Brachystemma calycinum D. Don Effectively Reduces the Locomotor Disability in Dogs with Naturally Occurring Osteoarthritis: A Randomized Placebo-Controlled Trial

Efficacy and Safety of a Diet Enriched with EPA and DHA, Turmeric Extract and Hydrolysed Collagen in Management of Naturally Occurring Osteoarthritis in Cats: A Prospective, Randomised, Blinded, Placebo- and Time-Controlled Study

This study evaluated a therapeutic diet high in eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) of marine source (EPA:DHA ratio 0.69:1), turmeric extract, and hydrolysed collagen in cats (N = 30) with naturally occurring osteoarthritis (OA) over a 13-week (W) period, followed by a 4-W washout, using four previously validated pain/functional outcomes. Compared to the placebo diet, the therapeutic diet significantly improved peak vertical force (p = 0.017; W16, 64% responders), correlating to enhanced weight bearing; stair assay compliance (p < 0.001; W16, 87% responders), reflecting reduced fatigue related to OA pain; night-time actimetry (cohort effect; p = 0.05, 67% responders), suggesting greater spontaneous mobility and comfort; and MI-CAT(V) score (cohort effect; p < 0.001, 80% responders), indicating reduced functional impairments. The earliest therapeutic response was observed at W06, marked by an inflection point between actimetric linear regressions of both cohorts, confirmed by significant MI-CAT(V) differences (p < 0.007; W08; W12; W16). The MI-CAT(V) clinical metrology instrument was validated for inter-rater reliability, minimal placebo effect (<15% responders), and OA severity clustering. Despite baseline differences in biomechanical assessments (p < 0.05), both moderate and severe OA clusters responded equally positively to the therapeutic diet. Based on all outcomes, the therapeutic diet showed promise for the long-term management of feline OA, with no observed side effects.

A 2022 Systematic Review and Meta-Analysis of Enriched Therapeutic Diets and Nutraceuticals in Canine and Feline Osteoarthritis

With osteoarthritis being the most common degenerative disease in pet animals, a very broad panel of natural health products is available on the market for its management. The aim of this systematic review and meta-analysis, registered on PROSPERO (CRD42021279368), was to test for the evidence of clinical analgesia efficacy of fortified foods and nutraceuticals administered in dogs and cats affected by osteoarthritis. In four electronic bibliographic databases, 1578 publications were retrieved plus 20 additional publications from internal sources. Fifty-seven articles were included, comprising 72 trials divided into nine different categories of natural health compound. The efficacy assessment, associated to the level of quality of each trial, presented an evident clinical analgesic efficacy for omega-3-enriched diets, omega-3 supplements and cannabidiol (to a lesser degree). Our analyses showed a weak efficacy of collagen and a very marked non-effect of chondroitin-glucosamine nutraceuticals, which leads us to recommend that the latter products should no longer be recommended for pain management in canine and feline osteoarthritis.

Proposed Canadian Consensus Guidelines on Osteoarthritis Treatment Based on OA-COAST Stages 1–4

The Canadian consensus guidelines on OA treatment were created from a diverse group of experts, with a strong clinical and/or academic background in treating OA in dogs. The document is a summary of the treatment recommendations made by the group, with treatments being divided into either a core or secondary recommendation. Each treatment or modality is then summarized in the context of available research based support and clinical experience, as the treatment of OA continues to be a multimodal and commonly a multidisciplinary as well as individualized approach. The guidelines aim to help clinicians by providing clear and clinically relevant information about treatment options based on COAST defined OA stages 1–4.

Use of a Collar-Mounted Triaxial Accelerometer to Predict Speed and Gait in Dogs

Simple Summary

Accelerometers have been used for several years to monitor activity in free-moving dogs. The technique has particular utility for measuring the efficacy of treatments for osteoarthritis when changes to movement need to be monitored over extended periods. While collar-mounted accelerometer measures are precise, they are difficult to express in widely understood terms, such as gait or speed. This study aimed to determine whether measurements from a collar-mounted accelerometer made while a dog was on a treadmill could be converted to an estimate of speed or gait. We found that gait could be separated into two categories—walking and faster than walking (i.e., trot or canter)—but we could not further separate the non-walking gaits. Speed could be estimated but was inaccurate when speed exceeded 3 m/s. We conclude that collar-mounted accelerometers only allowing limited categorisation of activity are still of value for monitoring activity in dogs.

Abstract

Accelerometry has been used to measure treatment efficacy in dogs with osteoarthritis, although interpretation is difficult. Simplification of the output into speed or gait categories could simplify interpretation. We aimed to determine whether collar-mounted accelerometry could estimate the speed and categorise dogs’ gait on a treadmill. Eight Huntaway dogs were fitted with a triaxial accelerometer and then recorded using high-speed video on a treadmill at a slow and fast walk, trot, and canter. The accelerometer data (delta-G) was aligned with the video data and records of the treadmill speed and gait. Mixed linear and logistic regression models that included delta-G and a term accounting for the dogs’ skeletal sizes were used to predict speed and gait, respectively, from the accelerometer signal. Gait could be categorised (pseudo-R2 = 0.87) into binary categories of walking and faster (trot or canter), but not into the separate faster gaits. The estimation of speed above 3 m/s was inaccurate, though it is not clear whether that inaccuracy was due to the sampling frequency of the particular device, or whether that is an inherent limitation of collar-mounted accelerometers in dogs. Thus, collar-mounted accelerometry can reliably categorise dogs’ gaits into two categories, but finer gait descriptions or speed estimates require individual dog modelling and validation. Nonetheless, this accelerometry method could improve the use of accelerometry to detect treatment effects in osteoarthritis by allowing the selection of periods of activity that are most affected by treatment.

Lack of effectiveness of tramadol hydrochloride for the treatment of pain and joint dysfunction in dogs with chronic osteoarthritis

OBJECTIVE To investigate the effectiveness of tramadol for treatment of osteoarthritis in dogs. DESIGN Randomized, blinded, placebo-controlled crossover study. ANIMALS 40 dogs with clinical osteoarthritis of the elbow or stifle joint. PROCEDURES Dogs orally received 3 times/d (morning, midday, and night) for a 10-day period each of 3 identically appearing treatments (placebo; carprofen at 2.2 mg/kg [1 mg/lb], q 12 h [morning and night], with placebo at midday; or tramadol hydrochloride at 5 mg/kg [2.3 mg/lb], q 8 h) in random order, with treatment sessions separated by a minimum 7-day washout period. Vertical ground reaction forces (vertical impulse [VI] and peak vertical force [PVF]) were measured and Canine Brief Pain Inventory (CBPI) scores assigned prior to (baseline) and at the end of each treatment period. Repeated-measures ANOVA was performed to compare VI and PVF data among and within treatments, and the χ² test was used to compare proportions of dogs with a CBPI-defined positive response to treatment. RESULTS 35 dogs completed the study. No significant changes from baseline in VI and PVF were identified for placebo and tramadol treatments; however, these values increased significantly with carprofen treatment. Changes from baseline in VI and PVF values were significantly greater with carprofen versus placebo or tramadol treatment. A significant improvement from baseline in CBPI scores was identified with carprofen treatment but not placebo or tramadol treatment. CONCLUSIONS AND CLINICAL RELEVANCE 10 days of treatment with tramadol as administered (5 mg/kg, PO, q 8 h) provided no clinical benefit for dogs with osteoarthritis of the elbow or stifle joint.

Therapeutic response analysis in dogs with naturally occurring osteoarthritis

OBJECTIVE

Reporting the rate of positive (+) and negative (-) responders based on an objective outcome measure of pain-related functional disability/lameness in dogs with naturally occurring osteoarthritis (OA), and the relationship between initial lameness severity and the odds of being a (+) responder.

STUDY DESIGN

Retrospective analysis of published peer-reviewed clinical trials in dogs with naturally occurring OA.

ANIMALS

Dogs (n = 213) with hip and/or stifle afflicted-joints.

METHODS

A responder analysis was undertaken using a previously determined cut-off value of ±2.0% of body weight using the peak of vertical force (PVF). Among the selected trials, PVF was acquired under similar conditions. Therapeutic approaches were therapeutic diets, natural health products and nonsteroidal anti-inflammatory drugs.

RESULTS

Among dogs receiving a therapeutic approach as described above (n = 121), 62.8% [95% confidence interval, 53.9-70.9] were defined as (+) responders, whereas 11.6% [7.0-18.5] were (-) responders, accounting for a net (+) response rate by 51.2% [42.0-60.4]. In dogs receiving a negative control (n = 92), the net (+) response rate was 1.1% [0.0-5.9]. The number needed to treat was 4, and the effect size 0.7 [0.4-1.0]. The odds ratio of being a (+) responder under the therapeutic approaches was 2.85 [1.57-5.17] (p < 0.001). For every less severe lameness manifested with an increment in PVF by 1% body weight, the chance of being a (+) responder following treatment decreased by 9% (odds ratio 0.91 [0.86-0.97], p = 0.006).

CONCLUSION AND CLINICAL RELEVANCE

The rate of (+) responder optimizes decision making for the management of pain-related clinical signs of OA. Evidence-based medicine was further supported by clinical metrics based on an objective outcome measure of pain-related functional disability/lameness. This study also revealed that dogs with a mild lameness are less prone to be improved, emphasizing the need to carefully manage OA dogs in spite of a more subtle affliction.

A medicinal herb-based natural health product improves the condition of a canine natural osteoarthritis model: a randomized placebo-controlled trial

An oral herb-based natural health product (NHP) was evaluated in the canine natural osteoarthritis model. At baseline, the peak vertical force (PVF, primary endpoint) and case-specific outcome measure of disability (CSOM) were recorded in privately-owned dogs. Dogs (16/group) were randomized to receive NHP formulations or a negative control. The PVF was measured at week (W) 4 and W8. Daily locomotor activity was recorded using accelerometer. The CSOMs were assessed bi-weekly by the owner. The NHP-treated dogs (n = 13) had higher PVF at W4 (p = 0.020) and W8 (p <0.001) when compared to baseline. The changes at W8 were higher than control dogs (n = 14, p <0.027) and consistent with Cohen's d effect size of 0.7 (95% confidence interval: 0.0-1.5). The NHP-treated dogs had higher locomotor activity at W8 (p = 0.025) when compared to baseline. No significant change was observed for the CSOM. The NHP improved the clinical signs of osteoarthritis in this model.

Does a placebo effect really occur in dogs afflicted by hip osteoarthritis as measured by force platform gait analysis?

A recent study investigated the therapeutic response of dogs afflicted by hip osteoarthritis when evaluating therapeutic modalities compared to a negative (placebo) control group. Authors suggested a placebo effect based on peak vertical force measurement. In addition, small effect size for each of the tested therapeutics as well as the extremely large sample size needed (>450) to discern therapeutic efficacy using force platform gait analysis were reported. We wish to express our concerns regarding the eligibility criteria used to select the studied cohort, the small effect size, and the placebo effect reported in force platform gait analysis.

A posteriori comparison of natural and surgical destabilization models of canine osteoarthritis

For many years Canis familiaris, the domestic dog, has drawn particular interest as a model of osteoarthritis (OA). Here, we optimized the dog model of experimental OA induced by cranial cruciate ligament sectioning. The usefulness of noninvasive complementary outcome measures, such as gait analysis for the limb function and magnetic resonance imaging for structural changes, was demonstrated in this model. Relationships were established between the functional impairment and the severity of structural changes including the measurement of cartilage thinning. In the dog model of naturally occurring OA, excellent test-retest reliability was denoted for the measurement of the limb function. A criterion to identify clinically meaningful responders to therapy was determined for privately owned dogs undergoing clinical trials. In addition, the recording of accelerometer-based duration of locomotor activity showed strong and complementary agreement with the biomechanical limb function. The translation potential of these models to the human OA condition is underlined. A preclinical testing protocol which combines the dog model of experimental OA induced by cranial cruciate ligament transection and the Dog model of naturally occurring OA offers the opportunity to further investigate the structural and functional benefits of disease-modifying strategies. Ultimately, a better prediction of outcomes for human clinical trials would be brought.

Effect of a diet enriched with green-lipped mussel on pain behavior and functioning in dogs with clinical osteoarthritis

This study aimed to establish the effect of a diet enriched with green-lipped mussel (GLM) on pain and functional outcomes in osteoarthritic dogs. Twenty-three client-owned dogs with osteoarthritis (OA) were fed a balanced control diet for 30 d and then a GLM-enriched balanced diet for the next 60 d. We assessed peak vertical force (PVF), which is considered to be the gold standard method, at Day (D)0 (start), D30 (end of control diet), and D90 (end of GLM-enriched diet). The owners completed a client-specific outcome measure (CSOM), which is a pain questionnaire, once a week. Motor activity (MA) was continuously recorded in 7 dogs for 12 wk. Concentrations of plasma omega-3 fatty acids were quantified as indicative of diet change. Statistical analyses were linear-mixed models and multinomial logistic regression for repeated measures. The GLM diet (from D30 to D90) resulted in an increase in concentrations of plasma omega-3 fatty acids (P < 0.016) and improvement of PVF (P = 0.003). From D0 to D30, PVF did not significantly change (P = 0.06), which suggests that the GLM diet had a beneficial effect on gait function. Moreover, PVF (P = 0.0004), CSOM (P = 0.006), and MA (P = 0.02) improved significantly from D0 to D90. In general, the balanced control diet could have contributed to reduced OA symptoms, an effect that was subsequently amplified by the GLM diet.

Clinical validity of outcome pain measures in naturally occurring canine osteoarthritis

Background

The conceptual validity of kinetic gait analysis and disability outcome assessment methods has guided their use in the assessment of pain caused by osteoarthritis (OA). No consensus on the best clinical methods for pain evaluation in canine OA exists, particularly, when evaluating treatments where a smaller treatment effect is anticipated than with pharmacological pain killers. This study thus aimed at determining the technical validity of some clinical endpoints on OA pain in dogs using the green-lipped mussel (GLM)-enriched diet.

Twenty-three adult dogs with clinical OA completed the prospective controlled study. All the dogs were fed a balanced diet over a 30-day control period followed by a GLM-enriched diet over a 60-day period. The kinetic gait analysis parameter (PVF_BW, peak vertical force adjusted for body weight change), electrodermal activity (EDA), and a standardized multifactorial pain questionnaire (MFQ) were performed on day (D) 0 (inclusion), D30 (start) and D90 (end). The owners completed a client-specific outcome measures (CSOM) instrument twice a week. Motor activity (MA) was continuously recorded in seven dogs using telemetered accelerometric counts. We hypothesized that these methods would produce convergent results related to diet changes. A Type I error of 0.05 was adjusted to correct for the multiplicity of the primary clinical endpoints.

Results

Neither the EDA nor the MFQ were found reliable or could be validated. Changes in the PVF_BW (P_adj = 0.0004), the CSOM (P_adj = 0.006) and the MA intensity (P_adj = 0.02) from D0 to D90 suggested an effect of diet(s). Only the PVF_BW clearly increased after the GLM-diet (P_adj = 0.003). The CSOM exhibited a negative relationship with the PVF_BW (P = 0.02) and MA duration (P = 0.02).

Conclusions

The PVF_BW exhibited the best technical validity for the characterization of the beneficial effect of a GLM-enriched diet. The CSOM and MA appeared less responsive following a GLM-diet, but these measures appeared complementary to gait analysis. Apparently, the CSOM provides the capacity to rely on pain OA assessment influenced by both lameness quantification (PVF_BW) and physical functioning (MA).