Osteoarthritis Management

Question 1

What three treatments are recommended in the primary care of Osteoarthritis?

Answer 1

Analgesics
Weight Loss
Exercise restriction

Question 2

How do force plates/ pressure mats help us assess Osteoarthritic pain?

Answer 2

allows objective measurement of limb use

Question 3

What are the advantages and disadvantages to using Client Reported Outcome Measures (CROMS)?

Answer 3

Validated questionnaire that allows scoring of subjective assessments and helps identify other measures such as quality of life and motility of the dog
X- Bias is still possible [‘caregiver effect’

Question 4

Why does weight loss improve osteoarthritic signs? (2)

Answer 4

lessens mechanical load and reduces adipogenic inflammation (fat deposition drives adipogenic mediators)

Question 5

For what duration should we administer NSAIDs in the management of osteoarthritis?

Answer 5

Single short dose has analgesic benefit
3 weeks duration has anti inflammatory benefit
then after 4-6 weeks treatment allow wind down period (taper dose)

Question 6

NSAID side effect are rare but what can increase the risk of them? (3)

Answer 6

Excessive dosing
Combination NSAIDs or use with a steroid
Pre existing disease

Question 7

Apart from Prostaglandin antagonistic NSAIDs, what other medications can we use for Osteoarthritis management? (4)

Answer 7

Corticosteroids
Galliprant (EP4 receptor antagonist)
Anti-NGF mAbs
Amantadine (NMDA antagonist)

Question 8

When and why is Galliprant indicated over normal NSAIDs?

Answer 8

If patient can’t tolerate NSAIDs e.g. Galliprant means less nausea/ vomiting
It inhibits inflammation without impacting PG2 functions

Question 9

Give an example of a renally safe NSAID.

Answer 9

[trick question]- there is none that is completely safe when the kidney is stressed

Question 10

What are Anti-NGF mAbs and how do they work?

Answer 10

Monthly injection of anti-NGF antibody
Osteoarthritic inflammation is high in nerve growth factor which has roles in pain signalling- this drug binds to NGF to reduce pain signalling

Question 11

Give the name of the Anti-NGF mAbs drug licensed in dogs and cats?

Answer 11

Dogs- Bedinvetmab (Librela)
Cat- Frunevetman (Solensia)

Question 12

How does Amantadine work and when is it contraindicated?

Answer 12

NMDA antagonist like ketamine that reduces central sensitization to provide analgesia
Contraindicated in patients with renal problems- excreted via the kidneys

Question 13

Why do omega 3 fatty acid supplements work in Osteoarthritis cases?

Answer 13

increase anti inflammatory cytokines

Question 14

What 3 surgical salvage procedures are available in the management of Osteoarthritis?

Answer 14

Arthroplasties- joint replacement
Arthrodesis- fusion of a joint
Amputation

Question 15

How does Intra articular botox to treat Osteoarthritic pain work?

Answer 15

Intra articular injection of botulinum toxin inhibits the pain pathway neurotransmitter release

Question 16

Tramadol is a weak opioid receptor agonist that blocks the descending pain pathway- how effective is this in OA management?

Answer 16

Not very- ineffective as the sole therapy but can be combined with other NSAIDs

Question 17

Gabapentin MAY work in OA management- what should we consider when using this? (3)

Answer 17

Shouldn’t be used as the sole therapy- not effective enough
Requires several weeks to have any effect
To stop we must taper the dose over several weeks or we risk seizures occuring

Question 18

Can we use Paracetamol to manage OA pain?

Answer 18

In dogs- yes but only licensed for 5 days and NEVER with an NSAID
In cats- NEVER!!!!

Question 19

When is paracetamol indicated for OA management?

Answer 19

If patient has GI issues- otherwise NSAIDs much more preferable

Question 20

Which stem cells are licensed for the treatment of canine OA?

Answer 20

equine umbilical cord stem cells (Xeno stem cell therapy)

Question 21

How does platelet rich plasma treat OA?

Answer 21

Contains alpha granules such as TGFb, VEGF etc. that promotes angiogenesis, immunomodulation and chondrogenesis

Question 22

What is the CAM home checklist?

Answer 22

canine arthritis management questionnaire- contains questions/ modification ideas for owners in their home such as stairs, food bowl height, non slip mats

Question 23

Summarise the four stages/ process of OA management in canine patients?

Answer 23

1. weight loss & exercise management
2. inflammation control with NSAIDs then piprants > biologics > steroids
3. wind down stage with gabapentin or amantadine
4. salvage procedures (surgery)

Question 24

How do we maintain pain perception consistency in our patients with OA?

Answer 24

Use a form to make it more systemic- average weekly score and 6 monthly review

Question 25

How can we quantitively measure OA progression in a physical exam?

Answer 25

Goniometry- measuring the joint ranges in each joint plane