HIL Osteoarthritis insert GB

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					HIL02402 Osteoarthritis insert GB                        27/3/07         10:59         Page 1

                                                                                                                    and they have also identified the elbows,               discussion with the client about these changes
          Osteoarthritis is a poorly described and             • Cats are not exercised the way dogs are so         stifles and hips as being the most commonly             may be needed to identify potentially
          under-recognised condition in cats.                    early indicators of osteoarthritis (decreased      affected joints.                                        affected cats.
          Historically there has been a widely held              exercise tolerance, gait abnormalities and
                                                                                                                    What are the clinical signs of OA in cats?              What are the options for
          opinion that cats generally either do not              lameness) may not be noticed.
                                                                                                                                                                            treating OA in cats?
          suffer from osteoarthritis or, that if they                                                               All the studies on feline arthritis that have been
                                                               • In many affected cats the disease appears
          do, it is rarely of clinical significance.                                                                performed suggest that cats with OA present             The health and welfare impact of chronic OA in
                                                                 to be bilateral, and this together with the
                                                                                                                    with a different spectrum of clinical signs to dogs     cats should not be underestimated. Although
                                                                 insidious onset of disease means that overt
                                                                                                                    and other species. The signs of OA in cats may          many cats do not show overt lameness, significant
                                                                 lameness is often not seen.
          Such assumptions have probably occurred for a                                                             be much more subtle, and unless clinicians are          pain and discomfort are often present, and the
          number of different reasons:                         • Cats are very adaptive – a typical response        ‘tuned in’ to looking for them, they can be easily      impact on quality of life can be very significant.
                                                                 to joint pain in cats may be to rest and sleep     overlooked. Owners may actually be more aware           One prospective study of cats with OA showed
          • The relatively small size/weight of cats leading
                                                                 more, which may just be attributed to ‘the         of the problem, but may not necessarily consider        analgesic therapy resulted in significant
            to the erroneous belief that cats put ‘less
                                                                 ageing process’ in many instances.                 what treatment options may be available.                improvements in the cats’ ability to jump, the
            strain’ on their joints.
                                                                                                                                                                            height of their jump, their activity level, their
                                                                                                                    There is no universal sign or collection of signs
                                                                                                                                                                            stiffness and also their lameness. Nearly two thirds
                                                                                                                    that is present in all cats with OA – the disease is
                                                                                                                                                                            of owners were able to perceive a marked
        What is the evidence that OA                                                                                variable and the clinical presentation also variable.
                                                                                                                                                                            improvement in their cats on therapy (Clarke &
        is important in cats?                                                                                       However, research suggests that lameness is a
                                                                                                                                                                            Bennett, 2006). Although there is a need to treat
                                                                                                                    relatively uncommon manifestation of OA in cats,
        Over the past five years, there have been a                                                                                                                         OA in cats, the options for therapy are quite
                                                                                                                    probably being manifest in less than half of all
        growing number of studies and publications                                                                                                                          limited in this species:
                                                                                                                    cases, and even then overt limping may not be
        that are helping to fundamentally change the way
                                                                                                                    present. In contrast, the two most common and           • Obesity management – this is an important
        we think about feline OA. Several retrospective
                                                                                                                    easily recognised manifestations of feline OA             element of treatment in overweight cats as a
        studies have looked at the prevalence of
                                                                                                                    appear to be:                                             reduction and normalisation of bodyweight may
        radiographically-evident OA in cats (which were
                                                                                                                                                                              help ameliorate clinical signs.
        being radiographed for other reasons). These                                                                • a reduced ability to jump (or an increased
        studies have all found a strikingly high prevalence                                                           reluctance to jump); and/or                           • Environmental modifications – owners may help
        of disease and it is now abundantly clear that OA                                                                                                                     by modifying the environment so that the cat
                                                                                                                    • a reduction in the height to which the cat will
        is a common problem in cats.                                                                                                                                          has to do less jumping (up or down). Chairs,
                                                                                                                      jump.These signs were present in more than
                                                               Osteoarthritis of the right stifle in an older cat                                                             stools, ramps or other objects can be placed
        Vertebral degenerative joint disease and                                                                      two thirds of cats with OA in one prospective
                                                                                                                                                                              strategically to help a cat manoeuvre into a
        spondylosis are very common in older cats – they                                                              study. Other clinical signs that may also suggest
                                                                                                                                                                              favoured position (e.g. on a windowsill) where it
        were seen in 80 per cent of 100 cats over the age                                                             the presence of OA include:
                                                               • 7% of 684 cats with VD coxofemoral joint                                                                     finds difficulty in jumping. High-sided litter trays
        of 12 years in one study (Hardie et al., 2002).
                                                                                                                    • lameness;                                               can be avoided to make getting in and out of
        However, the clinical significance of these              radiographs had evidence of some degree of
                                                                 hip dysplasia (Keller et al., 1999).               • stiffness and a stilted or shuffling gait (reduced      the tray easier. Owners can also spend a greater
        conditions remains controversial. Even when this is
                                                                                                                      stride length);                                         amount of time grooming the cat.
        ignored though, and just radiographic evidence of      These studies together show consistent and
        OA in diarthrodial appendicular joints is evaluated,   compelling evidence for a high prevalence of         • joint abnormalities such as swelling, pain and/or     • Drug therapy – although this can be very
        the prevalence of disease is still extremely high:     osteoarthritis in cat populations. The studies         reduced range of movement;                              valuable, problems with this approach exist:
        • 65% of 99 cats over the age of 12 years (Hardie      suggest that in general, at least 20 per cent of                                                               – glucocorticoids are potent anti-inflammatory
                                                                                                                    • constipation and/or inappropriate elimination
          et al., 2002)                                        cats have radiographic evidence of OA, but                                                                       drugs and may help to manage the pain and
                                                                                                                      (litter tray difficulties);
          15 of the 64 affected cats had moderate to           because of the strong association with age, the                                                                  discomfort associated with OA. They have not
                                                               prevalence is much higher in older cats. It should   • reduction in, or difficulty with, grooming;
          severe changes.                                                                                                                                                       been studied in feline OA, but based on
                                                               also be recognised also that these studies will      • difficulty going up or down stairs; and                   experience in other species, the effectiveness
        • 22% of 292 cats over the age of 12 months
                                                               have under-estimated the true prevalence of OA –                                                                 of steroids in OA is limited, and their use can
          (Godfrey, 2005)                                                                                           • reduced activity and/or interaction.
                                                               the vast majority of these cats will have had only                                                               be associated with both systemic side effects
          Mean age of affected cats was 11 years.
                                                               partial skeletal radiographs performed (and this     Because many of the clinical signs of feline OA             and potentially they may have long-term
        • 19% of 191 cats aged between 0.2 and 18              will inevitably have led to an under-recognition     are subtle and associated with ‘life-style changes’         deleterious effects on joint cartilage, as well
          years old (Clarke et al., 2005)                      of the true prevalence of disease).                  rather than changes that can be readily detected            as other systemic diseases common in older
          Cats with evidence of degenerative joint disease                                                          on clinical examination and orthopaedic                     cats (renal insufficiency, diabetes etc.).
                                                               These studies also suggest that feline OA is often
          were older (mean 10 years).                                                                               evaluation, a thorough clinical history and careful
                                                               (but by no means invariably) a bilateral disease;
HIL02402 Osteoarthritis insert GB                             27/3/07          10:59              Page 3

          – non-steroidal anti-inflammatory drugs                                                                                               Feline osteoarthritis
            (NSAIDs) have been shown to be beneficial
            in managing feline OA and are a first line of                                                                                       An important but under-recognised condition
            therapy in other species. However, at present                                                                                       Dr. Andy Sparkes BVetMed, PhD, Dip. ECVIM-CA,MRCVS,
            there are no NSAIDs licensed for long-term
                                                                                                                                                Head of the Feline Unit, Animal Health Trust, UK
            use in cats (and/or for the treatment of OA,
            although this may change in the future) and
            it is well recognised that NSAID therapy caries
            certain risks and contraindications. NSAIDs
            notably may cause gastric irritation and gastric
            ulceration in some patients; but possibly of
            greater concern is their potential adverse
            effects on renal function as renal insufficiency
            is very common in the group of feline patients
            most likely to be suffering from OA.
          – Glucosamine and chondroitin supplements
            (‘chondroprotectants’) have not specifically
            been evaluated in feline OA, but based on
            other findings in other species, it is possible
            these drugs may provide partial relief of the
            signs of OA in early/mild cases.
        Is there a role for diet in
        treating feline OA?
        Hill’s Pet Nutrition has been at the forefront of the
        nutritional management of canine arthritis with
         a unique and innovative diet (Prescription Diet™
        Canine j/d™) based on a combination of
        ingredients including specific n-3 fatty acids that
        help reduce joint pain and inflammation and
        modify the expression of genes involved in
        regulation of cartilage breakdown. This has been
        a highly successful product with clear and potent
        benefits being demonstrated in placebo-controlled
        clinical studies.
        A natural extension of this work was to look at
        the potential for nutritional management of feline
        OA, which is particularly important given the
        problems associated with drug therapy. There
                                                                 Clarke, S. P., Bennett, D. (2006) Feline osteoarthritis: a prospective study
         are many different aspects to dietary control,
                                                                 of 28 cases. J Small Anim Pract. 47:439–445.
        including the use of appropriate anti-oxidants,
                                                                 Clarke, S. P., Mellor, D., Clements, D. N., Gemmill, T., Farrell, M.,
        naturally-occurring chondro-protectants, and             Carmichael, S., Bennett, D. (2005) Prevalence of radiographic signs of
        also essential fatty acids. As might be predicted,       degenerative joint disease in a hospital population of cats. Veterinary
                                                                 Record 157:793–799.
        given cats’ unique metabolism – and especially
                                                                 Godfrey, D. R. (2005) Osteoarthritis in cats: a retrospective radiological
        the differences in fatty acid requirements and
                                                                 study. J Small Anim Pract 46:425–429.
        metabolism – the specific nutrient profile
                                                                 Hardie, E. M., Roe, S. C., Martin, F. R. (2002) Radiographic evidence of
        benefiting cats with OA is quite different from          degenerative joint disease in geriatric cats: 100 cases (1994–1997).
        that in dogs, but extensive research has led to the      J Am Vet Med Assoc 220:628–632.
        development of a product that already has been           Keller, G. G., Reed, A. L., Lattimer, J. C., Corley, E. A.(1999) Hip
        shown to be of benefit.                                  dysplasia: a feline population study. Vet Radiol. Ultrasound 40:460–464.

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