HPM Cat Osteoarthritis in the older cat

Osteoarthritis in the older cat

Osteoarthritis is characterized by the deterioration of articular cartilage and the presence of bone neoformations on the surface and periphery of affected joints. In cats, the most commonly affected joints are hips and elbows, but spinal lesions are also common, generally between the 7th and 10th thoracic vertebrae, and more severely in the lumbar and lumbosacral regions.

Owner observations are very important

Feline OA tends to be under-diagnosed, with only 16.7% of cats with OA exhibiting lameness. In addition, manipulation of joints with radiographic OA lesions triggers pain in only 33% of cases, whereas 67% of clinically painful joints present no obvious lesions.

In this clinical context, the owner’s observations are very important: it is highly advised to have the owner fill out a questionnaire on the cat's behavior in different situations to assess the cat's quality of life. It facilitates the long-term follow-up for the cat. Various tools have been designed to estimate the importance of chronic pain, such as the “client specific outcome measures” (CSOM) or the “feline musculoskeletal pain index” (FMPI) grids. It is also useful to ask owners to make videos of their pet in their usual environment, or to use a connected collar to estimate the cat's activity.

Management of feline OA

As in other species, treatment of feline OA requires a multimodal approach.

Medical treatment

Nonsteroidal anti-inflammatory drugs (NSAIDs) will be used as the first line of treatment, but analgesic medications may also be used, particularly in the presence of allodynia, which can affect up to 30% of cats with OA. To limit the risk of side effects, it is recommended to use only NSAIDs that are authorized for chronic use in cats, and the minimum effective dose will be prescribed. During the follow-up of the treatment, the dose may be gradually reduced, or administrations spaced out. Treatment should be accompanied by regular blood and urine tests, especially if the cat is already receiving other medications.

Opioids can be used for pain management but have poor oral bioavailability. New treatments are emerging regularly to complement this therapeutic arsenal. For example, although no studies have yet investigated the value of cannabinoids in cats with OA, cannabidiol has been proved to be effective in treating chronic pain in dogs.

Nutrition

A meta-analysis of 57 articles published between 1980 and 2021 recently confirmed the analgesic efficacy of omega-3 fatty acids (supplements or omega-3-enriched-food) for cats with OA. According to the owner's perception, supplementation with omega 3 essential fatty acids significantly improves activity level, number of walking up and down the stairs, interactions with the owner, reduces stiffness during gait and allows higher jumps.
Weight control is also essential to improve the animal's well-being.

Surgery

Although rarely performed in cats, surgery (total hip replacement or femoral head removal, arthroscopy or arthrotomy to remove mineralized fragments, joint lavage, etc.) may be considered when medical treatments do not provide relief to the cat.

Adjustment of the environment

The animal's quality of life will be improved by modifying its environment: installation of steps or ramps for climbing, comfortable sleeping area, easy access to water and food, daily brushing...

Physiotherapy

Massages, application of heat or cold, laser treatments, (etc.) are also indicated to complement the multimodal approach.

Early management of osteoarthritis increases the chances of success of an anti-inflammatory treatment and reduces the functional, behavioral and physiological consequences. The gradual reduction in pain-related activity promotes muscle wasting, reduced joint range of motion, and accelerates the progression of disability. Many behavioral problems are also linked to the presence of pain that is sometimes underestimated.

Sources

LASCELLES B., et al., “Cross-Sectional Study of the Prevalence of Radiographic Degenerative Joint Disease in Domesticated Cats”, Veterinary Surgery 39, 535–544, 2010.
BENNETT D., et al., “Osteoarthritis in the cat. 1. How common is it and how easy to recognize?” J. Feline Med. Surg., 2012, 14, 65-75.
CLARKE S.P., et al., « Feline osteoarthritis: a prospective study”, J. Small Anim. Pract., 2006, 47, 439-445.
KLINCK M.P., et al., “Owner-perceived signs and veterinary diagnosis in 50 cases of feline osteoarthritis.”, Can. Vet. J., 2013, 5, 1181-1186.
MONTEIRO B., et al., “Chronic pain in cats recent advanced in clinical assessment”, J. Feline Med. Surg. 2019, 21, 601-614.
BARBEAU-GRÉGOIRE M., et al., “A 2022 systematic review and meta-analysis of enriched therapeutic diets and nutraceuticals in canine and feline osteoarthritis”, Int. J. Mol. Sci., 2022, 23:10384.
CORBEE R.J., et al., “The effect of dietary long-chain omega-3 fatty acid supplementation on owner’s perception of behaviour and locomotion in cats with naturally occurring osteoarthritis”. JAPAN, 2013, 97(5), 846-853.

Feline chronic kidney disease

Feline chronic kidney disease (CKD) is a condition with a late clinical expression. It results from the progressive reduction in the number of functional nephrons due to irreversible nephropathy, usually bilateral. It is important to detect it as early as possible and to evaluate its stage of evolution according to the classification proposed by the International Renal Interest Society (IRIS).