Tools for addressing osteoarthritis pain

Patients with underlying orthopedic disease often experience pain that can be acute or chronic. Management of both types of pain, and considerations for the spectrum of care options for patients with forelimb lameness were discussed during an educational session at the Directions in Veterinary Medicine symposium in Miami, Florida. The session, sponsored by Synovetin, was presented by symposium faculty Curtis Dewey, DVM, MS, DACVIM, DACVS, CTCVMP; Mario D. Cabrera, DVM, CVA; and Matthew Brunke, DVM, DACVSMR, CCRP, CVPP, CVA.¹

Dewey took to the stage first, discussing neurogenic and musculoskeletal thoracic limb lameness and delving into knowing the difference. “Some of them cannot bear weight on the affected thoracic limb,” he said. “When it is clear that this dog is limping because it hurts vs the leg doesn’t work, it’s probably musculoskeletal. If it’s clear the dog is dragging its leg and can’t support weight, its neurologic.”

Pain management toolbox

Cabrera began his portion of the session by introducing an osteoarthritis (OA) toolbox inspired by the “Handy Manny” children’s cartoon about a handyman. “Everywhere he showed up, his tools went to work for him. They all worked together, and they all got the job done. It wasn’t one tool that could fix the problem, it was multiple tools,” said Cabera. “[Likewise,] there is not one fix-it for osteoarthritis. We need to bring the whole toolbox.”

Among the “tools” used by Cabrera for managing OA pain and treating the condition are weight management, exercise modification, dietary management, and surgery as well as drug therapies. Pharmaceutical considerations for treating OA include corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDS), gabapentin, grapriprant (Galliprant; Elanco), tramadol, and amantadine, and monoclonal antibody anti NGF. Additional tools that Cabrera noted for consideration in treating OA include novel radio-isotopes, osteo-cushion technology, cold laser therapy, acupuncture and massage.¹

“In talking about OA, we’re talking about a disease that is always there,” Cabrera said. “Use your best tools and prioritize. Adapt to the patient’s changing requirements. Use Manny’s toolbox.”

An injectable therapy

Brunke, the session’s final presenter, spoke about radiosynoviorthesis (Synovetin OA; Exubrion Therapeutics).^1,2 “Arthritis is not a cartilage disease. It’s a synovia disease,” he said.

Indicated for elbow OA management in canines, radiosynoviorthesis is an injection of radioactive Tin-117m. It decreases macrophages and subsequently decreases synovitis associated with pain and inflammation.²

During his presentation, Brunke noted that radiosynoviorthesis in humans has an efficacy rate of 80% or more with about 50,000 procedures performed annually.¹ In dogs, initial research showed about a 92% response rate in mild to moderate cases and 71% response rate in severe cases, with effects lasting 12 months in most cases, according to Brunke.²

In an interview with dvm360, Brunke suggested radiosynoviorthesis as a beneficial modality, based on research and his personal experience as a veterinarian. “It's been by far and away my favorite thing to use for elbow arthritis, having used a lot of other modalities. And this is where we're not only seeing the best results, but the most long-lasting ones,” he said.³

Takeaways

The presenters emphasized the need for veterinary professionals to be proactive in treating orthopedic conditions in companion animals, and not wait until there is severe cartilage damage. They also cited weight loss and exercise as important elements of a pain management plan.¹

Further, injectable therapy can be effective for cats and dogs for managing pain associated with OA. Brunke noted that the patient’s condition and level of evidence should be taken into consideration when choosing an injectate.¹

References

1. Brunke M, Cabrera MD, Dewey C. Acute and chronic forelimb lameness diagnosis and treatment options. Presented at: Directions in Veterinary Medicine; Miami, Florida. May 19-20, 2023.
2. Brunke M. Supplemental proceeding: Advanced OA management. Presented at: Directions in Veterinary Medicine; Miami, Florida. May 19-20, 2023.
3. Burke J. The latest advancements in elbow disease management. dvm360. April 23, 2023. Accessed May 22, 2023. https://www.dvm360.com/view/the-latest-advancements-in-elbow-disease-management