Canine osteoarthritis: An underdiagnosed condition

A recent study, conducted by Darryl L. Millis, DVM, DACVS, DACVSMR and Silke Hecht, Dr Med Vet, DACVR, DECVDI of the University of Tennessee College of Veterinary Medicine and published in the Journal of the American Veterinary Medical Association, examined the prevalence of undiagnosed osteoarthritis (OA) in dogs receiving a routine dental prophylaxis.

The study

In this study, 30 dogs receiving a routine dental prophylaxis at the University of Tennessee Veterinary Medical Center were screened for OA. Screening tests included an owner questionnaire, orthopedic examination by a board-certified surgeon, force plate analysis, and sedated radiographs of the dogs’ shoulders, carpi, hips, stifles, and tarsi.

This study included dogs aged 4 to 10 years old that weighed over 24 pounds (to allow for accurate force plate analysis). Chondrodystrophic dogs were excluded from the study, as were dogs with underlying systemic disease, history of previously diagnosed OA, or history of orthopedic surgery.

Study findings

Sixty percent of the study dogs (18 of 30 dogs) had radiographic evidence of OA in one or more joints. Additionally, 89% of dogs with OA (16 of 18 dogs) had two or more affected joints. This is especially remarkable given that study dogs had no known history of OA or joint disease.

Osteoarthritis was more common in the hindlimbs than the forelimbs. The coxofemoral joint was most commonly affected, with 37% of dogs showing radiographic evidence of coxofemoral OA. The prevalence of stifle OA was relatively low in this study (13%), likely because stifle OA is often associated with cruciate rupture. Dogs with cruciate rupture typically have obvious lameness, which would have excluded them from the study.

Most dogs with OA also had notable abnormalities on their lameness exam and/or physical exam.

Implications for clinical practice

This study underscores the need for effective OA screening in all canine patients, even if there’s no history of owner-observed lameness. “I encourage veterinarians to incorporate orthopedic examinations as part of all puppy and annual examinations,” said Millis. Early detection of orthopedic disease can improve prognosis, allowing for prompt treatment that will reduce pain and lameness over the patient’s lifetime.

Millis emphasized the need for orthopedic screenings in young dogs, looking for conditions like hip dysplasia, elbow dysplasia, and osteochondritis dissecans. While pet owners typically think of OA as an age-related condition, an early onset of OA is common in dogs with congenital orthopedic disease.

“Almost all veterinarians listen to the heart of puppies to screen for congenital heart defects,” Millis pointed out, “but how many do a thorough orthopedic exam to screen for developmental joint conditions?” Given the prevalence of developmental orthopedic diseases in dogs of all sizes, early screening is essential for all patients.

Millis also recommended making a thorough orthopedic history and orthopedic examination a key component of all annual examinations. “Many veterinarians and veterinary students may not like orthopedics, or they don’t feel comfortable with orthopedics,” he said, “but we are not talking about orthopedic surgery here.” All veterinarians, including general practitioners, should be comfortable taking an orthopedic history, evaluating a dog’s gait, and performing a thorough orthopedic exam.

In older dogs, increasing client education on the topic of OA is important. “I think that most owners might not understand the signs of early OA and attribute some of the changes in their dog to ‘old age’ or slowing down, without appreciating that the underlying cause is OA,” said Millis. “It really is incumbent on veterinarians to be the champion for their patients’ health and screen for OA.”

Regular screenings and training clients to recognize subtle signs of OA can play a key role in the diagnosis and management of this condition.

Tools for veterinarians

Given the prevalence of OA and the role of early detection, veterinarians have a responsibility to be proactive in their efforts to diagnose and manage this condition.

The 2022 AAHA Pain Management Guidelines for Dogs and Cats are a valuable resource for general practitioners, highlighting both pain assessment/screening and recommended treatment modalities. The supplemental AAHA Pain Management Guidelines Toolkit provides suggested workflows and team training to support implementation of these guidelines. These resources can support practices in ensuring that pain assessments (including pain scores) are performed at every patient visit, through a collaboration between the veterinary team and the client.

The 2022 WSAVA guidelines for the recognition, assessment, and treatment of pain are an additional resource that can help support veterinary teams. In addition to general guidelines related to the diagnosis and management of pain, WSAVA offers a pain management protocol for degenerative joint disease.

By incorporating these resources and giving conscious thought to screening every patient for orthopedic disease, practices can elevate their level of patient care and reduce patient suffering.

Photo credit: momnoi/iStock via Getty Images

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