Vetnuus | Desember 2023 8 « BACK TO CONTENTS Current evidence for non-pharmaceutical, non-surgical treatments of canine osteoarthritis C. Pye *,1, N. Clark *, N. Bruniges †, M. Peffers *,a and E. Comerford *,a *Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX †University of Liverpool Small Animal Teaching Hospital, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE 1Corresponding author email: christine.pye@liverpool.ac.uk An extract of an open access article published by the Journal of Small Animal Practice Osteoarthritis is a progressive degenerative disease process that affects a significant proportion of the canine population, impacting these animals’ quality of life. Currently, there is no cure and treatment consists of managing the clinical signs of pain and reduced mobility. There are many treatments for canine osteoarthritis and in this review we discuss the evidence base behind non-pharmaceutical, nonsurgical treatments of this disease. These treatments include weight management, nutraceuticals, acupuncture, physiotherapies such as therapeutic exercise, hydrotherapy as well as other therapeutic modalities including photobiomodulation therapy, electromagnetic field therapy and others. INTRODUCTION Osteoarthritis (OA) is a progressive, degenerative disease of synovial joints, and is a significant cause of pain, lameness and morbidity in dogs (Anderson et al. 2018). In the UK, it has been estimated that canine OA has a prevalence of between 2.5% and 6.6% of dogs presenting to primary care practices (O’Neill et al. 2014a,b, Anderson et al. 2018), although the true prevalence is likely to be much higher once discrepancies in the reporting systems and unreported cases are considered (O’Neill et al. 2014a,b). The evidence base behind pharmaceutical treatments of canine OA has been previously discussed (Pye et al. 2022). In the current review, we examine the evidence base behind the non-surgical, non-pharmaceutical treatment of canine OA which includes weight management, environmental modifications, nutraceuticals, physiotherapy, hydrotherapy, acupuncture and other physiotherapeutic techniques such as photobiomodulation (laser) therapy, therapeutic ultrasound and magnetic field therapy. As these treatments become more available and widespread, veterinary practitioners must be aware of the treatment options and their underlying evidence to adequately advise owners. The current review provides an overview of each treatment modality, enabling a consolidated review of the supporting evidence behind non-pharmaceutical, non-surgical treatment options. We discuss the more commonly used complementary therapies in this review acknowledging that it is not an exhaustive list of all physical therapy modalities for canine OA. WEIGHT MANAGEMENT Obesity is increasingly prevalent in both humans and dogs in developed nations (German et al. 2018, Haase et al. 2021, O’Neill et al. 2021, Pegram et al. 2021). Several systematic reviews in people found that obesity is a primary OA risk factor in various joints, including the knee and hand (Blagojevic et al. 2010, Yusuf et al. 2010). Obesity is also a risk factor for canine OA, with a recent systematic review for canine OA risk factors concluding that overweight dogs were significantly more likely to develop stifle OA secondary to cranial cruciate ligament disease (Anderson et al. 2020). Obesity leads to increased compressive forces on load-bearing joints and alters joint kinematics during gait (Brady et al. 2013, Al Khatib et al. 2022). A biochemical as well as biomechanical link between obesity and OA is likely, as adipose tissue is a metabolically active endocrine organ synthesising and secreting hormones such as adipokines (Coelho et al. 2013). As well as acting on the hypothalamus to increase metabolism (Baskin et al. 1999), adipokines (e.g. leptin and adiponectin) the sympathetic nervous system (Satoh et al. 1999) and induce a state of chronic inflammation by activating inflammatory responses disrupting haematopoiesis and causing dysregulation of immune responses (Abella et al. 2017). Serum leptin has been found to be increased in both obese people (Vuolteenaho et al. 2012) and obese dogs (Park et al. 2014a) compared to their lean counterparts. Both serum and synovial fluid leptin concentrations have been found to be significantly increased in human knee OA (Ku et al. 2009, Kroon et al. 2019). In laboratory experiments, leptin inhibited the growth of cultured chondrocytes, as well as inducing
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