VET Desember / December 2023 The Monthly Magazine of the SOUTH AFRICAN VETERINARY ASSOCIATION Die Maandblad van die SUID-AFRIKAANSE VETERINÊRE VERENIGING A Basic Introduction to Backyard Poultry Medicine – Part 2 of 3 CPD THEME Canine Osteoarthritis – alternative treatment nuus•news www.wvac2024.com
Dagboek • Diary www.wvac2024.com Ongoing / Online 2023 April 2024 SAVETCON: Webinars. Info: Corné Engelbrecht, SAVETCON, 071 587 2950, corne@savetcon.co.za / https://app.livestorm.co/svtsos Valley Farm Animal Hospital: CPD Evenings Ongoing. Monthly lectures, various speakers on a variety of topics – free of charge Venue: Valley Farm Animal Hospital, 829 Old Farm Road, Faerie Glen, Pretoria. Info: admin@valleyfarmvet.co.za Acupuncture – Certified Mixed Species Course Info: Chi University: https://chiu.edu/courses/cva#aboutsouthafrica@tcvm.com Certification in Clinical Integrative Canine Rehabilitation (Through College of Integrative Veterinary Therapies) Info: https://civtedu.org/courses World Veterinary Association Congress (WVAC ) 16-19 April Venue: CTICC (Cape Town International Convention Centre), Cape Town, South Africa Info: www.wvac2024.com August 2024 SAVA Oranje Vaal Branch Mini Congress 09-11 August Venue: Parys – venue to be confirmed. Info: conference@savetcon.co.za
December 2023 1 Contents I Inhoud President: Dr Paul van der Merwe president@sava.co.za Managing Director: Mr Gert Steyn md@sava.co.za/ +27 (0)12 346 1150 Editor VetNews: Ms Andriette van der Merwe vetnews@sava.co.za Bookkeeper: Ms Susan Heine accounts@sava.co.za/+27 (0)12 346 1150 Bookkeeper's Assistant: Ms Sonja Ludik bookkeeper@sava.co.za/+27 (0)12 346 1150 Secretary: Ms Elize Nicholas elize@sava.co.za/ +27 (0)12 346 1150 Reception: Ms Hanlie Swart reception@sava.co.za/ +27 (0)12 346 1150 Marketing & Communications: Ms Sonja van Rooyen marketing@sava.co.za/ +27 (0)12 346 1150 Membership Enquiries: Ms Debbie Breeze debbie@sava.co.za/ +27 (0)12 346 1150 Vaccination booklets: Ms Debbie Breeze debbie@sava.co.za/ +27 (0)12 346 1150 South African Veterinary Foundation: Ms Debbie Breeze savf@sava.co.za/ +27 (0)12 346 1150 Community Veterinary Clinics: Ms Claudia Cloete cvcmanager@sava.co.za/ +27 (0)63 110 7559 SAVETCON: Ms Corné Engelbrecht corne@savetcon.co.za/ +27 (0)71 587 2950 VetNuus is ‘n vertroulike publikasie van die SAVV en mag nie sonder spesifieke geskrewe toestemming vooraf in die openbaar aangehaal word nie. Die tydskrif word aan lede verskaf met die verstandhouding dat nóg die redaksie, nóg die SAVV of sy ampsdraers enige regsaanspreeklikheid aanvaar ten opsigte van enige stelling, feit, advertensie of aanbeveling in hierdie tydskrif vervat. VetNews is a confidential publication for the members of the SAVA and may not be quoted in public or otherwise without prior specific written permission to do so. This magazine is sent to members with the understanding that neither the editorial board nor the SAVA or its office bearers accept any liability whatsoever with regard to any statement, fact, advertisement or recommendation made in this magazine. VetNews is published by the South African Veterinary Association STREET ADDRESS 47 Gemsbok Avenue, Monument Park, Pretoria, 0181, South Africa POSTAL ADDRESS P O Box 25033, Monument Park Pretoria, 0105, South Africa TELEPHONE +27 (0)12 346-1150 FAX General: +27 (0) 86 683 1839 Accounts: +27 (0) 86 509 2015 WEB www.sava.co.za CHANGE OF ADDRESS Please notify the SAVA by email: debbie@sava.co.za or letter: SAVA, P O Box 25033, Monument Park, Pretoria, 0105, South Africa CLASSIFIED ADVERTISEMENTS (Text to a maximum of 80 words) Sonja van Rooyen assistant@sava.co.za +27 (0)12 346 1150 DISPLAY ADVERTISEMENTS Sonja van Rooyen assistant@sava.co.za +27 (0)12 346 1150 DESIGN AND LAYOUT Sonja van Rooyen PRINTED BY UVO: +27 (0)12 423 9460 VET nuus•news Diary / Dagboek II Dagboek • Diary Regulars / Gereeld 2 From the President 4 Editor’s notes / Redakteurs notas Articles / Artikels 8 Current evidence for non-pharmaceutical, non-surgical treatments of canine osteoarthritis Association / Vereniging 26 CVC News 28 SAVA News 34 In Memoriam 36 Legal Mews Events / Gebeure 6 World Veterinary Association Congress 2024 32 Prof Banie Penzhorn honoured by WAAVP Vet's Health / Gesondheid 38 Life Coaching Technical / Tegnies 39 Trilostane 40 Ophthalmology Column 41 Royal Canin Column Relax / Ontspan 48 Life Plus 25 Marketplace / Markplein 42 Marketplace Jobs / Poste 43 Marketplace/Jobs / Poste 47 Classifieds / Snuffeladvertensies 26 41 32 www.wvac2024.com
Vetnuus | Desember 2023 2 « BACK TO CONTENTS You will likely hear Merry Christmas many times during the holiday season. But have you ever stopped to WONDER why those are the words you hear? Why don't people wish you a Festive Christmas? In fact, why is Christmas merry when no other occasion seems to be? After all, you probably don't wish people a Merry Birthday very often. You probably also don't hear many Merry Hanukkahs or Merry Ramadans either! Historians and linguists can't pinpoint for sure exactly why we tend to use Merry Christmas. The greeting dates back to at least 1534 in London, when it was written in a letter sent to Henry VIII's chief minister Thomas Cromwell from bishop John Fisher. Scholars also note the phrase was used in the 16th-century English carol "We Wish You a Merry Christmas." Merry Christmas certainly picked up steam in 1843 with the publication of Charles Dickens's A Christmas Carol. That same year the phrase also appeared on the first commercially-sold Christmas card. However, Happy Christmas tends to be the preferred phrase for a significant minority of Great Britain. It could be due to the queen's influence. A rumour has circulated that Queen Elizabeth prefers happy to merry, because the word merry, to her, carries with it a sense of boisterousness and even intoxication. The Hebrew word merry is "meah", meaning joyful, merry, or glad. Some Christians therefore believe it is a more fitting greeting, given the unrestrained and emotional response followers should have to a celebration of the birth of their Savior, Jesus Christ. Joyful is feeling, expressing, or causing great pleasure and happiness. No matter your beliefs, let this time of year be a time of experiencing or feeling your great pleasure and happiness. This time of year is unfortunately also the time of year with most mental health challenges and suicides. May your actions go beyond your own experience and feelings to also ensure that they cause great pleasure and happiness in the lives of those you are interacting with daily. Do not be the one that is robbing people of their pleasure and happiness. If you must take action to address your actions, this is the time to do so! It is just too regularly to see reports of colleagues who just cannot handle the stressors anymore placed on them by colleagues. To the members and employees of SAVA, may this Christmas truly be a Merry Christmas where you will experience the feeling of great pleasure and happiness. Thank you to every person who contributed to my experience and feeling of great pleasure and happiness in serving you. I can honestly reverb the words of King Solomon “A merry heart doeth good like medicine”. Merry Christmas. v Kind regards, Paul van der Merwe From the President Dear members, 24-Hour, Toll-Free Helpline: 0800 21 21 21
December 2023 3 Helicopter/Mobility/V360 DID THAT. SCIENCE 1. 21 days in dogs and 28 days in cats. Hill’s data on file. * Prescription Diet j/d is also available for cats. help pets run, walk and jump more easily in as little as 21 days1 *
Vetnuus | Desember 2023 4 « BACK TO CONTENTS It is that time of year. A time of super joy and celebration for some. A time when friends and family come together and celebrate the birth of Jesus Christ. But it is also a time of great sadness for some. This can be due to various reasons. Unfortunately, there is no way that external can create joy within oneself. That said, and expanded as ‘the emotion of great delight or happiness caused by something exceptionally good or satisfying; keen pleasure; elation’ it seems like joy has its source outside of a person. If that were true, everybody could get a helium balloon and there should be joy in the world. Because, who can not find joy in a helium balloon, the whiskers of a kitten, puppy breath, sunrise, good music, the smell of horse skin, and the list can go on? Elsewhere I read: I tend to agree with this statement a little more. Happiness seems like a more superficial emotion where Joy happens inside your soul. I read in John 16 verse 22 the following “So also you have sorrow now, but I will see you again, and your hearts will rejoice, and no one will take your joy from you.” Many of us can say that this year had its fill of sorrow, I know that by just looking back at the Memoriams this past year, so many people filled with sorrow for loved ones that have passed, some young, too young, and some after a full life, some after sickness long or short and some out of the blue. I am sure if you think back you can quickly find a memory of sorrow. And John states it quite clearly. But there is a wonderful promise. This is my blessing to each one this festive season. Find your joy in the Lord, no one can take that away from you. On page 29 of this edition of Vetnews the first in a series of Good workplace codes of conduct. This will be a series of 7 codes with a place to sign in month 8. I want to encourage all practices to print a copy of each of these and put it up where all in the practice can see it. Visual reminders are important roadsigns to create a good workplace. Maybe there is an area a practice can tweak or adjust. Be mindful of good workplace practices I hope for all a peaceful and restful Christmas holiday. Please drive safe and come back refreshed in the New Year. If you are not privileged to take a holiday now, enjoy and be safe where you are and take good care of the critters. Andriette v From the Editor Editor’s notes / Redakteurs notas Andriette van der Merwe The dictionary states that joy is‘an emotion of great delight or happiness.’ “Happiness is fickle and requires happy circumstances. Joy, on the other hand, sticks around. It doesn’t get chased off by trouble.” Your heart will rejoice and no one will take your joy from you Email: assistant@sava.co.za ADVERTISE IN VETNEWS MAGAZINE
December 2023 5 “The South African Veterinary Association aims to serve its members and to further the status and image of the veterinarian. We are committed to upholding the highest professional and scientific standards by utilising the professional knowledge, skill and resources of our members, to foster close ties with the community and thus promote the health and welfare of animals and mankind”. MISSION STATEMENT Servicing and enhancing the veterinary community since 1920! Tel: 012 346 1150 E-mail: vethouse@sava.co.za www.sava.co.za EARLY EXPOSURE TO ANIMAL CARE DURING YEAR 1 TRAINING AT ANTIBIOTIC-FREE FARMS AND QUANTITATIVE GENETICS TRAINING (FARM ANIMALS) EU ACCREDITED VETERINARY DEGREE ALLOWING PRACTICE WORLDWIDE FINANCIAL AID SCHOLARSHIPS AVAILABLE GLOBAL FACULTY EXPERTISE IN SMALL AND LARGE ANIMAL MEDICINE ADVANCED FACILITIES INCLUDING ANATOMY AND CLINICAL SKILLS LABORATORIES CURRICULUM ALIGNED AS REQUIRED BY RCVS AVMA, EAEVE, AND WORLD ORGANIZATION FOR ANIMAL HEALTH. unic.ac.cy/vet STUDY VETERINARY MEDICINE IN CYPRUS DOCTOR OF VETERINARY MEDICINE (DVM) 5-Year Undergraduate Degree Programme Targeted for High School Leavers
Vetnuus | Desember 2023 6 « BACK TO CONTENTS
December 2023 7
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
December 2023 9 Leading Article the production of pro-inflammatory cytokines and other enzymes involved in the destruction of chondrocytes in OA (Simopoulou et al. 2007, Koskinen et al. 2011). Obesity is also linked to other diseases including cardiovascular disease and diabetes mellitus, and it has been hypothesised that OA progression may be worsened by these co-morbidities (Conaghan et al. 2005, Schett et al. 2013). Therefore, weight management is an important factor in OA treatment. Weight loss improved outcomes in terms of joint function, reduced pain and improved QOL for overweight or obese people with knee and hip OA (Messier et al. 2018, Panunzi et al. 2021). These improved clinical outcomes were more pronounced in people who lost more than 10% bodyweight (Atukorala et al. 2016, Messier et al. 2018). In dogs, four studies investigated outcomes in overweight or obese dogs with OA following a weight loss regime (Table 1). Three of these examined outcomes based on weight loss alone. A study involving weight loss in nine overweight and obese dogs with hip OA found a significant improvement in subjective measurements of lameness after 19 weeks, with the dogs losing between 11% and 18% of their bodyweight over the study (Impellizeri et al. 2000). Objective outcomes were used by two studies (Burkholder & Hulse 2000, Marshall et al. 2010). Weight loss led to improved objective measurements of lameness using kinetic gait analysis in 16 dogs with hip OA when body condition score fell from seven or eight out of nine, to four or five out of nine (Burkholder & Hulse 2000). Marshall et al. (2010) found improvements in subjective measurements of lameness, and objective kinetic gait analysis, after a weight loss of 6.1% of bodyweight and 8.85% bodyweight, respectively, in 14 obese dogs with either hip and/or elbow. One published study examined outcomes when physical therapy and weight loss were combined (Mlacnik et al. 2006). The effect of weight reduction and physical therapy (either a home-based physical therapy protocol or intensive programme including transcutaneous electrical nerve stimulation) on lameness was assessed, with greater improvements in the group undergoing weight reduction and intensive physical therapy compared to weight loss alone. These highlighted studies have limitations. Small sample sizes, lack of blinding and lack of control groups limit the level of evidence they provide, although it is difficult to blind owners and assessors to weight loss as it causes a visible change in appearance. However, from the evidence available, it is recommended to maintain a lean body condition in dogs with OA, and pursue a weight loss programme in dogs that are overweight or obese. NUTRACEUTICALS The term “nutraceutical” is defined as “a substance produced in purified or extracted form, which, when administered orally to patients, provides them the necessary elements for their structure and normal function to better their health and well-being” (Boothe 1997). Many nutraceuticals are marketed towards the prevention or treatment of canine OA; however, they are not subject to any regulation due to the lack of evidentiary efficacy reported (Vandeweerd et al. 2012, Comblain et al. 2017). Two previous systematic reviews of veterinary nutraceuticals concluded that there was evidence for clinical efficacy of omega-3 fatty acids in the treatment of canine OA (Vandeweerd et al. 2012, Barbeau-Grégoire et al. 2022), and the more recent of these also found a weak efficacy of collagen (Barbeau-Grégoire et al. 2022). Neither found evidence that glucosamine hydrochloride and chondroitin sulphate provided any beneficial effects in the treatment of canine OA. The most commonly used nutraceuticals are discussed and the evidence behind their efficacy is evaluated. Table 2 details published studies for each of these nutraceuticals Green-lipped mussel (Perna canaliculus) Green-lipped mussel (GLM) is derived from a mussel native to New Zealand and their extract provides essential amino acids, glycoproteins and omega-3 fatty acids. Hielm-Björkman et al. (2009), Soontornvipart et al. (2015) and Vijarnsorn et al. (2019) all demonstrated improvements in clinical outcomes in canine OA by alleviating inflammation and increasing weight-bearing abilities. Furthermore, there has been reported improvement in limb manipulation with a reduction in pain, swelling, crepitus after treatment with GLM in OA dogs (Servet et al. 2006). Dobenecker et al. (2002), however, found no observed effect of adding powdered GLM extract into the animal’s diet and GLM was found to be less effective than carprofen (Hielm-Björkman et al. 2009). Although studies investigating the use of GLM have provided some positive clinical effects in canine OA, there are multiple inconsistencies with respect to the benefits provided. There is currently no recommended dose of GLM, and it is difficult to compare study findings due to different dosages and administration techniques used. Further research is needed to investigate the efficacy of GLM versus non-steroidal anti-inflammatory drugs (NSAIDs) and other pharmaceutical therapies, but also to clarify the optimal dose of GLM to gain improvements in the clinical presentation of OA. Polyunsaturated fatty acids (omega-3) Omega-3 fatty acids modulate the expression and activity of inflammatory biomarkers causing cartilage degradation in OA (Barrouin-Melo et al. 2016, Buddhachat et al. 2017, Adler et al. 2018). Multiple double-blinded randomised studies have found a significant improvement in clinical signs of OA in dogs fed omega-3 supplementation (Fritsch et al. 2010, Roush et al. 2010, Mehler et al. 2016). However, most of these improvements were recorded using subjective methodology, e.g. owner questionnaires using non-validated scoring systems. Both Hielm-Björkman et al. (2012) and Moreau et al. (2013) used objective gait analysis to determine peak vertical force (PVF) and vertical impulse (VI). Moreau et al. (2013) found that the omega-3-infused diet improved locomotor and performance abilities, as well as increased PVF, suggesting that the dogs were inclined to load more weight on the arthritic limbs. Hielm-Björkman et al. (2012) also found greater PVF values and QOL scores, compared to a significant deterioration in veterinary assessments in the placebo group. The study provided evidence that supplementing omega-3 could be used as part of multimodal analgesia for dogs suffering from OA.
Vetnuus | Desember 2023 10 « BACK TO CONTENTS Leading Article Table 1. Studies investigating weight loss as a treatment for canine osteoarthritis Author Study Type Groups Sample Size Study Length Outcome measurements Conclusions Evidence level (Aragon & Budsberg 2005) Impellizeri et al. (2000) Non-blinded prospective clinical trial Weight loss programme 9 19 weeks Subjective: NRS, VAS Dogs lost between 11% and 18% of their bodyweight over 10 to 19 weeks. All measures of lameness were significantly lower at the end of the study compared to baseline III Burkholder & Hulse (2000)† Non-blinded prospective clinical trial Weight loss programme 16 Not given Objective: kinetic gait analysis Significant improvement in objective measurements with weight loss to optimal body condition III Mlacnik et al. (2006) Non-blinded prospective randomised clinical trial Caloric restriction and intensive physical therapy including TENS caloric restriction and home-based physical therapy 29 6 months Subjective: subjective lameness and pain scores (0 to 4) Objective: kinetic gait analysis Mean weight loss after 6 months was 13.6% in group 1 (caloric restriction and intensive physical therapy) and 9.3% in group 2 (caloric restriction and home-based physical therapy). Significant improvement in kinetic gait analysis in both groups at end of study, but more rapid change was evident in dogs receiving intensive physical therapy III Marshall et al. (2010) Non-blinded prospective clinical trial Weight loss programme 14 16 weeks Subjective: NRS, VAS Objective: kinetic gait analysis Dogs lost an average of 8.6% of initial bodyweight. Significant decrease in subjective measures of lameness from weight loss of 6.1% of bodyweight onwards. Significant reduction in objective measurements of lameness from 8.85% onwards III NRS Numerical rating scale, VAS Visual analogue scale, TENS Transcutaneous electrical nerve stimulation
December 2023 11 Table 2. Studies investigating nutraceuticals as a treatment for canine osteoarthritis Nutraceutical category investigated Nutraceutical compound investigated Author Study type Groups Sample size Study length Outcome measures Conclusions Evidence level (Aragon & Budsberg 2005) Omega-3-based nutraceuticals Green-lipped mussel (Perna canaliculus) Bierer & Bui (2002) Double-blind, randomised, non-placebo- controlled study Green-lipped mussel powder Green-lipped mussel incorporated into a treat Green-lipped mussel incorporated into a main meal 96 dogs 6 weeks Subjective: veterinary assessment, NRS Total OA scores and scores for joint pain and joint swelling were significantly reduced following 6 weeks of greenlipped mussel supplementation in all three forms III Dobenecker et al. (2002) Double-blind, randomised, placebocontrolled study Chondroitin sulphate Mussel extract Placebo 70 dogs 12 weeks Subjective: owner-reported questionnaire, veterinary assessment None of the tested substances led to a distinct improvement of the recorded symptoms or even to a total recovery in general II Pollard et al. (2006) Double-blind, randomised, placebo controlled study Green-lipped mussel Placebo 81 dogs 56 days Subjective: owner-reported questionnaire, veterinary assessment Green-lipped mussel had a beneficial effect on the clinical signs of dogs presumptively diagnosed with mild-to- moderate DJD II Dear SAVA member Please note that Vethouse will close on Thursday, 21 December 2023 at 12:00 and resume business on 03 January 2024. SAVA wishes all its members and their families a joyous festive season and everything of the best for the year ahead. Kind regards Gert Steyn: Managing Director Geagte SAVV lid Neem asseblief kennis dat Vethuis sal sluit op Donderdag, 21 Desember 2023 om 12:00 en sal heropen op 03 Januarie 2024. Die SAVV wens alle lede en hul families ‘n wonderlike feestyd en alles van die beste vir die jaar wat voorlê. Vriendelike groete Gert Steyn: Besturende Direkteur Leading Article >>> 12
Vetnuus | Desember 2023 12 « BACK TO CONTENTS Nutraceutical category investigated Nutraceutical compound investigated Author Study type Groups Sample size Study length Outcome measures Conclusions Evidence level (Aragon & Budsberg 2005) Tabel 2 continued Hielm-Björkman et al. (2009) Double-blind, randomised, placebocontrolled study Green-lipped mussel Carprofen Placebo (isotonic sodium-chloride solution) 45 dogs 8 weeks Subjective: veterinary-assessed mobility index and owner-evaluated chronic pain index via VAS Objective: force plate analysis (PVF) Freeze-dried green-lipped mussel is more effective than the placebo in treating chronic pain due to moderate to severe. Although green-lipped mussel was not as effective as carprofen II Soontornvipart et al. (2015) Double-blind, randomised, non-placebo controlled study Green-lipped mussel Omega-3 fatty acids in fish oil 66 dogs 24 weeks Subjective: veterinary assessment, weightbearing scores Objective: serum OA biomarkers (WF6), force plate analysis (PVF), range of motion (ROM) via goniometer Green-lipped mussel administration led to good clinical outcomes. The fish oil did not show any positive effects in the canine OA treatment III Vijarnsorn et al. (2019) Randomised, doubleblinded study Firocoxib Greenlipped mussel Combination of firocoxib and Green-lipped mussel 79 dogs 4 weeks Subjective: veterinary assessment (OAS (orthopaedic assessment score) CMI: CBPI Objective: PVF, serum prostaglandin E2 concentration A combination of both greenlipped mussel and firocoxib is most effective in alleviation of inflammation and improvement of weight bearing ability II Fish oil (Omega-3) Hielm-Björkman et al. (2012) Double-blind, randomised, placebocontrolled study Deep sea fish oil Corn oil (placebo) 77 dogs 16 weeks Subjective: locomotion assessment via VAS, QoL VAS, comparative questionnaire, veterinary assessment, owner assessment of outcome CMI: HCPI Objective: PVF and VI, use of rescue NSAIDs There was no statistically significant benefit in using deep sea fish oil as an analgesic However, owners indicated an improvement in mobility at the end of the study with the HCPI CMI II Mehler et al. (2016) Double-blind, randomised, placebocontrolled, cross-over designed study Triglyceride n-3 oil Placebo oil 78 dogs 84 days Subjective: veterinary assessment using multiple VAS Daily supplementation of a dog’s diet with omega-3 correlates to reduced pain and lameness in OA dogs II
December 2023 13 Moreau et al. (2013) Double-blind, randomised, placebocontrolled study Veterinary therapeutic diet rich in omega-3 fatty acids (omega-3) from fish origin Regular diet used as control 30 dogs 13 weeks Subjective: veterinary assessment CMI: CSOM Objective: force plate analysis (PVF) High levels of omega-3 from fish origin improved both CSOM and PVF scores II Collagen-based nutraceuticals Collagen Deparle et al. (2005) Double-blind, randomised, placebocontrolled study No undenatured type-II collagen (placebo) Undenatured type-II collagen at 1 mg/day Undenatured type-II collagen at 10 mg/day 15 dogs 90 days followed by a 30-day withdrawal period Subjective: veterinary assessment using VAS and observational questionnaire Objective: biochemical assay (creatinine, blood urea nitrogen, alanine aminotransferase and aspartate aminotransferase) Daily treatment of arthritic dogs with undenatured type-II collagen reduces signs and symptoms associated with OA. The greatest physical improvements were noted after a treatment period of 90 days II Stabile et al. (2019) Blinded, randomised, prospective, controlled study Undenatured type-II collagen (1 tablet/day) Robenacoxib (1 mg/kg/day) 60 dogs 30 days Subjective: veterinary assessment CMI: LOAD questionnaire Objective: radiography The results of this study showed that undenatured type-II collagen and robenacoxib were able to similarly improve mobility of dogs affected by OA Collagen, glucosamine hydrochloride and chondroitin sulphate II Gupta et al. (2012) Double-blind, randomised, placebocontrolled study Placebo 10 mg active undenatured type-II collagen 2000 mg glucosamine hydrochloride and 1600 mg chondroitin sulphate 10 mg active undenatured type-II collagen, 2000 mg glucosamine hydrochloride and 1600 mg chondroitin sulphate 7 to 10 dogs per group 150 days Subjective: veterinary assessment by multiple VAS and visual gait analysis Objective: force plate analysis (PVF and VI) and biochemical assay (creatinine, blood urea nitrogen, alanine aminotransferase and aspartate aminotransferase) Dogs treated daily with undenatured type-II collagen (10 mg) showed a marked reduction in OA pain with maximum improvement seen on day 150. Efficacy of undenatured type-II collagen is significantly greater than glucosamine hydrochloride and chondroitin sulphate II Leading Article 24-Hour Toll-Free Helpline: 0800 21 21 21 Nutraceutical category investigated Nutraceutical compound investigated Author Study type Groups Sample size Study length Outcome measures Conclusions Evidence level (Aragon & Budsberg 2005) Tabel 2 continued
Vetnuus | Desember 2023 14 « BACK TO CONTENTS Current evidence for non-pharmaceutical, non-surgical treatments of canine osteoarthritis <<< 13 D’Altilio et al. (2007) Double-blind, randomised, prospective, controlled study Placebo 10 mg active undenatured type-II collagen, 2000 mg glucosamine hydrochloride and 1600 mg chondroitin sulphate 2000 mg glucosamine hydrochloride and 1600 mg chondroitin sulphate 10 mg active undenatured type-II collagen 20 dogs 120 days followed by a 30-day withdrawal period Subjective: veterinary assessment by multiple VAS Objective: bodyweight, biochemical assay (creatinine, blood urea nitrogen, alanine aminotransferase and aspartate aminotransferase) Supplementing glucosamine hydrochloride, chondroitin sulphate with undenatured type-II collagen reduced overall pain, pain upon limb manipulation, and exercise induced lameness to a significant extent. Although this benefit was also lost following the 30-day treatment withdrawal period II Nutraceuticals with chondroitinglucosamine Chondroitin sulphate Dobenecker et al. (2002) See study details above under the omega-3 based nutraceuticals section Glucosamine hydrochloride and chondroitin sulphate Gupta et al. (2012) and D’Altilio et al. (2007) See study details above under the collagen-based nutraceuticals section McCarthy et al. (2007) Multi-centred double-blind, randomised prospective controlled study 475 mg/g glucosamine hydrochloride, 350 mg/g, chondroitin sulphate, 50 mg/g N-acetyl- d- glucosamine, 50 mg/ ascorbic acid and 30 mg/g of zinc sulphate Carprofen (2 mg/kg BID for 7 days followed by 2 mg/ kg SID for 63 days) 42 dogs 70 days Subjective: veterinary assessment via VAS Dogs treated with glucosamine hydrochloride and chondroitin sulphate+ showed statistically significant improvements in scores for pain, weight-bearing and severity of the condition by day 70. Slower onset of clinical response than for carprofen-treated dogs II VACCINATION BOOKS The LAST ORDERS for 2023 for vaccination books will be 30 November. No orders will be accepted after this – this is to ensure that stock will be dispatched by 15 December 2023. Orders for 2024 will resume on 16 January. To order/for more information contact Debbie Breeze on 012 346 1150 or debbie@sava.co.za Nutraceutical category investigated Nutraceutical compound investigated Author Study type Groups Sample size Study length Outcome measures Conclusions Evidence level (Aragon & Budsberg 2005) Tabel 2 continued
December 2023 15 Scott et al. (2017) Double-blind, randomised placebocontrolled study Glucosamine hydrochloride and chondroitin sulphate Placebo 60 dogs 97 days Subjective: veterinary assessment CMI: canine brief pain inventory (CBPI) Treatment with oral glucosamine hydrochloride and chondroitin sulphate for a 90-day treatment period when compared to placebo treatment did not result in a significant increase in activity counts in dogs with clinical OA II Others Curcumoids Innes et al. (2003) Double-blind randomised placebocontrolled parallel group clinical study P54FP Placebo 61 dogs 8 weeks Subjective: veterinary assessment, ownerreported assessment Objective: force plate analysis (PVF and VI) Results showed statistically significant treatment effect in favour of P54FP (P>0.05), but the owners’ assessment just failed to reach statistical significance II Elk velvet antler Moreau et al. (2004) Double-blind, randomised placebocontrolled study Quality elk velvet antler for 60 days (n=25 dogs) Placebo for 30 days and then quality elk velvet antler for 30 days (n=13 dogs) 38 dogs 60 days Subjective: veterinary assessment, owner interpretation Objective: Force plate analysis (GRF), radiography Performances in daily life activities, and vitality were significantly improved on quality elk velvet antler, exceeding those observed when placebo was administered. Thirteen dogs did not show significant improvement II Vitamin E Rhouma et al. (2013) Double-blind, randomised placebocontrolled study Placebo (n=8) Vitamin E group receiving 400 IU/animal per day 15 dogs 55 days Subjective: VAS and NRS Objective: electrodermal activity (EDA), structural assessment of stifle joints at day 56 Supplement with a high dose of vitamin E showed a reduction in inflammation joint markers and histological expression, as well as a trend to improving signs of pain II Nutraceutical category investigated Nutraceutical compound investigated Author Study type Groups Sample size Study length Outcome measures Conclusions Evidence level (Aragon & Budsberg 2005) Tabel 2 continued Leading Article >>> 16
Vetnuus | Desember 2023 16 « BACK TO CONTENTS Avocado and soybean unsaponifiables Boileau et al. (2009) Double-blind, randomised placebocontrolled pilot study Placebo Avocado/ soybean unsaponifiables (10 mg/ kg per day) 16 dogs 8 weeks Objective: macroscopic and histomorphological analyses of cartilage and subchondral bone of the femoral condyles and/ or tibial plateaus, and immunohistochemical Treatment with avocado/soybean unsaponifiables can reduce the development of early osteoarthritic cartilage and subchondral bone lesions in the anterior cruciate ligament dog model of osteoarthritis II S-adenosyl l-methionine (SAMe) Imhoff et al. (2011) Double-blind, randomised placebocontrolled study Placebo SAMe 33 dogs 6 weeks Subjective: veterinary assessment and CBPI Objective: force plate analysis(PVF and VI), goniometry Data do not support the use of SAMe as an effective standalone treatment for reducing clinical signs of OA II NRS Numerical rating scale, VAS Visual analogue scale, PVF Peak vertical force, VI Vertical impulse, CMI Clinical metrology instrument, LOAD Liverpool Osteoarthritis in Dogs questionnaire, CBPI Canine Brief Pain Inventory, HCPI Helsinki chronic pain index, OA osteoarthritis, CSOM client-specific outcome measure Collagen The undenatured form of type II collagen (UC-II) is a nutraceutical derived from the cartilage of chicken sternum (Bagi et al. 2017) and has recently been shown to prevent the increase of pro-inflammatory and cartilage degeneration biomarkers in Labrador retrievers (Varney et al. 2022). Previous research has shown that UC-II has greater efficacy compared to other supplements such as glucosamine-hydrochloride and chondroitin-sulphate (Gupta et al. 2012). A similar study highlighted the beneficial effects of UC-II; Deparle et al. (2005) found that daily treatment of arthritic dogs with undenatured type-II collagen reduced OA signs with the greatest physical improvements noted following a 90-day treatment. Stabile et al. (2019) also noted a clinical improvement in OA dogs treated with UC-II similar to those treated with robena coxib after 30 days. There are no approved dosages of UC-II, although 440 mg of UC-II daily improved clinical signs without adverse effects (D’altilio et al. 2007). UC-II has been found to be non-toxic (Marone et al. 2010) and has no known adverse effects in the liver or kidneys. However, more work is required to identify the objective effectiveness of UC-II as caregiver bias can influence the results of many subjective studies (Conzemius & Evans 2012). Glucosamine hydrochloride and chondroitin sulphate Glucosamine and chondroitin are amino saccharides which have anti-inflammatory and anti-catabolic effects in vitro (Henrotin & Lambert 2013). In humans, glucosamine is available in several dosage forms (Bhathal et al. 2017), however, there is variable efficacy due to inconsistent dosages and poor oral bioavailability (Altman 2009, Sawitzke et al. 2010). There are multiple manufactured glucosamine and chondroitin products, all with varying strengths and formulations. Based on current literature, the beneficial effects of glucosamine and chondroitin in the treatment of canine OA can neither be confirmed or denied as clinical trials have had mixed results. McCarthy et al. (2007) found dogs consuming glucosamine/chondroitin had statistically significant Current evidence for non-pharmaceutical, non-surgical treatments of canine osteoarthritis <<< 15 Nutraceutical category investigated Nutraceutical compound investigated Author Study type Groups Sample size Study length Outcome measures Conclusions Evidence level (Aragon & Budsberg 2005) Tabel 2 continued
December 2023 17 Leading Article improvements in scores for pain, weight-bearing and OA severity by day 70, and was non-inferior to carprofen at day 70. Contrastingly, Scott et al. (2017) found that dogs treated with oral glucosamine hydrochloride and chondroitin sulphate for 90 days did not display increased activity levels when compared with a placebo, although owner assessment scores increased, indicating a possible caregiver placebo effect. Further research (evidence level I or II) is required to determine the efficacy of using glucosamine and chondroitin in improving clinical outcomes in OA as their analgesic efficacy has not been well demonstrated (Moreau et al. 2003). Curcuminoids Curcuminoids are natural turmeric-derived polyphenols (Henrotin et al. 2010). Many in vitro studies have demonstrated the anti-oxidant and anti-inflammatory properties of these compounds (Henrotin et al. 2010, Comblain et al. 2017). However, the bioavailability of naturally occurring curcumin in dogs is uncertain. Innes et al. (2003) described a significant effect for dogs treated with Curcuminoid P54FP using objective assessments, although owners failed to notice a difference in their dogs’ mobility. In contrast, Comblain et al. (2017) found no changes in objective variables (PVF and OA biomarkers). A recent systematic review of 10 human studies demonstrated reduction in pain and improved function in patients with knee OA pain (Paultre et al. 2021). Curcumin has been shown to be an active iron chelator in vivo, although it is unclear how this would affect carnivores such as dogs (Jiao et al. 2009, Badria et al. 2015). There is a need for a large-scale clinical trial as most data is relying on experimental, in vivo studies. Currently, recommended doses include 50 to 250 mg curcumin three times daily (Fougère & Wynn 2007), although future trials also need to focus on the bioavailability of the available forms and thus accurate dosages before these can be recommended as a reliable treatment for canine OA. Elk velvet antler Elk velvet antler is a Chinese medicine used to treat various diseases and is derived from the inner antler core in the velvet stage of growth (Zhang et al. 1992). In vivo studies have shown antiinflammatory effects in a rodent model of inflammation (Cheng et al. 2022). Velvet antler also contains chondroitin sulphate (Moreau et al. 2003, Henrotin & Lambert 2013, Bhathal et al. 2017, Scott et al. 2017). Moreau et al. (2004) used quality elk velvet antler in dogs with OA, with the majority of dogs improving in daily activities and their weight-bearing abilities (based on gait analysis). Further research into how elk velvet antler can inhibit the degenerative process of OA would be useful, alongside its efficacy compared to commonly prescribed OA medication (e.g. NSAIDs). Vitamin E Several human studies have shown benefits of vitamin E on OA clinical signs over a short-term period, primarily by reducing free radicals and synthesis of pro-inflammatory cytokines (Farbstein et al. 2010, Rizvi et al. 2014, Chin & Ima-Nirwana 2018). In dogs with surgically induced OA, nitric oxide and prostaglandin E2 in synovial fluid were lower following treatment with vitamin E, and histological OA lesions were reduced in dogs fed a high dose of vitamin E (400 IU/day) (Rhouma et al. 2013). Lameness and pain [assessed by visual analogue scales (VAS), numerical rating scales (NRS) and electrodermal activity] were also reduced in the vitamin E-treated group (Rhouma et al. 2013). Vitamin E is thought to be well tolerated in dogs with no adverse effects reported (Musco et al. 2019). However, there is a requirement for studies in naturally occurring canine OA and a longitudinal study to assess the synergy between Vitamin E and other compounds used to treat canine OA to determine the overall effectiveness. Avocado/soybean unsaponifiables The use of avocado/soybean unsaponifiables (ASU) in vitro has been shown to reduce interleukin-1 beta, and increase collagen synthesis in chondrocytes (Mauviel et al. 1991). Oral treatment improved subchondral bone structure (Cake et al. 2000) and reduced early OA cartilage and subchondral bone lesions (Boileau et al. 2009). ASU acts by downregulating synthesis by chondrocytes and correcting the imbalance between catabolic and anabolic processes which contribute to the onset and development of cartilage lesions in OA (Henrotin et al. 2003). Some studies have demonstrated that the beneficial effects of ASU can persist after treatment has ended (Blotman et al. 1997, Maheu et al. 1998). One human study found ASU to be a slow-acting drug, with symptomatic efficacy only occurring from the second month (Maheu et al. 1998). Canine studies have a maximum duration of treatment of eight weeks (Boileau et al. 2009). Thus, a longer study is required to identify the use and efficacy of ASU in the management of canine OA when used alone and in conjunctionwith other medication. S-adenosyl l-methionine S-adenosyl l-methionine (SAMe) is a nutraceutical commonly used to treat canine liver diseases such as chronic hepatitis, hepatic lipidosis and cholangiohepatitis (Wallace et al. 2002, Center et al. 2005). Due to its anti-oxidant properties, some have suggested that SAMe may have a beneficial use in canine OA (Gutierrez et al. 1997, McCarty & Russell 1999). SAMe has been shown to maintain the biomechanical strength of articular cartilage (Gutierrez et al. 1997) and promote a functional articular matrix (Bradley et al. 1994). One study found that SAMe was not an effective standalone treatment for canine OA as both subjective and objective outcomes did not show improvement in reducing clinical signs within 6 weeks of treatment (Imhoff et al. 2011). Previous human research has shown that SAMe has a slower onset of action when compared with NSAIDs; patients noticed no difference in pain scores with SAMe and NSAIDs after 2 months (Najm et al. 2004). Imhoff et al. (2011) did not assess the equivalence between SAMe and NSAIDs, thus, further research would be interesting for comparison to human medicine. However, from current research, there is no evidence to show the use of SAMe would be beneficial in the treatment of canine OA. Nutraceuticals –conclusion In reviewing the available evidence, the use of omega-3 could provide some analgesic effect for dogs with OA. However, commonly used products such as chondroitin-glucosamine have not been shown to have an analgesic effect (Paultre et al. 2021). Despite this, it is important to note that OA is a progressive disease and the duration of the trial is a key factor when assessing response to treatment. Other nutraceuticals such as green-lipped mussel and elk velvet antler demonstrate promising results, yet evidence is minimal for these products and further clinical studies are required to fully assess their efficacy. ACUPUNCTURE Acupuncture originated as a treatment of pain for people in China around 3000 years ago (Hao & Mittelman 2014). Over the past few decades, a growing yet mixed body of evidence has emerged in
Vetnuus | Desember 2023 18 « BACK TO CONTENTS human medicine as to its effectiveness in the treatment of human OA (Manheimer et al. 2018, Tian et al. 2022). In dogs, the use of acupuncture as a treatment modality for chronic musculoskeletal pain has gained more acceptance over the past few decades, with a variety of postgraduate courses available. Acupuncture involves the stimulation of specific anatomical locations, termed acupuncture points, that relate to areas linked with neurovascular structures, such as nerve fibres, mechanoreceptors, small arterioles and venules, as well as lymphatics and mast cells (Dewey & Xie 2021). These points are mainly located along pathways called “meridians” that are associated with certain internal organs, body systems and major nerve pathways (Wang et al. 2010). Acupuncture points correspond with areas of increased electrical conductance or reduced electrical resistance (Reichmanis et al. 1975, Johng et al. 2002), and have been described in the dog (Yang et al. 2017). There are various forms of acupuncture, including dry-needle acupuncture, electro-acupuncture, aquapuncture, moxibustion and implantation acupuncture (Hielm-Bjorkman et al. 2001, Jaeger et al. 2006, Kapatkin et al. 2006, Li et al. 2016, Sha et al. 2016). Mechanisms of action of acupuncture The analgesic effects of acupuncture are multimodal and complex, and are believed to be exerted through local, spinal and supraspinal mechanisms (Carlsson 2002, Huntingford & Petty 2022) which are briefly summarised here. Locally, inserting a needle during acupuncture causes a microtrauma, which provides a stimulus that leads to anti-inflammatory and immune responses in the tissue (Carlsson 2002). These include increased local blood flow, the activation of peripheral sympathetic nerve fibres, the release of europeptides and endogenous opioids, and a decrease of proinflammatory cytokines (Kimura et al. 2006, Park et al. 2014b, Chen et al. 2020). At the spinal level, acupuncture has been found to reduce chemokines and inflammatory cytokine release, reducing neuronal excitability and having an anti-inflammatory effect (Liang et al. 2016, Wei et al. 2021). At the supraspinal level, within the brain, acupuncture has been found to activate descending inhibitory pain pathways (Zhang et al. 2018, Huang et al. 2021, Lyu et al. 2021). Evidence for the use of acupuncture as a treatment for OA Designing a rigorous randomised controlled trial to study the effects of acupuncture has particular challenges (Chen et al. 2019). Placebo-controlling an acupuncture clinical trial can be difficult, and therefore many trials use forms of “sham” acupuncture as control. Sham acupuncture often consists of inserting needles into non-acupuncture point areas, or inserting them very superficially, but this action itself may have a physiological effect on subjects (Kim et al. 2022). Other clinical trials use a group that receive no treatment as a control. In dogs, as many outcomes rely on owner assessment, the owner can be blinded to the treatment group if the dogs are removed from their owner while they either receive acupuncture or no treatment (Baker-Meuten et al. 2020). Several systematic reviews and meta-analyses have examined the efficacy of acupuncture in human participants with OA and have mixed conclusions (Manheimer et al. 2010, Manyanga et al. 2014, Manheimer et al. 2018, Allen et al. 2022, Tian et al. 2022). Current guidelines from the National Institute for Health and Care and Excellence (2022) in the UK advise against offering acupuncture or dry needling to manage OA in people. These guidelines cite a lack of evidence of clinical benefits and cost-effectiveness, although they do conclude that there may be some benefit to electro-acupuncture in some people and advise further research is required. Clinical trials investigating acupuncture as a treatment for canine OA are listed in Table 3. These studies include a mixture of acupuncture techniques, including dry needle acupuncture (Lane & Hill 2016, Teixeira et al. 2016, Silva et al. 2017, Baker-Meuten et al. 2020), electro-acupuncture (Kapatkin et al. 2006, Silva et al. 2017, Chomsiriwat & Ma 2019) and gold wire or gold bead implants at acupuncture points (Hielm-Bjorkman et al. 2001, Jaeger et al. 2006). The evidence behind the efficacy of acupuncture as a treatment for canine OA in these trials is mixed. Baker-Meuten et al. (2020) investigated the efficacy of acupuncture on the treatment of OA in various joints in 32 client-owned dogs over 1 year of age and over 10 kg in bodyweight. The investigators found no difference between baseline measurements versus placebo and acupuncture treatments for objective gait analysis, accelerometery or subjective orthopaedic examination, but did find a significant improvement with acupuncture versus baseline and placebo in some of the clinical metrology instrument (CMI) scores. Teixeira et al. (2016) also found improvements in CMI scores after 4 weeks of acupuncture treatments in dogs with hip dysplasia. Lane & Hill (2016) investigated the effect of a combined acupuncture and manual therapy protocol compared to no treatment in 47 dogs with lameness of various causes, including OA. The study found a short-term improvement in subjective owner assessments after two treatments 6 days apart. However, no objective outcome measurements were used, and as acupuncture was combined with other physical therapies, it cannot be concluded that the effects were due to acupuncture alone. Silva et al. (2017) concluded that the use of acupuncture alone or in combination with analgesics reduced pain and improved QOL in dogs with neurological and musculoskeletal conditions; however, the trial was not blinded, used a mixture of acupuncture, electro-acupuncture and other alternative therapies and only states the outcomes of dogs with a range of musculoskeletal disorders and not specifically OA. Studies investigating electroacupuncture in dogs with OA present mixed conclusions. Kapatkin et al. (2006) found no significant improvement in nine dogs with elbow OA treated with electro-acupuncture for 3 weeks in either owner assessment or objective gait analysis. Chomsiriwat & Ma (2019) however, did find a significant improvement in CBPI scores and hip joint range of movement in 31 dogs treated with either electro-acupuncture or laser therapy for 8 weeks compared to baseline in dogs with hip OA. This study, however, lacked a control group. Implantation of gold wire or gold beads at acupuncture points was performed on 38 and 78 dogs with hip OA, respectively (HielmBjorkman et al. 2001, Jaeger et al. 2006). Hielm-Bjorkman et al. (2001) found no significant effect, whereas Jaeger et al. (2006) found significantly greater improvements in signs of pain and mobility with subjective outcome measures in the treated group compared to control. Acupuncture –conclusions Currently available research investigating acupuncture for the alleviation of OA-associated pain does not draw firm conclusions regarding its efficacy in either veterinary or human medicine (Kapatkin et al. 2006, Manheimer et al. 2018, Baker-Meuten et al. 2020, Tian et al. 2022). There are published studies that have reported improvements in outcomes such as CMI scores and subjective outcome measurements for canine OA using different Current evidence for non-pharmaceutical, non-surgical treatments of canine osteoarthritis <<< 17
RkJQdWJsaXNoZXIy OTc5MDU=