You walk into your exam room for a routine wellness appointment to find your harried-looking client wrangling two energetic kids while your patient, a five-year-old Labrador, romps around trying to get in on the fun. After everyone is reasonably calm, you perform your physical exam, noting some tenderness in the dog’s left stifle.

You tell your client about your osteoarthritis concerns, and she nods along while trying valiantly not to glance at the texts pinging urgently on her phone. You recommend she schedule a follow-up orthopedic exam for radiographs and to discuss treatment possibilities.

“Let me talk to my spouse about it and I’ll get back to you,” she says, as she guides her small moiling herd toward the front desk, already late for soccer practice. You sigh and make a note in the chart to follow up if you do not hear from her. Sounds familiar? As general practice veterinarians, we have a lengthy list of issues to cover during wellness visits, and conversations about osteoarthritis (OA) can get lost in the noise and chaos. In fact, in a recent osteoarthritis study, over half (51 percent) of dog owners said their veterinarian had never talked to them about arthritis or joint problems.¹ That is a lot of clients, especially considering OA affects nearly 40 percent of dogs.²

As much as I would like to believe my clients hang on my every word, I can say with reasonable confidence at least some of those dog owners surveyed are like the one described above—they got the information from their veterinarian; it just did not register. However, the fact remains even if we are talking about OA in the exam room, not enough dog owners are hearing us. This means too many dogs are suffering with joint problems that could be treated.

In my own clinic, I have tried to close this gap by creating the OA pyramid of care, a protocol that helps us begin joint discussions early in every dog’s life as part of routine care, right along with vaccine protocols and parasite prevention. This approach streamlines the process for our team, so we are as efficient as possible, and it helps more dogs get early treatment and care for their joints.

Here is how to implement the pyramid of care in practice, starting with the very first appointment.

Discuss OA at every visit ​

As we know, a client may need to hear about your OA concerns several times before it registers, and the best time to start the conversation is when your patient is healthy, before the disease process may have begun.​ With at-risk breeds (Labs, German shepherds, goldens, and so on), have the discussion at the first puppy visit, since we know the issues that can lead to OA are present when these dogs are developing.​

The earlier your team intervenes with measures to protect cartilage and maintain mobility, the better off your patients will be.​ Rule of thumb? Shift your focus (and that of your clients’) from thinking of OA as an “old dog disease” to identifying OA risk in young dogs.​

Educate dog owners about early signs

Whether a dog is young or old, large or small, high-risk or low-risk in terms of breed, we know they can be affected by OA. So, educate your clients to be on the lookout and let you know ASAP if their dog:

• Acts more anxious, restless, or irritable​
• Struggles to get comfortable and frequently changes positions​
• Is slower to get up or sit down​
• Shifts weight from side to side or front to back while standing​
• Shows affected mobility after activity or less interest in play​
• Hesitates before doing normal activities, such as walking, sitting, or climbing stairs

A couple of helpful hints based on my experience: An “injury” in a young dog may be OA​. In other words, if a young dog starts limping, the owner may assume a soft-tissue injury and present to your clinic that way. It may be related to OA, requiring appropriate management, so keep that on your differentials list.

Also, do not ask clients if their dog is showing signs of pain—they may not know what to look for. Instead ask, “Does your dog have any physical limitations that you’ve noticed?” or, “Any issues getting up on or down from the couch or in and out of the car?”

Implement a consistent protocol

Here’s where the pyramid of care comes in to make the process consistent for your team and to catch OA early. It builds from the ground up, adding or incorporating new management strategies with each advancing stage (Figure 1). Too often, conversations about OA do not happen until stages 3 and 4, or even 5, when they should begin at stage 1 or, at the latest, 2, to protect as much joint function as we can and push the clinical signs later into the patient’s life. If there is one thing I hammer home with my team and my clients about OA intervention, it is, “Start early, start early, start early.”

Recommend a DMOAD

While NSAIDs, nutraceuticals, or joint supplements can all play a role in multimodal management of OA, the drug options primarily focus on managing the pain associated with OA. A DMOAD, on the other hand, acts on joint tissues to help slow the progression of structural changes in addition to controlling clinical signs.

I introduce polysulfated glycosaminoglycan in my canine patients as soon as there is evidence of OA—which means at stage 2 and every subsequent stage, as appropriate, in the pyramid of care. The key to success is, again, to start early once diagnosed, which means being proactive ​with our patients’ joint health.

Building the bond

At the heart of this “early and often” approach to OA communication lies the bond between our patients and their owners. When we create a path to intervene in OA before mobility is severely affected (or affected at all!), we can help increase the number of high-quality years our clients spend with their canine family members. If you are at all like me, this is what being a veterinarian is all about.

Rick Marrinson, DVM, operates and practices at Longwood Veterinary Clinic in Longwood, Fla. Dr. Marrinson is a paid consultant for American Regent Animal Health. The views expressed are those of the author and not necessarily those of American Regent Animal Health.

References

1. Adequan Canine Osteoarthritis Awareness Study, S&A and Dogster. July 2022.
2. A. Wright, D. M. Amodie, N. Cernicchiaro et al., Identification of canine osteoarthritis using an owner-reported questionnaire and treatment monitoring using functional mobility tests, J Small Anim Pract. 2022;63(8):609-618. https://pubmed.ncbi.nlm.nih.gov/35385129