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In this article Melina Grin from Pet Nurture explores the prevalence, causes and diagnosis of osteoarthritis including management and treatment of Degenerative Joint Disease in cats.
What causes Arthritis in cats?
Osteoarthritis primary cause is due to mechanical ‘wear and tear’; cartilage within the joint is worn away, producing chronic debilitating pain, resulting in discomfort, inflammation, ongoing damage, and changes around the joint.
The other major type of arthritis is due to an injury or trauma (fracture, dislocation, and other joint wounds) or abnormality.
Certain breeds are at an increased risk due to genetical joint problems such as Hip Dysplasia (seen in Maine Coons, Persians, Siamese, Tonkinese, Burmese, Balinese, and other breeds) and Patella Luxation (common in Abyssinian and Devon Rex). Sottish Folds are particularly prone to severe arthritis affecting multiple joints. The other form of arthritis seen in humans is rheumatoid arthritis, which is in part an auto-immune disease.
True clear cause of DJD is not known at present. Additional studies are required to determine if it is like Osteoarthritis in humans, where mechanical injury to joints may be crucial in the disease development or whether other factors are involved. Most cats with arthritis do not appear to have an obvious predisposing reason.
Age, metabolic illness, sex, obesity, lifestyle, trauma, and genetics are major risk factors for Osteoarthritis development.
How can I tell if my cat has Degenerative Joint Disease?
Feline Arthritis is quite common in cats. Due to diagnostic challenges and decreased owner cat visits to the veterinarians, it can be difficult to say how many cats are affected. Recent studies indicate that as many as 92% of cats may have DJD, even young cats can be affected, but it may not be as noticeable until it worsens with age.
Pain in cats with DJD is usually more severe in older cats and occurs frequently in the lower back, shoulders, knees, hips, and hocks (ankles).
Subtle signs of Degenerative Joint Disease
DJD signs are subtle in nature and pain often goes undetected since cats are solitary hunters who must remain strong and healthy to be able to hunt and protect themselves from predators and apparent threats. Being masters of disguise, cats hide signs of weakness or pain as a protective instinct.
Cats with DJD seldom limp since the disease impacts the same joint bilaterally (e.g. both hips) which differs significantly from arthritis in dogs, who exhibit more pain in one limb, so it is more noticeable.
Often cats restrict activity to minimise use of sore joints so tend not to display the same symptoms of arthritis as other creatures. Cats do not show overt signs of hobbling or pain associated with arthritis, however changes in gait may be observed at times.
Cat parents play a vital role in identifying signs of DJD since owners know their cat’s usual temperament, routine, and pursuits. Any change in the cat’s normal behaviour can be a sign of pain, sickness or stress which will require veterinary check.
What are the major signs associated with arthritis in cats?
- Reduced mobility: reluctance to jump up or down, climb vertical space, heavy landings when jumping down, difficulty going up or downstairs and stiffness in legs after rest.
Serafina getting used to her pet stroller
Photo by Pet Nurture - Altered grooming: changes in coat condition and grooming behaviour, overgrooming certain areas (e.g. due to pain over a joint), diminished grooming period and overgrown nails due to inactivity.
- Decreased activity: reduced play time and interaction, hiding, decreased cat flap use, sleeping a lot and/or snoozing in different locations (e.g. low surfaces).
- Changes in normal temperament: grumpy or less happy, less active, inappropriate urination (house-soiling), reduced appetite, hissing and vocalisation when touched in painful area, self-mutilation (e.g. hair plucking), and handling resentment due to pain.
Owner monitoring of behaviours associated with pain in cats is crucial. There are two compelling tools for owners and vets to assess animals’ pain, physical function, and quality of life:
International Cat Care Mobility checklist. This quick checklist is designed to determine if your cat may have any changes that might be indicative of the presence of arthritis or joint pain.
How is Arthritis diagnosed in cats?
If your cat displays some of the above symptoms, take your cat to the veterinarian, who will perform a clinical exam to test for arthritis. The vet may manipulate the joint to check for pain, grinding, stiffness, muscle atrophy (wastage), asymmetry and reduced movement.
X-rays may also be carried out though not always needed, to check for bone changes and monitor disease progression. Occasionally blood and urine tests or joint fluid analysis may be required to rule out immune-based arthritis, infections, or other health issues.
Specialist clinics may perform Quantitative Sensory Testing (QST). In QST, calibrated devices are used to induce a noxious stimulus (e.g. mechanical, thermal, electrical) against the skin of the animal until a behavioural reaction is observed, while others may perform a Goniometer test (joint range of motion) or Gait Analysis. Gait Analysis provides information on the ground reaction forces produced by each paw during the gait cycle.
Cats with DJD show substantial differences in responses during orthopaedic examination and are less friendly when compared with sound cats.
How can you help a cat with Osteoarthritis?
Several treatment options should be considered when managing osteoarthritis in cats. A multimodality approach is recommended for Osteoarthritis treatment to improve comfort and quality of life.
Therapy choices are made based on individual patients in conjunction with pet owner and veterinary surgeon.
#1. Medical Treatment
Non-steroidal anti-inflammatories (NSAIDs): Meloxicam, Robenacoxib and pain management drugs: Tramadol and Gabapentin have been studied in cats with osteoarthritis-associated pain. Amitriptyline and Amantadine are probable therapies, although scientific evidence is poor. Developing therapies include anti-nerve growth factor antibody, cannabinoids, and Mesenchymal stem cell therapy.
Stem cell therapy is a relatively new technique in veterinary medicine and has immuno-modulatory and anti-inflammatory properties. Stem cell therapy has been used successfully to treat arthritis, ligament and tendon injuries and severe bone fractures in dogs, cats, and horses, nevertheless treatment of arthritis in dogs is most common. It is alleged that cell-based therapy does not result in regeneration of joint tissues however regenerative medicine is the goal for many diseases including DJD.
Cannabinoids or CBD products - yet to be legalised for pets in Australia - are used to control chronic pain and reduce inflammation in people. Theoretically, Palmitoylethanolamide (PEA) is an endocannabinoid which may be an exciting choice to manage inflammation and pain in animals. However, so far it has not been scientifically evaluated in cats.
#2. Therapeutic Diet and Joint Supplements
Being overweight will exacerbate arthritis so should be avoided. Weight management and controlled weight loss supervised by a vet is essential. Your vet may recommend a special diet to achieve this safely.
Diets consisting of high levels of Omega-3 fish oil, especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), are likely to be beneficial.
A recent study in cats has suggested a beneficial effect of a diet high in EPA and DHA including chondroitin sulphate, glucosamine hydrochloride, and green-lipped mussel extract. During the study, activity significantly decreased in the group fed control diet and systematically increased in the group fed the DJD diet.
Green Lipped Mussel (Perna canaliculus) extract is a derivative from mussels and contains the same Omega 3 fatty acids EPA and DHA that oily fish do. It possesses anti-inflammatory properties, wide variety of vitamins, minerals, amino-acids, antioxidants and seems to be one of the most effective joint supplements for dogs and cats.
Although now there is a diet containing fatty acids, glucosamine, chondroitin sulphate, L-carnitine, Lysine, antioxidants such as vitamin C, E and beta carotene which is suitable for treatment of cats with mobility disorders (Hill’s j/d). At this stage there is no published data to support its efficacy.
ZiwiPeak is an alternative diet that may be suitable for arthritic cats since it contains New-Zealand green-lipped mussel for natural glucosamine and chondroitin.
#3. Herbal Remedies
There are a range of well-known herbs with anti-inflammatory properties that have been effectively used for arthritis support. Consult your holistic veterinarian for further advice. More work is necessary to be done in joint supplementation since the manufacture of nutraceuticals is inadequately regulated so the quality of various products may differ enormously, however dietary modulation and supplementation may be an effective means of treating DJD associated pain in cats.
#4. Alternative Treatments
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| Serafina being treated with Laser Therapy Photo by Pet Nurture |
Massage reduces pain, stress, tension, and discomfort in chronic OA patients. Owners can be trained to apply massage and passive range of motion exercises, which may further reinforce the owner-pet bond.
Acupuncture has been used in other species to treat chronic pain of OA. This treatment has not been established in regulated studies, but anecdotal reports indicate it could be useful for some cats. It should be administered by a specially trained veterinary surgeon but not used as a replacement for medication.
Actipatch / Assisi Loop
Actipatch is a new drug-free technology which utilises electromagnetic pulse therapy to relieve musculoskeletal pain and inflammation in humans and animals. The US version is known as Assisi loop.
#5. Surgery
Surgical treatment for OA is less common in cats than dogs, but may be helpful in certain cases, typically where there has been a traumatic injury in the past. Surgical options include joint replacement and arthrodesis (fusion of a painful joint).
#6. Environmental enrichment for arthritic cats
While arthritis is a chronic condition that cannot be cured, there are numerous environmental modifications that can be done to make your arthritic cat more comfortable at home, such as:
✔️ Raise food and water dishes 7 – 9cm from the floor.
✔️ Place food and water bowls in readily accessible areas to avoid jumping.
✔️ Add non-slip stairs, stools, or gentle sloping ramps to help with easy access to favourite viewing platforms and sleeping areas. You'll find some ideas in our story on "Designing an Enriching Environment for Cats".
✔️ Place rugs to avoid sliding on slippery wooden floors.
✔️ Ground level hiding spots and simple puzzle toys.
✔️ Provide comfortable, padded bedding, even a heated cat bed (supervised).
✔️ Keep bedding in a warm, quiet, dry environment in a draft free location. Igloo beds make an older cat feel safe and cosy.
✔️ Help with daily brushing, ear and eye cleaning, and nail care.
✔️ Numerous litter boxes in accessible locations with one or more low edges.
✔️ Provide consistent playtime and gentle exercise to aid muscle and joint strength.
✔️ Use synthetic feline facial pheromone (Feliway) to improve emotional health in stressful behavioural setting.
Conclusion
Osteoarthritis is a common feline health condition which is under-diagnosed and under-treated.
Physical therapy and weight control play an important part in preventing and managing chronic pain while behavioural therapy through reinforcement of pleasurable experiences and environmental modifications can help maintain and reduce negative pain experiences promoting a positive cat’s sense of wellbeing.
Although managing pain in cats can be challenging, integration of both pharmaceutical and non-pharmaceutical options will deliver best results for pet owner and cat.
written by Melina Grin, Pet Nurture (July 2020) for Australian Cat Lover (all rights reserved).
About the writer
While working in the Veterinary field she found a distinct interest and passion in Small Animal Rehabilitation and Feline Behaviour. Melina is the proud director of Pet Nurture in Sydney, Australia (unique Mobile Animal Wellness Centre specialising in cats).
Melina is currently studying to become a qualified Veterinary Nurse with a view to progressing to Animal Behaviour Therapy. She also gives her time and expertise to several animal rescues and is the Founder of the newly created Facebook group: Feline Courses, Seminars, Webinars & Events
Bibliography
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Care, I. C. (2018, July 26). Arthritis & Degenerative Joint Disease in Cats. Retrieved July 01, 2020, from International Cat Care: https://icatcare.org/advice/arthritis-and-degenerative-joint-disease-in-cats/
Goldberg, M. E. (2017, February 23). A look at chronic pain in cats. Veterinary Nursing Journal. Retrieved July 07, 2020, from http://dx.doi.org/10.1080/17415349.2016.1269625
Heath, I. R. (2016). Feline Behavioral Health and Welfare. St Louis, MO: Elsevier. Retrieved July 03, 2020
Huntingford, J. (2020, July). Managing the Pain of Feline Degenerative Joint Disease. Today Veterinary Practice. Retrieved July 2, 2020
Karen Overall, I. R.-D.-M. (2004, December 01). Feline Behaviour Guidelines. (A. A. Practitioners, Compiler) USA. Retrieved July 02, 2020
Masakata Enomoto, B. D. (2020). Development of a checklist for the detection of a degenerative joint disease-associated pain in cats. (AAFP, Ed.) Journal of Feline Medicine and Surgery, 1-11. Retrieved July 04, 2020
Monteiro, B. P. (n.d.). Feline Chronic Pain and Osteoarthritis. USA. Retrieved July 06, 2020
Practitioners, A. A. (2017). Degenerative Joint Disease in Cats Feline Arthritis. (B. Ingelheim, Compiler) US. Retrieved July 05, 2020, from www.catvets.com
PURINA, N. (2010). Canine and Feline Clinical Nutrition. Saint Louis, Missouri, United States of America: Gloyd Group Inc. Retrieved July 07, 2020
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