Arthritis is a very frustrating disease for veterinarians. Often times, we struggle along with pet owners about making decisions regarding euthanasia on pets who are mentally fine but can no longer get themselves around to do even basic animal things like eating and passing waste. It is tough to control risk factors when they are younger, and medications can become very limited with age and possible toxicities. With cats, pain control choices are so limited by their sensitivity to these toxicities that we are often stuck using narcotics. Luckily, there are new classes of drugs coming along to help us tackle this debilitating issue.
The first is a new class of anti-inflammatories. Inflammation causes many issues, and inflammation of the joints is the definition of arthritis. So, decreasing inflammation will not only decrease damage but it will decrease pain. Steroids are among the most potent anti-inflammatories but come with well-known side effects. Non-steroidal anti-inflammatories (NSAIDs) were developed as the answer to these side effects by targeting more specific things in the body. Aspirin was the first, but still has side effects like increased bleeding. Scientists continued to work on more specific targeting newer classes of drugs (Tylenol, Advil, etc.) that did not cause bleeding, but could still cause issues with organ damage. This is even more pronounced in dogs and cats, often to a fatal level. However, there is a new super-targeted class of anti-inflammatory called a prostaglandin antagonist that has been proven very safe. It was tested safely at very high doses and has allowed us to control pain in dogs where other treatments were deemed dangerous.
Unfortunately, this medication is still not available for cats. However, another completely new type of treatment has been doing very well with alleviating pain in both dogs and cats: monoclonal antibody therapy. In general, this type of medical treatment is not that new. In fact, you’ve probably seen MANY ads for products treating other types of disease using this technology. Any drug you may have seen that ends in “mab” falls into this category. Monoclonal antibodies are the same as antibodies produced by a patient’s own body against things like infections. In those cases, the immune system sends these molecules into the body to identify and bind to natural compounds in the body that are being over-produced and eliminating the excess from the body. We have already used this in dogs with allergies.
For arthritis pain in dogs and cats, this new treatment goes after a compound in the body that leads to nerves signaling pain to the brain. A monthly injection is given that decreases this compound and it has significantly decreased pain in patients. Like anything, results may vary, but we have already seen dogs and cats that could barely walk who are now running in the woods like we shaved several years off their age. Since we still don’t know how this will affect the actual arthritis in these patients, we are continuing anti-inflammatory therapy and simply adding this to current treatment regimens. Regardless, we are very happy to have this option to make our patients’ lives even better. If you think your dog or cat could benefit from these injections, please reach out to your veterinarian to discuss it as an option.