Arthritis, or more correctly, osteoarthritis or degenerative joint disease (DJD), is a common condition in dogs and a rare condition in cats. Arthritis technically means "inflammation of the joint." Inflammation is characterized by swelling, stiffness, and pain; therapy is designed to counteract these effects of inflammation. When possible, the therapy should also slow down the progression of the arthritis, or, actually help the joint to heal.

A joint is the space between two bones. In dogs, the joints commonly affected with arthritis include the knee, shoulder, ankle, elbow, and most commonly, the hips. The joints between the vertebrae of the backbone also commonly develop arthritis. In cats, the backbone, hips, knees, and joints connecting the smaller bones of the feet are often afflicted.

As the animal walks and plays, a large amount of stress is placed on all the components of the joint. Biomechanical and biochemical alterations in the joint occur. With years of wear and tear on the joints, the cartilage breaks down and arthritis can develop. As wear and tear continues, the cartilage is disrupted and joint instability results.

The earlier the pet is diagnosed, the greater the chance for healing to occur using natural treatments.

Glucosamine For Pets

Glucosamine and chondroitin are commonly prescribed chondroprotective nutraceuticals. (See Totalhealth article on "Chondroitin for Osteoarthritis," in the Pet section, for more information on chondroitin.)

When we talk about chondroprotective nutraceuticals (nutritional products), we’re talking about "cartilage-protective" compounds. Unlike corticosteroids and other medications, these products actually help the cartilage rebuild and repair itself. In essence, they are "cartilage-friendly" products. These compounds also help relieve pain and inflammation. Interestingly, these improvements seem to last for several weeks after glucosamine supplements are discontinued. Chondroprotective agents can be given orally or by injection; often both forms will be used in the severely arthritic and painful pet.

Optimum functioning of the joints is important for pain-free movements by the pet. While any pet can exhibit lameness or arthritis, it is usually the older pet that is affected. Articular cartilage, the cartilage that lines the joints, must remain healthy to allow the pet to function at its maximum capability. The articular cartilage acts as a shock absorber for the joint, providing a smooth surface between bones to eliminate bone-on-bone contact. As the cartilage is destroyed, bony surfaces contact and irritate each other, causing pain, inflammation, and reduced activity. While corticosteroids and certain non-steroidal medications certainly relieve the pain and inflammation, they further destroy the articular cartilage making a bad situation even worse.

Cartilage is made of cells called chondrocytes that make a matrix of molecules, which add to the strength of the cartilage. This matrix consists of collagen, a protein that connects tissues, and substances called proteoglycans. These proteoglycans are made of glycosaminoglycans (GAGs) and hyaluronic acid. Surrounding the cartilage, and bathing the joint, is joint (synovial) fluid. Cartilage is a tough material that protects the underlying bones and acts as a shock absorber for the joints during movement.

There is a normal amount of wear and tear on the joint cartilage. The various cells and fluids are constantly being broken down and synthesized. It is important that the cartilage receive proper nutrition, especially when it is damaged and inflamed. Chondroprotective agents seek to replenish the raw materials that are essential for the healing and synthesis of cartilage, its matrix, and joint fluid.

Various products, each supplying different nutritional products, are available to assist in relieving inflammation and helping cartilage to heal when it is damaged. The following ingredients may be included in the various nutritional chondroprotective products. Each doctor has a "favorite" product. If one doesn’t help your pet, your doctor may suggest trying a different one. Keep in mind these are true holistic products; there are no harmful side effects such as those often encountered with the long-term use of corticosteroids or nonsteroidal medications.

Glucosamine is the most common chondroprotective supplement for the treatment of osteoarthritis. Glucosamine is produced naturally in the body, where it is a key building block for making cartilage. (It serves as a building block for the glycosaminoglycans and proteoglycans.) Glucosamine is an amino-sugar (made from glutamine and glucose) that is incorporated into the articular (joint) cartilage. It is supplied as a supplement in one of three forms: glucosamine sulfate, glucosamine hydrochloride (a salt of D-glucosamine; D-glucosamine is eventually converted by the body into glucosamine sulfate), or N-acetylglucosamine. Glucosamine is not usually obtained directly from food; supplements are derived from chitin, a substance found in the shells of shrimp, lobsters, and crabs.

Scientific Evidence
Studies show that while all three forms of glucosamine are effective, glucosamine hydrochloride and glucosamine sulfate were more effective than N-acetylglucosamine. Results take four to eight weeks to develop. Interestingly, these improvements often last for several weeks after glucosamine supplements are discontinued.

Glucosamine is rapidly taken up by cartilage cells and helps stimulate the synthesis of synovial fluid and cartilage, and also helps inhibit the destructive enzymes that can destroy cartilage and proteoglycans. The anti-inflammatory aspect of glucosamine may result from the scavenging of harmful free radicals (similar to antioxidants). Glucosamine is used by the cartilage for the synthesis of glycosaminoglycans.

A number of studies in people and pets show that glucosamine is equally effective for treating osteoarthritis when compared to NSAIDs, without the side effects. In fact, glucosamine and chondroitin are among the few supplements for which we actually have good studies in people and pets. For both people and pets, solid evidence indicates that glucosamine supplements effectively relieve pain and other symptoms of osteoarthritis. In both people and dogs, patients given glucosamine experienced significantly reduced pain and improved movement, to a greater extent than the improvements seen in the placebo groups.

Other studies showed that non-steroidal medications and glucosamine proved equally effective at reducing symptoms. In people, one group that received a combination treatment (nonsteroidal piroxicam plus glucosamine) didn't show significantly better results than either treatment taken alone. In this same study, after 90 days into the study, treatment was stopped and the participants were followed for an additional 60 days. The benefits of piroxicam rapidly disappeared, but the benefits of glucosamine lasted for the full 60 days.

While there are a number of glucosamine products from reputable manufacturers, many of the early major studies done in pets have used a proprietary product (Cosequin and Cosequin-DS) containing glucosamine and chondroitin. Clinical evidence indicates other products from well-known manufacturers are also effective.

Dosages
Dosages vary depending upon the product. As a guideline for combination products, a starting dose of 1000 to 1500 mg of glucosamine with 800 to 1200 mg of chondroitin is recommended per day for a 50 to 100-pound dog. This dose is then lowered after four to eight weeks.

While arthritis is rare in cats when compared with dogs, clinical experience suggests that glucosamine and chondroitin products may also be quite helpful for arthritic cats. In general, the recommended dosage for smaller dogs is used.

Glucosamine appears to be extremely safe with no side effects; mild GI upset is rarely observed. No significant side effects have been reported in any of the studies of glucosamine.

Look for part 2 in the November issue of TotalHealth.

GLUCOSAMINE AND CHONDROITIN constitute the major GAGs in the joint cartilage: glycosaminoglycans serve as major components of articular cartilage. Glycosaminoglycans function by decreasing the presence of harmful pro-inflammatory prostaglandins and other inflammatory enzymes that degrade the cartilage matrix. This results in reduced pain and inflammation, decreased enzymatic destruction of the cartilage, and stimulation of anabolic (cartilage-building) pathways. The GAGs also appear to increase the synthesis of proteoglycans, hyaluronic acid (which acts as a joint lubricant), and collagen.

One novel product called Adequan contains glycosaminoglycans extracted for bovine cartilage and is available in an injectable form. The recommended regimen is a series of eight injections, two each week for four weeks. If the pet has responded favorably during the 4-week trial, the pet is then given an injection as needed (usually one injection every one to 12 months). This injectable product can be used with oral chondroprotective supplements as well. The injectable product can be used to get a faster response than the oral supplements. Further injections are given as needed, or pets can be maintained on oral supplements according to the response seen and the convenience of the pet owner. This product has also shown effectiveness when flushed into joints during joint surgery, allowing faster and smoother recovery.

Side effects with GAGs are extremely rare but are reported to include a dose-dependent inhibition of blood clotting. Concerned owners may want to have their pets' doctors regularly monitor blood coagulation parameters and use homeopathic remedies to help increase blood-clotting factors.

The following points concerning chondroprotective therapy are important to maximize success when using these supplements:

Safety. They are extremely safe and equally effective when compared to NSAIDs.

Cost. This may be an issue for some pet owners. The typical daily cost of using a glucosamine-chondroitin supplement is approximately $1.50/day for a 50-pound dog. This cost can decrease as the dosage of the supplement is lowered to allow the owner to use the least amount to maintain pain relief. The comparable cost of the most popular NSAIDs is approximately $2 to $3 a day for a 50-pound dog making the supplements less expensive, equally effective, and without potentially serious side effects.

Early Diagnosis. Since these supplements work by acting on living cartilage cells, they are most effective when used early in the course of the disease. This requires adequate and early diagnosis.

Response Time. Because they are not drugs but nutritional supplements, the response may not be seen for four to eight weeks. During the four to eight weeks, an increased "induction" dose is used and then the dose is lowered as improvement is seen. Additional short-term therapy (with NSAIDs, acupuncture, or other therapy) can be used during the induction phase.

Effectiveness. The supplements can also be used effectively when no clinical signs are present but yet disease exists. In many practices, a number of dogs are diagnosed via screening radiographs with hip dysplasia and started on the supplements pending a decision on the owner's part for surgical correction or until clinical signs occur.

Product Purity. The purity of products is an important factor. There are many generic knock-off products that sell for much less than patented products produced by reputable manufacturers. Studies have been done showing the effectiveness of these compounds that have used pure grades of products. Products of lesser purity, while often costing less, may also be less effective. Unlike traditional drugs, these compounds are not regulated and labeling can be inaccurate or misleading; manufacturers are not required to analyze their products regarding purity, uniformity, or content. Purchase only quality products from reputable manufacturers as recommended by your doctor.

Recommended Reevaluation. Because the chondroprotective supplements are so effective after four to eight weeks in improving signs seen in arthritic pets, the diagnosis should be reevaluted after this period of time if improvement is not seen.

Shark Cartilage
There is a reported link between blood vessel growth and the development of osteoarthritis as well. The synovial (joint) fluid of arthritic pets includes an increasing amount of a chemical called endothelial cell-stimulating angiogenic factor. This chemical encourages the growth of new blood vessels in the arthritic joint. It is theorized that by inhibiting angiogenesis, further degeneration of cartilage might be prevented.

In the laboratory, shark cartilage has been shown to contain chemicals that inhibit blood vessel formation. Arthritic pets and people taking shark cartilage supplements often experience increased mobility and decreased pain. In one study, eight of ten dogs showed improvement when treated at a dosage of 750 mg/5 kg of body weight for three weeks. When treatment was temporarily discontinued, pain and lameness returned. Administering additional shark cartilage at 50 percent of the original dose resulted in improvement. The relief from pain and inflammation was theorized to occur as a result of decreased blood vessel formation.

Improvement may also result from a relief from pain due to a large number of mucopolysaccharides contained in the cartilage, which can help nourish and heal the cartilage. As a result of studies such as this one, many vets feel it is prudent to prescribe shark cartilage as it can substitute for therapy with medications like non-steroidal drugs that have potential side effects. The main problem with using shark cartilage is the large dosage required. This suggested dosage would require giving a large number of capsules to the pet daily. And since it is among our more expensive supplements, the dosage of shark cartilage needed for medium to large breed arthritic dogs would be unaffordable for most pet owners.

Shark cartilage should not be used in people who have recently suffered a heart attack, in pregnant women, and those who have or are recently recovering from deep surgery. Similar precautions probably apply to pets.

Because of the potential for impure product, owners should consult with their doctors before using shark cartilage.

Several products on the market supply a much lower dosage than that listed in the reported studies. This lower dosage has proved beneficial in some dogs. Because shark cartilage is very expensive to use in larger dogs ($40 to $50 for 2-week supply) some owners are tempted to give less than the recommended dosage. This can be useful after a one to two month stabilization period. Work with your doctor to determine the most effective dose. As is often the case with nutritional supplements, we don't know the best or most effective dose for shark cartilage. Therefore, we must use the products currently available and adapt the dosage to the individual pet's needs.

Perna
Perna canaliculus, the green-lipped mussel, is a shellfish that is a natural source of highly concentrated glycosaminoglycans (GAGs), including chondroitin, as well as a number of other nutrients, including complex proteins, amino acids, nucleic acids, naturally chelated minerals, and an inhibitor of prostaglandin syntheses, which makes it effective as an anti-inflammatory supplement.

Several studies in people have confirmed improvement in patients with osteoarthritis and rheumatoid arthritis. Ongoing studies, as well as anecdotal evidence, show the benefit of Perna in dogs with osteoarthritis. (Benefits in cats are scant, as arthritis is quite rare in cats when compared to dogs. However, veterinarians are using many dog products safely in cats.)

Stabilized powder (Seatone, MacFarlane Laboratories, Surrey Hills, Victoria, Australia) and the lipid extract (Lyprinol, MacFarlane Laboratories, Surrey Hills, Victoria, Australia) showed similar results in people with rheumatoid and osteoarthritis. The lipid extract is a 20-fold concentrate of the originally dried mussel. As is true with the powder form, the lipid extract is believed to be a potent but slow-acting antiinflammatory that inhibits cyclooxygenase and5-lipooxygenase. This is probably via the omega-3 fatty acid content of the mussels. In a laboratory experiment in rats, the dosage of Lyprinol was 20 mg/kg. In studies in people, a dosage of 300 mg twice daily for the first 30 days followed by a dosage of 150 mg twice daily showed positive results. Check with your vet for dog and cat dosages of these products.

Perna is inexpensive and readily accepted by most dogs. A product showing favorable results in pets is called Glyco-Flex Plus; it combines benefits of Perna with MSM.

Sea Cucumber
The sea cucumber, cucumaria frondosa, also known by the names, trepang and beche demer, is a marine animal related to urchins. It is believed these organisms inhibit harmful prostaglandins involved in causing pain and arthritis. They are also rich in nutrients needed by cartilage. One popular product supplies the sea cucumber in a unique jerky-type treat (Sea Jerky-R), which dogs find quite palatable. Other compounds in this product include sea kelp, natural vitamin E, lecithin, garlic, omega-3, and glucosamine hydrochloride. Each treat provides 1200 mg of chondroitin.

In testing by independent laboratories the product showed excellent anti-inflammatory activity in rats. The anti-inflammatory response was superior to that of Rimadyl and phenylbutazone. This study also showed that Sea Jerky-R had higher activity than a product made from Perna mussels and a glucosamine/chondroitin supplement, indicating this product might be preferred if a dog fails to respond to another supplement.

The recommended dosage for this product is one piece of jerky per day for a 60 to 70-pound dog. While it was assumed the active ingredient in the product was chondroitin, further research showed that while the sea cucumber contains chondroitin, another substance called InflaStatin appears to be the active ingredient.

These treats are perfect for the dog that is hard to medicate.

The jerky treats can also be used in conjunction with other similar pill supplements, as it is unlikely to overdose a pet on glucosamine or chondroitin. For those pets with arthritis, most owners and doctors like the idea of giving them a daily treat that is good for them.

Dear Readers,

Welcome to the December 2018 issue of TotalHealth Magazine.

Charles K. Bens, PhD, “NAD—The Superstar For Cellular Healing.” Bens educates us on the role of NAD (nicotinamide adenine dinucleotide) a form of vitamin B acting as an enzyme that has been proven to be a key nutrient in preventing and reversing the cellular damage in the human body. Bens has includes several graphics, which helps to explain the role of NAD. And informs us of what symptoms may be involved if you have this deficiency.

“My New Plan To Reset Your Metabolism In Just 4 Days,” by Ann Louise Gittleman, PhD, CNS. Long-time weight loss, detox, and anti-aging expert shares some of the accolades received from readers of her new book “Radical Metabolism.” Many pleased readers have taken action based on the book.

Gene Bruno, MS, MHS, “The Natural Treatment of Rheumatoid Arthritis.” If you are looking to reduce pain and promote healthy joints in those suffering from RA, Bruno has suggestions of natural supplements that may help lessen RA symptoms. O3FA (omega-3 fatty acids), Valerian and California poppy may help promote sleep and pain relief for arthritis sufferers. He suggests that the concurrent use of all of these natural substances may yield a better result than any one individually.

Amy Shah, MD, contributes “OTC Pain Medication Mistakes And Cleaner Options.” This article is for all of us current and future shoppers at the over-the-counter medicine aisle. It can be summarized as a wake-up call to read the labels, know what all the ingredients are and how they may affect you whether combining with prescription drugs. Shaw advises all to talk to our pharmacist and consult with our doctors.

Gloria Gilbère, CDP, DAHom, PhD, offers “Traditional Holiday Drinks From Ecuador, Colombia And Peru.” With the traditional holiday drinks recipes from Ecuador, Colombia, and Peru, Gilbère gives us a snapshot of what you might expect to experience when traveling to those South American countries during the holiday season. Gilbère suggests adapting the ingredients to fit our own holiday traditions.

Shawn Messonnier, DVM, this month brings us Part 3 of “Arthritis In Pets.” The focus is on acupuncture. Our resident vet presents all the types of this therapy: Laser therapy, Aquapuncture, Implantation, Electroacupuncture, Moxibustion, and Acupressure. If your pet is showing signs of arthritis you’ll find this third in the series of value.

Thanks to you our readers, the authors and advertisers who have all supported TotalHealth during the 2018 year. We wish all a Happy and Healthy Holiday Season!

Best in health,

TWIP—The Wellness Imperative People

Click here to read the full December 2018 issue.

• NAD—The Superstar For Cellular Healing
  Charles Bens, PhD
• My New Plan To Reset Your Metabolism In Just 4 Days
  Anne Louise Gittleman, PhD, CNS
• The Natural Treatment of Rheumatoid Arthritis
  Gene Bruno, MS, MHS
• OTC Pain Medication Mistakes And Cleaner Options
  Amy Shah, MD
• Traditional Holiday Drinks From Ecuador, Colombia And Peru.
  Gloria Gilbère, CDP, DAHom, PhD
• Treating Arthritis In Pets With Acupuncture
  Shawn Messonnier, DVM

Click here to read the full December 2018 issue.

Acupuncture is without a doubt one of the most field-tested techniques available in complementary medicine. For skeptics who question the effectiveness of this popular therapy, a large amount of empirical, as well as experimental, information and studies show the effectiveness of acupuncture.

In its purest sense, acupuncture involves the placement of tiny needles into various parts of a pet’s body. These needles stimulate the acupuncture points, which can affect a resolution of the clinical signs. The points are chosen based on diagnostic tests and or traditional formulas that are known to help pets with specific problems. The points correspond to areas of the body that contain nerves and blood vessels. By stimulating these points, acupuncture causes a combination of pain relief, stimulation of the immune system, and alterations in blood vessels, causing a decrease in clinical signs. Other forms of acupuncture are often chosen to provide the pet more prolonged stimulation, as they produce a higher and more continuous level of stimulation.

They include:
Laser therapy. Acupuncture points may be stimulated by low intensity or cold lasers to promote positive physiologic effects associated with healing and decreased pain and inflammation.

Aquapuncture. Aquapuncture utilizes the injection of tiny amounts of fluid (often vitamins, but also sterile water, antibiotics, herbal extracts, analgesics, local anesthetics, corticosteroids, nonsteroidal medications, or electrolyte solutions) at the acupuncture site for a more prolonged effect.

Implantation. To achieve a more prolonged and intense stimulation of acupuncture points, various objects (usually beads made of gold, silver or stainless steel) are surgically implanted at acupuncture sites.

Electroacupuncture. This form of therapy uses a small amount of non-painful electricity to stimulate the acupuncture site for a more intense effect. Moxibustion. This is the burning of an herb (typically Astesmisia Vulgaris) on or above acupuncture points. The heat from the burning herb gives additional stimulation to the acupuncture points. Care must be taken to avoid burning the pet.

Acupressure. This form involves applying pressure with the fingers to specific acupuncture points. Owners can be taught to apply acupressure at home to the points that have been used during veterinary treatments to augment the acupuncture treatments to give further relief from pain and inflammation.

Most holistic doctors combine acupuncture with other treatments to achieve a truly “holistic” therapy. For example, for pets with osteoarthritis, nutritional supplements that are designed to heal the damaged cartilage are often added to acupuncture treatment, as by itself it will not heal damaged cartilage. Once the pet has improved, doctors will use acupuncture on an “as needed” basis when the pet shows increased stiffness.

Safety Issues
As a rule, acupuncture compares quite favorably with traditional therapies. In some cases, it may be preferred when conventional therapy is ineffective or potentially harmful (such as long-term use of corticosteroids or nonsteroidal anti-inflammatory medication). At other times, acupuncture may be used when an owner cannot afford traditional therapy (such as back surgery for intervertebral disk disease or hip replacement surgery for the pet with severe hip dysplasia). It is ideal if doctors discuss both acupuncture and conventional therapies to allow the owner to make the best decision for the pet.

Side effects are rare. Accidental puncture of an underlying vital organ can occur; this usually happens if the incorrect needle size is placed in an area in which there is minimal soft tissue covering the organ. Infection can occur at the site of needle insertion; needles should not be placed in areas in which the skin is infected or inflamed. In rare instances, the needle can break (due to patient movement and incorrect placement and removal) and surgery may be needed to remove it.

Some pets require sedation in order to allow insertion of the needles. In some animals, clinical signs may worsen for a few days before they improve. This is not unusual in pets treated with complementary therapies and is explained by the body going through the healing process. In addition, some animals treated with conventional medications also get worse before the medication kicks in.

Many owners worry that acupuncture is painful and their pets will suffer. Usually, it is not painful. Occasionally, the animal will experience some sensation as the needle passes through the skin. Once in place, most animals will relax, and some may become sleepy. Fractious animals may require mild sedation for treatment. Alternatively, a complementary therapy to calm the pet, such as an herbal remedy called Rescue Remedy, can be used prior to and during acupuncture treatment.

Treatments
The number of acupuncture treatments that a pet will require varies. Usually, owners are asked to commit to eight treatments (two to three a week) to assess whether it will work. On average, treatments last about 15 to 30 minutes for needle acupuncture and five to ten minutes for aquapuncture or electroacupuncture. If the pet improves, acupuncture is done as needed to control the symptoms. Other therapies may be used to decrease the number of visits for acupuncture.

While acupuncture can be useful for a variety of disorders, most clients seek therapy for pets with musculoskeletal or neurological disorders.

Scientific Evidence
Numerous reports in the human medical literature attest to the benefits of acupuncture. One study showed 65 percent of people treated with chronic neck and shoulder pain achieved longterm improvement. Another study of 22 patients with chronic low back pain showed a 79.1 percent success rate. Acupuncture was twice as effective as the nonsteroidal anti-inflammatory medication piroxicam.

In pets, one study found 70 percent of dogs with chronic degenerative joint disease (osteoarthritis) showed greater than 50 percent improvement in mobility after treatment with acupuncture. In pets with osteoarthritis, acupuncture has been theorized to work by relieving muscle spasms around the joint, by producing pain relief by stimulating central endorphin releasing systems, by improving blood circulation, by direct anti-inflammatory effects, and by releasing local trigger points and relieving stiffness. Chinese medical theory holds it works by unblocking Qi and blood in the body’s meridians and treating the Bi syndrome.

A proper diagnosis must be made prior to starting therapy. Acupuncture cannot be effective for treatment of osteoarthritis if the pet doesn’t actually have osteoarthritis. Many dogs treated incorrectly for osteoarthritis, in fact, have a neurological disease. This requires different therapy.

Conventional Therapy
Therapies include the use of corticosteroids or nonsteroidal anti-inflammatory medications. Corticosteroids can be given by injection, by mouth, or by both. The most commonly used are prednisone, prednisolone, dexamethasone, and triamcinolone. Injections can be short-acting or longer-acting injections.

While very effective when used to relieve pain and inflammation, they have both short and longterm side effects. Short-term include increased water intake, increased urination, increased appetite, destruction of joint cartilage, and very rarely, either depression or excitability. Long-term effects that can occur include suppression of the immune system, infections, diabetes, liver disease, osteoporosis, Cushing’s disease, and obesity. Side effects are common in dogs but relatively rare in cats.

When needed, short-term use of fast-acting corticosteroids is preferred. Depot (long-lasting) injections, while commonly used in cats, should rarely, if ever, be used in dogs. In cats, an occasional depot injection (one to three a year) is usually not associated with side effects. However short-acting injections and oral medications are preferred. Side effects of NSAID usage include liver disease, kidney disease, ulceration of the stomach and intestinal tract, and possibly further destruction of the joint cartilage.

The safest use of NSAID therapy is combing them with natural treatments designed to restore joint cartilage, as well as relieve pain and inflammation. Once clinical signs improve, NSAIDs are safely used on as needed basis when the pet experiences a particularly painful day.