Beyond Pharmaceuticals: Prevention and treatment of osteoarthritis in cats and dogs

For many years, osteoarthritis (OA) pain in dogs and cats was managed with a single pharmaceutical agent, if and when the clinician determined the animal was suffering. Recently, it has been realized that pain is a very complex process involving signaling molecules, pathways, substances, receptors, and transmitters with different modes of action. It is unrealistic to think that only one pharmaceutical could be effective in eliminating chronic pain.¹ It is equally unrealistic to think that drugs alone can manage pain effectively for the life of the animal. Successful management combines owner education, weight and nutrition optimization, nutraceutical and pharmaceutical therapies, physical medicine, interventional and regenerative approaches, and environmental modifications. 

Pathophysiology and treatment targets 

Joint stress triggers synovial cells, chondrocytes, macrophages, and fibroblasts to release proinflammatory cytokines, such as tumor necrosis factor alpha and interleukins, that upregulate cyclooxygenase-2 enzymes and increase prostaglandins that perpetuate inflammation. This inflammatory milieu upregulates matrix metalloproteinases (MMPs) and aggrecanases. When MMP activity exceeds that of their tissue inhibitors (TIMP-2), the balance shifts toward cartilage matrix degradation. Cartilage thinning produces joint-space narrowing, subchondral bone remodeling with sclerosis and osteophyte formation, effusion, and periarticular swelling, leading to pain, reduced use, and secondary muscle atrophy. Therapeutic aims are, therefore, to reduce inflammatory prostaglandins, decrease MMP-2 and MMP-9 production, and increase TIMP-2 to restore enzyme balance and slow cartilage destruction.²

General guidelines for OA prevention and treatment ³

1. Client education: Educate owners on OA pathophysiology, risk factors, staging, and recognizable pain behaviors, emphasizing that OA is a chronic, managed—not curable—condition requiring individualized, often multimodal therapy rather than reliance on a single medication. Address nutrition and weight management at the initial visit and ongoing, reviewing evidence-based nutraceuticals and how they integrate with pharmaceuticals and physical medicine modalities. Schedule early and frequent reassessments (at least 2 early follow-ups) to monitor response, adjust therapy, and reinforce owner participation in home exercises and lifestyle modifications.
2. Weight management: The prevalence of OA is likely close to 60% of all dogs, and over 50% of all dogs are overweight. Excess weight causes an excess load on an abnormal joint, creating more pain. In addition, adipose tissue secretes proinflammatory adipokines, which increase the overall inflammation in the joints and elsewhere in the body. Research has shown that as little as a 6% weight reduction reduces the pain of OA in dogs and cats.^4,5
3. Exercise: All dogs with OA need regular exercise, but high-impact exercises should be limited. Prolonged rest is not indicated as it leads to muscle atrophy, stiffness, and contracture. Therapeutic exercise contributes to pain management through exercise-induced hypoalgesia, which results from activation of the opioid system with beta-endorphin release from the pituitary. Exercise activates large afferent nerves, and mechanical hypoalgesia is induced by repeated low-load exercises regardless of exercise mode. Exercises used for OA patients include stretching, strengthening, balance, proprioception, flexibility, endurance, and muscle re-education.

Canine OA staging tool

The canine OA staging tool (COAST) is a new staging system for canine OA, proposed by leading experts in orthopedic health and pain management, that provides a standardized approach to evaluating dogs with clinical signs of OA, as well as identifying those at risk of developing OA. It is designed for first-opinion practices to identify and stage preclinical and clinical OA. COAST is used to stratify risk and direct therapy.⁶

• Stage 0–1 (preventive/at-risk): Emphasize weight optimization, strategic supplements, and early physical conditioning. Balance and proprioception exercises, along with strengthening, should be the focus in this stage.
• Stage 2 (mild clinical signs): Follow stage 0-1 guidelines but institute multimodal analgesia for flares (nonsteroidal anti-inflammatory drugs; NSAIDs), begin/optimize rehabilitation (acupuncture, photobiomodulation therapy [formerly known as laser therapy]) and chondroprotective strategies.
• Stage 3–4 (moderate to severe): Institute advanced multimodal pain control (NSAIDs, anti–NGF monoclonal antibodies (mABs), ± adjunct neuropathic agents), cannabinoids, joint injections, tailored rehabilitation, and quality-of-life/end-of-life discussions as needed.⁴

Feline OA

The COAST tool is designed specifically for staging canine osteoarthritis and is not validated for cats. Despite this, management principles for feline OA are like those for dogs, focusing on multimodal care. Almost 100 % of cats over 10 years of age have OA in one form or another. Cats are often diagnosed based on behavioral changes, such as decreased activity, reluctance to jump, or difficulty climbing, rather than solely on imaging. Feline treatments include mABs (eg, frunevetmab) monthly injections, judicious long-term use of NSAIDs such as meloxicam or robenacoxib where appropriate, and injectables such as Adequan. Nutraceuticals, environmental modifications, weight management, and rehabilitation therapies are essential.^7,8

Evidence-based nutraceuticals and injectables

• Omega-3 fatty acids (such as eicosapentaenoic acid [EPA]/docosahexaenoic acid [DHA]) have the strongest nutraceutical evidence. The mechanism of action is to replace arachidonic acid–derived eicosanoids with fewer inflammatory mediators, thereby reducing inflammatory prostaglandins and leukotrienes. Therapeutic diets or marine supplements can be used (no flaxseed oil). The recommended dose for dogs is 100 mg/kg of EPA and DHA and 50 mg/kg for cats. Supplementation with vitamin E may be required if the patient is on a homemade or boutique diet. Do not go over the recommended dose for cats.^9-11
• Green-lipped mussel (Perna canaliculus) contains EPA/DHA, ETA (eicosatetraenoic acid) glycoproteins, and glycosaminoglycans (GAGs). Randomized controlled trials (RCTs) show benefit when compared with NSAIDs or other nutraceuticals.^12-14

• Undenatured type II collagen oral immune tolerance mechanism reduces anti–type II collagen immune activity; RCTs in dogs show force-plate improvements vs placebo/glucosamine. Typical dosing is 40 to 80 mg of undenatured collagen.^15-17
• The combination of glucosamine and chondroitin has mixed results. Some trials show a benefit, whereas others do not. Consider it when owners prefer it, but counsel them on its variable bioavailability and limited high-quality evidence.^18-20
• PSGAG (Adequan) and pentosan polysulfate sodium are injectable chondroprotectants with evidence for early intervention to reduce progression; PSGAG dosing is commonly 4.4 mg/kg subcutaneously twice weekly for 4 weeks, then every 6 months. Pentosan doses vary by region but are often 1 ml/33 kg weekly for 4 weeks, then monthly.

Physical medicine and rehabilitation

Rehabilitation is integral and should be prescribed with progressive goals.

• Therapeutic exercises, such as low-impact strengthening, proprioception, range-of-motion, and endurance exercises, can be prescribed in the hospital or at home to restore muscle mass and joint support. Avoid high-impact activities.
• Water therapy, such as hydrotherapy and workouts on an underwater treadmill, is excellent for low-impact conditioning, gait retraining, and muscle strengthening.
• Manual therapies such as joint mobilizations (Maitland grades), spinal manipulation therapy, soft tissue mobilization, and therapeutic massage may all be used to reduce nociception and improve mobility.
• Modalities such as photobiomodulation and acupuncture are frequently recommended for analgesia and tissue healing, and pulsed electromagnetic field therapy and shockwave therapy are advised for focal pain.^21-23

Regenerative and interventional therapies

• Platelet rich plama (PRP) and mesenchymal stem cell therapies: There is growing evidence for symptom relief mediated by growth factors and immunomodulation.
• Hydrogel injections: There is evidence in humans and horses, with some canine evidence now published. However, cost may be a factor.
• Intra-articular corticosteroids: They may provide short-term relief for refractory synovitis, but the risks to cartilage must be considered.²³

Environmental and assistive interventions

Environmental modifications often provide significant functional improvement with low risk. This includes ramps, nonslip flooring, raised bowls, and orthopedic bedding. Assistive devices may include harnesses, slings, braces, toe grips, and mobility carts when indicated.

Summary

OA management should be multimodal, stage-appropriate, and evidence-informed. Prioritize weight reduction, omega-3–rich nutrition, targeted nutraceuticals, and chondroprotective injectables early; combine rehabilitation and physical medicine for musculoskeletal support; and implement multimodal pharmacologic strategies for analgesia. Regenerative and interventional options can be valuable adjuncts. Veterinarians must individualize plans, thoroughly educate owners, monitor outcomes and adverse effects, and adjust treatments to maximize long-term comfort and function.

References

1. Anderson KL, Zulch H, O’Neill DG, Meeson RL, Collins LM. Risk factors for canine osteoarthritis and its predisposing arthropathies: a systematic review. Front Vet Sci. 2020;7:220. doi:10.3389/fvets.2020.00220
2. Rychel JK. Diagnosis and treatment of osteoarthritis. Top Companion Anim Med. 2010;25(1):20-25. doi:10.1053/j.tcam.2009.10.005
3. Marcellin-Little DJ, Hulse DA, Huntingford JL, et al. A proposed framework for practical multimodal management of osteoarthritis in growing dogs. Front Vet Sci. 2025;12:1565922. doi:10.3389/fvets.2025.1565922
4. Huck JL, Biery DN, Lawler DF, et al. A longitudinal study of the influence of lifetime food restriction on development of osteoarthritis in the canine elbow. Vet Surg. 2009;38(2):192-198. doi:10.1111/j.1532-950X.2008.00487.x
5. Lawler DF, Evans RH, Larson BT, Spitznagel EL, Ellersieck MR, Kealy RD. Influence of lifetime food restriction on causes, time, and predictors of death in dogs. J Am Vet Med Assoc. 2005;226(2):225-231. doi:10.2460/javma.2005.226.225
6. Mosley C, Edwards T, Romano L, et al. Proposed Canadian consensus guidelines on osteoarthritis treatment based on OA-COAST stages 1-4. Front Vet Sci. 2022;9:830098. doi:10.3389/fvets.2022.830098
7. Enomoto M, Lascelles BDX, Gruen ME. Development of a checklist for the detection of degenerative joint disease-associated pain in cats. J Feline Med Surg. 2020;22(12):1137-1147. doi:10.1177/1098612X20907424
8. Clarke SP, Mellor D, Clements DN, et al. Prevalence of radiographic signs of degenerative joint disease in a hospital population of cats. Vet Rec. 2005;157(25):793-799. doi:10.1136/vr.157.25.793
9. Bauer JE. Therapeutic use of fish oils in companion animals. J Am Vet Med Assoc. 2011;239(11):1441-1451. doi:10.2460/javma.239.11.1441
10. Johnson KA, Lee AH, Swanson KS. Nutrition and nutraceuticals in the changing management of osteoarthritis for dogs and cats. J Am Vet Med Assoc. 2020;256(12):1335-1341. doi:10.2460/javma.256.12.1335
11. Mehler SJ, May LR, King C, Harris WS, Shah Z. A prospective, randomized, double blind, placebo-controlled evaluation of the effects of eicosapentaenoic acid and docosahexaenoic acid on the clinical signs and erythrocyte membrane polyunsaturated fatty acid concentrations in dogs with osteoarthritis. ProstaglandinsLeukot Essent Fatty Acids . 2016;109:1-7. doi:10.1016/j.plefa.2016.03.015
12. Pollard B, Guilford WG, Ankenbauer-Perkins KL, Hedderley D. Clinical efficacy and tolerance of an extract of green-lipped mussel (Perna canaliculus) in dogs presumptively diagnosed with degenerative joint disease. N Z Vet J. 2006;54(3):114-118. doi:10.1080/00480169.2006.36622
13. Kampa N, Kaenkangploo D, Jitpean S, et al. Study of the effectiveness of glucosamine and chondroitin sulfate, marine based fatty acid compounds (PCSO-524 and EAB-277), and carprofen for the treatment of dogs with hip osteoarthritis: a prospective, block-randomized, double-blinded, placebo-controlled clinical trial. Front Vet Sci. 2023;10:10:1033188. doi:10.3389/fvets.2023.1033188
14. Kampa N, Kaenkangploo D, Jitpean S, et al. Evaluation of the comparative efficacy of green lipped mussel plus krill oil extracts (EAB-277), Biota orientalis extracts or NSAIDs for the treatment of dogs with osteoarthritis associated pain: a blinded, placebo-controlled study. Front Vet Sci. 2024;11:1464549. doi:10.3389/fvets.2024.1464549
15. Gupta RC, Canerdy TD, Lindley J, et al. Comparative therapeutic efficacy and safety of type‐II collagen (UC‐II), glucosamine and chondroitin in arthritic dogs: pain evaluation by ground force plate. J AnimPhysiol Anim Nutr . 2012;96(5):770-777. doi:10.1111/j.1439-0396.2011.01166.x
16. Stabile M, Samarelli R, Trerotoli P, et al. Evaluation of the effects of undenatured type II collagen (UC-II) as compared to robenacoxib on the mobility impairment induced by osteoarthritis in dogs. Vet Sci. 2019;6(3):72. doi:10.3390/vetsci6030072
17. Varney JL, Fowler JW, Coon CN. Undenatured type II collagen mitigates inflammation and cartilage degeneration in healthy Labrador retrievers during an exercise regimen. Transl Anim Sci. 2021;5(2):txab084. doi:10.1093/tas/txab084
18. Scott RM, Evans R, Conzemius MG. Efficacy of an oral nutraceutical for the treatment of canine osteoarthritis: a double-blind, randomized, placebo-controlled prospective clinical trial. Vet CompOrthop Traumatol . 2017;30(5):318-323. doi:10.3415/VCOT-17-02-0020
19. Barbeau-Grégoire M, Otis C, Cournoyer A, Moreau M, Lussier B, Troncy E. A 2022 systematic review and meta-analysis of enriched therapeutic diets and nutraceuticals in canine and feline osteoarthritis. Int J Mol Sci. 2022;23(18):10384. doi:10.3390/ijms231810384
20. Frye C, Carr BJ, Lenfest M, Miller A. Canine geriatric rehabilitation: considerations and strategies for assessment, functional scoring, and follow up. Front Vet Sci. 2022;9:842458. doi:10.3389/fvets.2022.842458
21. Looney AL, Huntingford JL, Blaeser LL, Mann S. A randomized blind placebo-controlled trial investigating the effects of photobiomodulation therapy (PBMT) on canine elbow osteoarthritis. Can Vet J. 2018;59(9):959-966.
22. Huntingford JL, Petty MC. Evidence-based application of acupuncture for pain management in companion animal medicine. Vet Sci. 2022;9(6):252. doi:10.3390/vetsci9060252.
23. Koh RB, Huntingford J. Integrative Treatment of Common Musculoskeletal and Neurological Conditions. Integrative Veterinary Medicine. 2023 May 30:144-56.