Diagnosis of arthritis in cats

Klinck MP, Frank D, Guillot M and Troncy E. Owner-perceived signs and veterinary diagnosis in 50 cases of feline osteoarthritis. Can Vet J. 2012; 53: 1181-6.

Osteoarthritis (OA) is common in older cats and the associated chronic pain and functional limitations are a serious animal welfare concern. In this study from the University of Montreal, owners of 50 cats were interviewed to collect information on specific osteoarthritis signs observed in the home. Information was collected on signs relating to mobility, self-maintenance, social and exploratory behavior, and activity and habits at diagnosis and after treatment. The mean age at diagnosis of OA was 12 years and many cats (44%) had concurrent diseases. Owner-reported abnormalities led to OA diagnosis in most cases; either as the primary finding (30%), or combined with abnormal physical examination or radiographic findings (64%). Owners frequently reported changes in mobility, particularly gait, jumping, and use of stairs. It was rare for a diagnosis of OA to be based on physical examination findings alone. 

The most common treatments were glucosamine and polysulfated glycosaminoglycan products. Feline OA diagnosis and therapeutic monitoring remains challenging for veterinary practitioners and it appears to rely heavily on owner-perceived signs. Questioning of owners with cats at risk for OA revealed various observable signs potentially useful in detection and monitoring. [MK]

See also: Bennett D, Zainal Ariffin SM and Johnston P. Osteoarthritis in the cat: 1. how common is it and how easy to recognise? J Feline Med Surg. 2012; 14: 65-75. 

Related blog articles:
Improving treatment of chronic pain in cats (April 2012)
Osteoarthritis in cats (August 2010)

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Winn Feline Foundation Library
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Klinck MP, Frank D, Guillot M and Troncy E. Owner-perceived signs and veterinary diagnosis in 50 cases of feline osteoarthritis. Can Vet J. 2012; 53: 1181-6.

Osteoarthritis (OA) is common in older cats and the associated chronic pain and functional limitations are a serious animal welfare concern. In this study from the University of Montreal, owners of 50 cats were interviewed to collect information on specific osteoarthritis signs observed in the home. Information was collected on signs relating to mobility, self-maintenance, social and exploratory behavior, and activity and habits at diagnosis and after treatment. The mean age at diagnosis of OA was 12 years and many cats (44%) had concurrent diseases. Owner-reported abnormalities led to OA diagnosis in most cases; either as the primary finding (30%), or combined with abnormal physical examination or radiographic findings (64%). Owners frequently reported changes in mobility, particularly gait, jumping, and use of stairs. It was rare for a diagnosis of OA to be based on physical examination findings alone. 

The most common treatments were glucosamine and polysulfated glycosaminoglycan products. Feline OA diagnosis and therapeutic monitoring remains challenging for veterinary practitioners and it appears to rely heavily on owner-perceived signs. Questioning of owners with cats at risk for OA revealed various observable signs potentially useful in detection and monitoring. [MK]

See also: Bennett D, Zainal Ariffin SM and Johnston P. Osteoarthritis in the cat: 1. how common is it and how easy to recognise? J Feline Med Surg. 2012; 14: 65-75. 

Related blog articles:
Improving treatment of chronic pain in cats (April 2012)
Osteoarthritis in cats (August 2010)

More on cat health:
Winn Feline Foundation Library
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Follow us on Twitter
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Long term treatment with meloxicam in cats

Gowan RA, Baral RM, Lingard AE, et al. A retrospective analysis of the effects of meloxicam on the longevity of aged cats with and without overt chronic kidney disease. J Feline Med Surg. 2012; 14: 876-81.

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed pharmaceuticals for the treatment of pain and inflammation in humans, dogs, and horses. Meloxicam is metabolized primarily through the oxidative pathway rather than the glucuronidation pathway, an important factor in limiting toxicity in cats. The dependence of many NSAIDs on the glucuronidation pathway is part of the reason for the cat’s susceptibility to NSAID toxicity. Meloxicam is a COX-2 selective inhibitor with a COX-1/COX-2 ratio of inhibition of 2.7; thus, adverse effects of meloxicam are still of concern and primarily involve the gastrointestinal tract and kidneys due to the dependence of these organs on COX-1 for health. In the European Union, Switzerland, Australia, and New Zealand, meloxicam is licensed for long-term treatment of chronic pain in cats. In the United States, meloxicam has a black box label for avoiding its repeated use due to an increased risk of acute renal failure and death. This unacceptable risk has not been a concern in other countries, possibly due to better patient selection and the lower doses used. Regardless of licensed or extra-label use of meloxicam, previous studies have shown that it can be administered safely to aged cats with or without chronic kidney disease (CKD), at least at low therapeutic doses and provided they are clinically stable and monitored carefully.



This study builds on previous work of Gunew et al. and Gowan et al. and further examines the effect of long-term meloxicam administration on renal function in cats with and without pre-existing CKD by providing long-term survival data. A total of 82 cats were enrolled in the study of which 47 had CKD and 35 did not have evidence of overt CKD. Treatment with meloxicam did not appear to decrease longevity in cats with pre-existing CKD, as survival times (median 1608 days) were not reduced when compared with previously published data. Quality of life is a major concern for cat owners, in particular with regard to chronic painful conditions. In conclusion, these authors recommend that meloxicam should be considered as part of a therapeutic regimen in cats with chronic painful conditions, with or without overt stable CKD. [GO]

See also:
Sparkes AH, Heiene R, Lascelles BDX, et al. ISFM and AAFP consensus guidelines: Long-term use of NSAIDs in cats. J Feline Med Surg. 2010; 12: 521-38.

Gowan RA, Lingard AE, Johnston L, Stansen W, Brown SA and Malik R. Retrospective case-control study of the effects of long-term dosing with meloxicam on renal function in aged cats with degenerative joint disease. J Feline Med Surg. 2011; 13: 752-61. 

Related blog articles:
Meloxicam for feline arthritis (June 2008)
Cats and arthritis (2009)

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Join us on Google+

Gowan RA, Baral RM, Lingard AE, et al. A retrospective analysis of the effects of meloxicam on the longevity of aged cats with and without overt chronic kidney disease. J Feline Med Surg. 2012; 14: 876-81.

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed pharmaceuticals for the treatment of pain and inflammation in humans, dogs, and horses. Meloxicam is metabolized primarily through the oxidative pathway rather than the glucuronidation pathway, an important factor in limiting toxicity in cats. The dependence of many NSAIDs on the glucuronidation pathway is part of the reason for the cat’s susceptibility to NSAID toxicity. Meloxicam is a COX-2 selective inhibitor with a COX-1/COX-2 ratio of inhibition of 2.7; thus, adverse effects of meloxicam are still of concern and primarily involve the gastrointestinal tract and kidneys due to the dependence of these organs on COX-1 for health. In the European Union, Switzerland, Australia, and New Zealand, meloxicam is licensed for long-term treatment of chronic pain in cats. In the United States, meloxicam has a black box label for avoiding its repeated use due to an increased risk of acute renal failure and death. This unacceptable risk has not been a concern in other countries, possibly due to better patient selection and the lower doses used. Regardless of licensed or extra-label use of meloxicam, previous studies have shown that it can be administered safely to aged cats with or without chronic kidney disease (CKD), at least at low therapeutic doses and provided they are clinically stable and monitored carefully.



This study builds on previous work of Gunew et al. and Gowan et al. and further examines the effect of long-term meloxicam administration on renal function in cats with and without pre-existing CKD by providing long-term survival data. A total of 82 cats were enrolled in the study of which 47 had CKD and 35 did not have evidence of overt CKD. Treatment with meloxicam did not appear to decrease longevity in cats with pre-existing CKD, as survival times (median 1608 days) were not reduced when compared with previously published data. Quality of life is a major concern for cat owners, in particular with regard to chronic painful conditions. In conclusion, these authors recommend that meloxicam should be considered as part of a therapeutic regimen in cats with chronic painful conditions, with or without overt stable CKD. [GO]

See also:
Sparkes AH, Heiene R, Lascelles BDX, et al. ISFM and AAFP consensus guidelines: Long-term use of NSAIDs in cats. J Feline Med Surg. 2010; 12: 521-38.

Gowan RA, Lingard AE, Johnston L, Stansen W, Brown SA and Malik R. Retrospective case-control study of the effects of long-term dosing with meloxicam on renal function in aged cats with degenerative joint disease. J Feline Med Surg. 2011; 13: 752-61. 

Related blog articles:
Meloxicam for feline arthritis (June 2008)
Cats and arthritis (2009)

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Join us on Google+

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Health care decisions by and for Medicare patients differ widely by place; Lexington big in back surgery, low in mastectomy

All medicine involves decisions and, according to a new series of nine reports published by the Dartmouth Atlas Project, those decisions differ drastically by location for Medicare patients. In the East South Central region -- Kentucky, Tennessee, Alabama and Mississippi), the variation between how things are diagnosed and treated can change when one crosses county lines.

An example, with numbers but without explanation: The total knee replacement rate in Harlan is 3.3 per 1,000 Medicare beneficaries; in Bardstown, it's 13.8. As the report goes on to note: "If you have heart disease and live in Huntsville, Ala., you are half as likely to undergo balloon angioplasty than if you live in Hattiesburg, Miss., and twice as likely to undergo back surgery if you live in Lexington, Ky." The greatest variation in the region was seen in mastectomy, ranging from a low of 0.3 percent per 1,000 female Medicare beneficiaries in Lexington to 2.1 per 1,000 in Tupelo, Miss.

The point, researchers say, is that providers and patients need to work together to determine care. The report looked at rates for early-stage breast cancer, stable angina, low back pain, arthritis of the knee or hip, carotid artery disease, gallstones, enlarged prostate, and early-stage prostate cancer. Read the report here.

All medicine involves decisions and, according to a new series of nine reports published by the Dartmouth Atlas Project, those decisions differ drastically by location for Medicare patients. In the East South Central region -- Kentucky, Tennessee, Alabama and Mississippi), the variation between how things are diagnosed and treated can change when one crosses county lines.

An example, with numbers but without explanation: The total knee replacement rate in Harlan is 3.3 per 1,000 Medicare beneficaries; in Bardstown, it's 13.8. As the report goes on to note: "If you have heart disease and live in Huntsville, Ala., you are half as likely to undergo balloon angioplasty than if you live in Hattiesburg, Miss., and twice as likely to undergo back surgery if you live in Lexington, Ky." The greatest variation in the region was seen in mastectomy, ranging from a low of 0.3 percent per 1,000 female Medicare beneficiaries in Lexington to 2.1 per 1,000 in Tupelo, Miss.

The point, researchers say, is that providers and patients need to work together to determine care. The report looked at rates for early-stage breast cancer, stable angina, low back pain, arthritis of the knee or hip, carotid artery disease, gallstones, enlarged prostate, and early-stage prostate cancer. Read the report here.

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Report: Two-thirds of Kentuckians obese by 2030 if trends continue; cost to nation's future unquestionably high

Nearly two-thirds of adults in Kentucky will be obese by 2030 if rates continue to climb as they are now, an analysis reported Tuesday. The level of obesity, defined as being roughly 30 or more pounds overweight, is projected to reach 60.1 percent in Kentucky in 2030, up from 30.4 percent in 2011, according to an analysis commissioned by the nonprofit Trust for America’s Health and the Robert Wood Johnson Foundation. Nancy Hellmich and Laura Ungar of The Courier-Journal in Louisville report that if states’ obesity rates continue on their current trajectories, the number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension, and arthritis could increase 10 times between 2010 and 2020, and double again by 2030. Medical costs associated with treating preventable obesity-related diseases could increase by up to $66 billion per year by 2030, and the loss in economic productivity could be as high as $580 billion annually. (Read more)

The joint report also shows that states could prevent obesity-related diseases and dramatically reduce health care costs if they reduced the average body mass index (BMI) of their residents by just 5 percent by 2030. Doing so would spare millions of Americans serious health problems, and the country could save billions of dollars in health spending. See the interactive map showing how much improvement could be made if that small change were made here.

The report also features a series of joint policy recommendations from TFAH and RWJF, including full implementation of the Healthy, Hunger-Free Kids Act, protection of the federal health reform law's Prevention and Public Health Fund, and inclusion of additional physical education and activity components in the Elementary and Secondary Education Act. To download the full report, go here. 

Nearly two-thirds of adults in Kentucky will be obese by 2030 if rates continue to climb as they are now, an analysis reported Tuesday. The level of obesity, defined as being roughly 30 or more pounds overweight, is projected to reach 60.1 percent in Kentucky in 2030, up from 30.4 percent in 2011, according to an analysis commissioned by the nonprofit Trust for America’s Health and the Robert Wood Johnson Foundation. Nancy Hellmich and Laura Ungar of The Courier-Journal in Louisville report that if states’ obesity rates continue on their current trajectories, the number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension, and arthritis could increase 10 times between 2010 and 2020, and double again by 2030. Medical costs associated with treating preventable obesity-related diseases could increase by up to $66 billion per year by 2030, and the loss in economic productivity could be as high as $580 billion annually. (Read more)

The joint report also shows that states could prevent obesity-related diseases and dramatically reduce health care costs if they reduced the average body mass index (BMI) of their residents by just 5 percent by 2030. Doing so would spare millions of Americans serious health problems, and the country could save billions of dollars in health spending. See the interactive map showing how much improvement could be made if that small change were made here.

The report also features a series of joint policy recommendations from TFAH and RWJF, including full implementation of the Healthy, Hunger-Free Kids Act, protection of the federal health reform law's Prevention and Public Health Fund, and inclusion of additional physical education and activity components in the Elementary and Secondary Education Act. To download the full report, go here. 

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Dietary Therapy for Feline Arthritis

Lascelles BDX, DePuy V, Thomson A et al: Evaluation of a therapeutic diet for feline degenerative joint disease, J Vet Intern Med 24:487, 2010.

Cats with degenerative joint disease (DJD) or arthritis commonly have radiographic evidence of its presence. DJD is often associated with pain and pain can result in decreased mobility. This study set out to test a diet high in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) content and supplemented with green-lipped mussel extract and glucosamine/chondroitin sulfate for its pain-relieving and activity-enhancing effects in cats with painful, mobility-impairing DJD. Forty client-owned cats were enrolled in a randomized, blinded, prospective study. Outcome measures were subjective owner and veterinarian assessments, and objective activity monitoring (accelerometry). Results showed that activity significantly increased in the cats fed the test diet over a control diet. Evidence is also accumulating that diets high in DHA and EPA might be beneficial in preventing obesity and promoting weight loss by creating an appropriate physiological environment. [VT]

Related articles:
Lascelles BD, Robertson SA: DJD-associated pain in cats: what can we do to promote patient comfort?, J Feline Med Surg 12:200, 2010.

More on cat health: Winn Feline Foundation Library
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Lascelles BDX, DePuy V, Thomson A et al: Evaluation of a therapeutic diet for feline degenerative joint disease, J Vet Intern Med 24:487, 2010.

Cats with degenerative joint disease (DJD) or arthritis commonly have radiographic evidence of its presence. DJD is often associated with pain and pain can result in decreased mobility. This study set out to test a diet high in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) content and supplemented with green-lipped mussel extract and glucosamine/chondroitin sulfate for its pain-relieving and activity-enhancing effects in cats with painful, mobility-impairing DJD. Forty client-owned cats were enrolled in a randomized, blinded, prospective study. Outcome measures were subjective owner and veterinarian assessments, and objective activity monitoring (accelerometry). Results showed that activity significantly increased in the cats fed the test diet over a control diet. Evidence is also accumulating that diets high in DHA and EPA might be beneficial in preventing obesity and promoting weight loss by creating an appropriate physiological environment. [VT]

Related articles:
Lascelles BD, Robertson SA: DJD-associated pain in cats: what can we do to promote patient comfort?, J Feline Med Surg 12:200, 2010.

More on cat health: Winn Feline Foundation Library
Join us on Facebook
Follow us on Twitter

Read More