In the last two articles, we looked at managing arthritis with alternative and nutritional options. I left pharmacologic treatment until last because we also prefer to save this until other options have been exhausted. As anyone who has seen a pharmaceutical commercial can tell you, there is no medication that is side-effect free. Things have gotten much better in recent years with more targeted drugs, but we will still prefer to play it as safe as possible.
The main cause of arthritis is inflammation: the body’s normal response to damage or stress where hormones and certain blood cells are sent to an area to deal with and clean up after some issue. It leads to swelling, pain, and, in chronic cases, long-term damage to surrounding tissues. In the case of joints, these chronic issues arise from old injuries, obesity, anatomic abnormalities (like hip dysplasia), or auto-immune diseases. With this in mind, arthritis medications are targeted at decreasing inflammation.
Steroids are the most potent anti-inflammatory we can use. However, they are loaded with side effects from blocking other things like the immune system, clotting, and other natural processes in the body. The first non-steroidal anti-inflammatory drug was aspirin. It is still considered one of the most potent and effective drugs for this purpose and we actually do recommended it in the buffered-only form in some cases. However, it also has a long list of side effects like stomach ulcers, bleeding issues, and organ damage. That is what led to the more specific anti-inflammatories, commonly called the “profens”. While human drugs like Tylenol and ibuprofen are toxic to pets, there have been safer veterinary formulations like carprofen and meloxicam. These drugs do not cause the bleeding issues and other problems associated with the broader effects of steroids and aspirin. They block inflammation and pain very well, and have been our go-to for both injuries and arthritis for over 25 years. However, they are still not side effect-free. In some cases, especially at higher doses and long-term, there can be some damage to the liver and kidneys. These values are monitored regularly when patients are on these medications. Unfortunately for cats, many of the drugs listed above can be extremely toxic and they are used with caution and extra monitoring.
More recently, a new class of medication was released that is even more targeted against inflammation by blocking compounds in the body called prostaglandins. As this medication is extremely specific for inflammation, the side effects are rare, even at very high doses. It does take longer to kick in than the older classes of medication making it a poor choice for severe, acute injuries. But, it has done wonders for our chronic arthritis patients, especially those who have experienced side effects from the other drugs.
Even with the pain-blocking effects of these anti-inflammatories, some patients still need extra pain control to keep them comfortable and happy. Drugs like gabapentin and certain narcotics are used in these cases to balance pain control without sedation or changes in personality. However, with newer restrictions due to the opioid crisis, it is getting tougher to prescribe these medications.