Osteoarthritis in Dogs Part II: Treatment Options

Our last blog post regarding osteoarthritis in dogs discussed causes and preventative measures with an emphasis on the multifactorial nature of the disease. Let’s say your companion dog is diagnosed with osteoarthritis. The goal is to reduce inflammation and the debilitating chronic pain associated with the disease. Please be advised that we will be discussing cutting-edge treatment options and the latest information on pharmaceuticals that are also commonly prescribed. 

We will be listing each item to manage osteoarthritis individually and then discussing the multimodal approach. Multimodal is how we best manage the symptoms and pain associated with osteoarthritis. 

By the way, we are not endorsing any of these options except for the basics.

The Basics to Manage Osteoarthritis in Dogs

#1. Weight Loss is Critical 

Marshall et al. published a pivotal study on the topic in 2010. We consider this to be a “gold standard” study. They stated, “The results indicate that body weight reduction causes a significant decrease in lameness from a weight loss of 6.10% onwards. Kinetic gait analysis supported the results from a body weight reduction of 8.85% onwards. These results confirm that weight loss should be presented as an important treatment modality to owners of obese dogs with osteoarthritis and that noticeable improvement may be seen after modest weight loss in the region of 6.10 – 8.85% body weight.”

Please speak to your veterinarian about a weight loss plan

#2. Physical Activity 

Dogs still need to be physically active. True; it might not be running or agility courses, but walks and exercises will help. 

#3. Modify Home Environment

We suggest memory foam or low-heated beds, raising the food bowl between a dog’s elbow and shoulder level, a ramp to get in and out of the car, non-skid rugs, and pet steps to get on furniture or beds. You can also use baby gates to block off rooms that might have slippery floors. As well, please remember to trim their nails. 

The Rest

Nutraceuticals and Pharmaceuticals

Osteoarthritis causes inflammation and is painful. So, treatment options focus on either reducing inflammation and/or or pain management. 


Glucosamine/Chondroitin – The study results are mixed as to the use of glucosamine and chondroitin. The “pro” glucosamine/chondroitin group found that this combination may slow cartilage degeneration, contribute to cartilage repair, reduce inflammation of the joints, and improve elasticity. Many researchers are now saying, “Might help/won’t hurt” because there is no evidence of long-term harm in providing companion dogs with these joint supplements, if given at the appropriate dosage. 

One of the inherent misconceptions is that we should administer these to dogs that are diagnosed with osteoarthritis. While we can do this, as stated in the prior posting, their premise is to be preventative and given before the onset of symptoms. 

Be advised that the potential effects of glucosamine/chondroitin likely will not be noticeable for 4-8 weeks.

Hyaluronic Acid – Hyaluronic acid is a glycosaminoglycan just like glucosamine and chondroitin. At this time, it can be injected into the damaged joint area. 

Omega-3 Fatty Acids and Green-Lipped Mussel Extract – Help reduce the inflammation associated with osteoarthritis. 

Undenatured Type II Collagen – Has been shown to reduce the clinical signs of osteoarthritis in dogs and enhance their mobility. 

If you are feeding a food that is already high in these, you should not add additional supplementation. 

Conventional Pharmaceutical Anti-Inflammatory

Glucocorticoids such as prednisone are not recommended for long-term use and could, in fact, cause joint damage and induce Cushing’s Syndrome. 

Non-steroidal anti-inflammatory drugs (NSAIDs) are available for dogs by prescription to provide immediate relief. Unfortunately, they have side effects that can wreak havoc on the gastrointestinal tract and kidneys. 

Radiocolloid therapy (Synovetin OA, for example) is a radiation-based injection that goes directly into the affected joint and is indicated for low to intermediate grade osteoarthritis. Its goal is to decrease synovial inflammation, promote a healthier joint environment, and slow the cascade of events leading to cartilage degradation and advanced disease.

Conventional Pharmaceutical Anti-Pain

Tramadol – A randomized, blinded, placebo-controlled crossover study by Budsberg et al. found that tramadol was ineffective at pain relief for dogs. Tramadol is therefore an outdated therapy. 

Gabapentin – Gabapentin decreases pain, although figuring out the effective dosage can be difficult. 

Amantadine – Amantadine is often prescribed for advanced cases of the disease to inhibit pain sensation in the nerve pathways and works synergistically with other pain relievers. 

Buprenorphine – Buprenorphine is an opioid and should be given with extreme caution particularly in dogs with hypothyroidism, Addison’s disease, liver, heart or lung conditions. 

Anti-Nerve Growth Monoclonal Antibodies – Brand name, Librela, was recently approved for dogs in Europe and the United Kingdom, and will possibly be approved in the United States in 2023. It stops nerve growth caused by chronic arthritis, by essentially shutting down the ability to transmit pain through new nerves. Since it is an injectable, it should not effect the kidneys or the liver. 

On the Horizon?

It feels like new research into treatment options for osteoarthritis in dogs is released daily. Here’s a sampling. 

Cannabidiol – A watershed randomized, double-blind, placebo-controlled study from 2020 found that cannabidiol has anti-inflammatory properties and can improve quality of life for dogs suffering from osteoarthritis. Please do not start buying over-the-counter cannabidiol. The study authors note that additional work needs to be done. If you are thinking about cannabidiol to alleviate your companion dog’s symptoms, please speak with your veterinarian. Note that at present, veterinarians in California are not permitted to prescribe any type of cannabidiol.

Platelet-Rich Plasma (PRP) – A small study consisting of 5 dogs that had both pain and lameness was performed, and they were not reacting well to other therapies such as pharmacological or physical approaches. PRP has the capacity to stimulate regeneration of injured tissues such as tendons, ligaments and cartilage. According to this study, the five dogs were injected once at the joint with PRP. All dogs demonstrated a decrease in lameness, three out of five were deemed pain-free, and the other two had less pain. Several researchers are looking into leukoreduced (removal of the white blood cells) PRP, autologous (from the same body) PRP, and combinations with other possible medications. Many of these studies show promise. 

Blood Cell Secretome (BCS) – BCS is also known as autologous conditioned serum, and has anti-inflammatory properties. Researchers in Portugal stated that injection of BCS was able to improve the overall condition of osteoarthritic patients. Note that the abbreviation, BCS, is most commonly used to mean “Body Condition Score “. 

Steroids – The same Portuguese researchers explored other injectables like triamcinolone acetonide (a glucocorticoid) mixed with BCS, as well as stanozolol (anabolic steroid). They are seeing positive results with these treatments. 

Mesenchymal Stromal Cells (MSC) – MSC usually come from the adipose tissue of living canine donors. The results appear to be mixed, thus far. So, more research should be done. 

Hyaluronic Acid – At the current time, hyaluronic acid is injected. A 2021 study investigated administering it orally following canine cruciate ligament surgery and found it effective. 

Hyaluronic-Plus – Several studies over the past couple of years have been mixing hyaluronic acid plus ozone gas, platelet-rich plasma, or canine adipose-derived mesenchymal stromal cells

Non-Pharmaceutical Options

The point of non-invasive therapy is to manage inflammation, reduce pain, facilitate tissue repair and growth, and alter gene expression. 

Some of the non-pharmaceutical therapies are underwater treadmill, massage, chiropractic care, and physical therapy. Other options include: 

Acupuncture – The benefits of acupuncture are that it is minimally invasive, has no adverse side effects, and can mitigate pain. It has to be done on a recurring basis. Western medicine has been somewhat slow in accepting the use of acupuncture. However, a randomized, placebo-controlled, blinded, 2020 Colorado State University study suggested that companion dog parents whose dogs had acupuncture noted that their dogs were in less pain than the caregivers whose dogs had the placebo. Remember, this study was blinded so the caregivers had no idea if their dogs did or did not receive acupuncture. 

Whole Body Vibration – Dogs stand, sit or lie down on a plate that is vibrating. It forces muscles to contract and relax quickly. As well, it may help improve balance.

Low Level Laser Therapy – A study published in late 2022 demonstrated that weekly treatments of low level laser therapy for six weeks effectively increased the level of activity of dogs with osteoarthritis. The study also concluded that it may also be used as an adjuvant therapy to treat chronic joint pain and reduce pharmaceutical use. With this treatment, there are several variables such as wavelength, manner of application, temperature, time length of application and number of treatments. 

Pulsed Electromagnetic Field Therapy (PEMF) – Pulses the electromagnetic fields in tissue to promote healing and many devices like the Assisi Loop can be used at home. A 2012 study determined that PEMF lessened the clinical signs of osteoarthritis in dogs after 20, 18-minute treatments.

Extracorporeal Shockwave Therapy – Shockwave therapy uses high-energy sound waves to help decrease lameness and pain, as well as promote healing growth factors. This is not the same as radial shockwave therapy. 

Transcutaneous Electrical Nerve Stimulation (TENS) – TENS is typically used during therapy sessions to reduce pain by targeting sensory nerves with electrical stimulation. 

Multimodal Approach to Osteoarthritis

Please remember that we are not endorsing any one of these treatment options. We want you to have a comprehensive list of available approaches to discuss with your veterinarian. We want to emphasize that a multimodal approach is necessary to manage and care for osteoarthritis in dogs. 

Case in point, 14 dogs with osteoarthritis in the hips were split into two groups. Group one had one injection of hyaluronic acid. The second group had the same injection, but also whole-body vibration therapy every two days for 12 weeks. While improvement was seen in both groups, the second group demonstrated improvement earlier and better mobility. 

Another study published in the Journal of American Veterinary Medical Association split 29 dogs into two groups. Both groups were put on calorie restriction diets. One group, though, had a home-based physical therapy program. The second group had intensive physical therapy and TENS for pain. 

Results? Both groups lost substantial amounts of weight. However, the dogs that had intensive physical therapy had better outcomes and significant improvements in mobility after six months. 

Additional References

Alves, J C et al. “Effect of a single intra-articular high molecular weight hyaluronan in a naturally occurring canine osteoarthritis model: a randomized controlled trial.” Journal of orthopaedic surgery and research vol. 16,1 290. 3 May. 2021, doi:10.1186/s13018-021-02423-4.

Alves, J C et al. “Platelet-rich plasma therapy in dogs with bilateral hip osteoarthritis.” BMC veterinary research vol. 17,1 207. 5 Jun. 2021, doi:10.1186/s12917-021-02913-x.

Boström, Anna et al. “Systematic Review of Complementary and Alternative Veterinary Medicine in Sport and Companion Animals: Extracorporeal Shockwave Therapy.” Animals : an open access journal from MDPI vol. 12,22 3124. 12 Nov. 2022, doi:10.3390/ani12223124.

Franklin, Samuel P, and Ashley L Franklin. “Randomized Controlled Trial Comparing Autologous Protein Solution to Hyaluronic Acid Plus Triamcinolone for Treating Hip Osteoarthritis in Dogs.” Frontiers in veterinary science vol. 8 713768. 28 Jul. 2021, doi:10.3389/fvets.2021.713768.

Huntingford, Janice L, and Michael C Petty. “Evidence-Based Application of Acupuncture for Pain Management in Companion Animal Medicine.” Veterinary sciences vol. 9,6 252. 26 May. 2022, doi:10.3390/vetsci9060252.

Johnson KA, Lee AH, Swanson KS. Nutrition and nutraceuticals in the changing management of osteoarthritis for dogs and cats. J Am Vet Med Assoc. 2020 Jun 15;256(12):1335-1341. doi: 10.2460/javma.256.12.1335.  

Kim, Sohyun et al. “Intra-Articular Injections of Allogeneic Mesenchymal Stromal Cells vs. High Molecular Weight Hyaluronic Acid in Dogs With Osteoarthritis: Exploratory Data From a Double-Blind, Randomized, Prospective Clinical Trial.” Frontiers in veterinary science vol. 9 890704. 7 Jun. 2022, doi:10.3389/fvets.2022.890704. 

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