Degenerative Joint Disease (DJD) affects diarthrodial joints and is characterised by the progressive wear of the hyaline cartilage within a joint. Initial hyaline cartilage thinning is followed by joint effusion and osteophyte formation and proliferation around the margins of the joint. It is what we know as osteo-arthritis in humans and this term may also be used. The most commonly affected joints in dogs are the hip, elbow, lumbar spine (lower back), stifle (knee) and carpus (foot).
DJD can be categorised as either primary or secondary. Primary is what we would know as classic ‘wear and tear’ and is most commonly seen in elderly and obese dogs with no known trauma preceding the onset. It is more common in some large breeds and may be more common in working or sporting dogs.
Secondary O/A can develop if a dog has an underlying developmental joint anomaly such as hip or elbow dysplasia. (Note: Both of these conditions are more common in certain breeds and should be screened in correct breeding programs. They have always been thought to be congenital but there has been much research in recent years on the nature/nurture debate and it has been found that nurture plays a larger role than previously thought. It is therefore important that developing puppies are not given free exercise and are not allowed to jump in and out of cars, on and off of sofas, or up and down stairs.)
Secondary O/A can also develop if a dog has an acquired joint abnormality which leads to instability or incongruity of the joint. Examples of this would be cruciet rupture, or OCD lesions.
Signs and Symptoms
Owners will first notice and report limping, stiffness (especially in the morning), altered posture or gait, dog unusually not wanting to get up onto sofa/bed, slowing down on or not wanting to go for a walk, difficulty standing after prolonged stasis. A previously gentle dog may become irritable with other dogs or family members. They may also notice their dog nibbling and licking an affected joint. Restlessness can also be reported. The stiffness and limping may well improve as the dog ‘warms up’ with gentle exercise.
Clinical signs of DJD include localised joint swelling, tenderness to palpate around the joint, muscle wasting, pericapsular fibrosis, crepitation, and loss of full range of movement.
Radiographic changes in the joint may show effusion, periarticular soft-tissue swelling, osteophytosis, subchondral bone sclerosis, and narrowed joint space.
Initial diagnosis is made by your Vet taking into account both clinical history and findings on examination. Definitive diagnosis is made on X-ray under anaesthetic. Joint fluid samples may be taken and examined microscopically.
If the dog is obese, the vet may recommend a calorie controlled diet.
DJD is irreversible but pain can be controlled with NSAIDs available on prescription from the vet such as Metacam (Meloxicam) or Rimadyl. A vet may also choose to medicate using an opioid such as Tramadol.
Surgical approaches are indicated where pain cannot be controlled adequately. The most common procedures are fusion and joint replacement (e.g. hip replacement in humans). Osteotomies are also possible. In extreme cases, amputation may be necessary.
Referral for physical therapy is appropriate where surgical intervention is not yet indicated.
As there is no cure for DJD, Osteopathic principals come into their own in the treatment and management of the condition. Reducing load, maintaining joint mobility, improving blood supply, and fluid dynamics are key. Goals of Osteopathic treatment are to reduce pain, increase comfort and mobility, and slow further progression by optimising function. As well as offering hands on treatment, recommendations for small changes in day to day life will also all help and combine to give a greater improvement and quality of life.
Gentle hands on treatment including soft tissue massage will help to alleviate symptoms. Specific joint articulation and functional movements will assist in improving not only range of movement but also blood supply. Damaged cartilage will not heal but as this structure receives it’s nutrition from diffusion, a supply of healthy blood will bring nutrients to help to maintain and optimise the health of the joint.
If one joint/limb is more painful, the others may be being overloaded. Optimising function throughout will help to dissipate forces and disperse load more evenly during gait.
We will support veterinary recommendation for weight loss as this is one of the prime contributory factors in DJD. Pets who are able to exercise less may require less calories to maintain their weight.
Running, turning, twisting (e.g. Frisbee chasing) will put more load upon the joints, as will hill walking. Regular and appropriate exercise will help to maintain muscular strength, joint mobility and regulate weight.