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Multimodal approach to osteoarthritis advocated

01 February 2013, at 12:00am

SOME 600 vets and nurses attended the Excellence in multimodal osteoarthritis management CPD events last October, undertaken in a collaboration between Pfizer Animal Health and Hill’s Pet Nutrition, hearing that the key challenge of osteoarthritis is how to manage it.

Professors Stuart Carmichael and John Innes and David Prydie presented the latest thinking on the disease and delegates ran through a series of diagnosis and management exercises and left with a toolkit of ideas to apply in practice. Sessions addressed medical and surgical management of the osteoarthritic patient as well as rehabilitation and weight management.

Prof. Carmichael explained why management of the disease is so important: “We know osteoarthritis is very common because we see it all the time in dogs, yet there is still an underlying notion that it is a poorly treated disease.

“This is probably because of the very nature of the disease. It’s a chronic, incurable disease which presents when two different forms – an acute flare and chronic disease – occur together. It is also worth reminding ourselves that dogs are programmed not to show signs until it has become chronic, so it is difficult for owners to spot.

“The underlying chronic signs tend to go unnoticed and therefore unmanaged so vets need to focus on the chronic disease element and its impact and put more emphasis on the complexity of the problem. It is also a lifetime disease requiring vets to focus on compliance – the owner needs to come on the journey to ensure the correct treatment.”


He continued: “It is the complexity of the disease that has driven the need for a multimodal approach. In looking at the complexity of the pathology, vets should divide the disease into different stages (Figure 1).

“The first logical extension of the disease is outside the joint. That extension is then followed by loss of mobility and then neurological changes, by which time even a normal stimulus becomes a painful stimulus. An end-stage joint will no longer respond to non- surgical treatment so this stage needs to be recognised.

“How can we use what we know about the disease to affect its management? By recognising what stage the disease is at, vets can assess how the dog would respond to different treatments, bearing in mind the disease almost always affects multiple joints so every joint needs to be assessed.

“Both clinical and pathological signs should be used to conduct an appraisal including structural changes, physical consequences, pain response and general information such as the vet’s background knowledge of the disease,” he said.”

Using a multimodal management scheme allows the identification of treatments that are different in their attack, but also synergistic. By using a combination of treatments, dependence on one treatment method is reduced. Vets can identify which areas are important by following a six-point plan to develop a management strategy for osteoarthritis (Figure 2),” Prof. Carmichael said.

The speakers demonstrated that by utilising multiple management options simultaneously in the treatment of osteoarthritis, the synergy provides less dependence on each individual intervention and helps achieve a better overall result.