contains extra Omega 3 FAs, antioxidants, glucosamine and Vitamin E), Hills J/D (this contains extra Omega 3 FAs, antioxidants, glucosamine, chondroitin and L-carnitine) and Royal Canin Advanced Mobility (this contains collagen, antioxidants, Omega 3 FAs and turmeric).

Other products not fully discussed but to consider/being studied: collagen, duralactin