More Aching Joints

Here is another set of questions that are a good follow-up to my previous discussion about osteoarthritis.

Quick question...have you heard of a procedure where you actually clean the joint? I think it involves removing some of the scar tissue or build up that is causing the pain. I've heard it was a less invasive option. Also, that are your thoughts on giving the animal a cortisone shot?

Remember that osteoarthritis is a complex of problems, and is rarely treated or controlled by a single simple option. There are also various degrees of the disease, from mild to severe. The progression of the disease can begin with inflammation and cartilage erosion, and proceed to spurs and remodeling of the bone around the joint. However, it is never just a single factor. Pain comes from several factors, including the mentioned cartilage erosion, lack of synovial (joint) fluid, chemical mediators of inflammation, abnormal bone structure, and instability of the joint. Because it is usually a multifactoral disease, a multimodal approach to treatment is best. A single treatment is rarely the best option.

I have not heard of any surgical option used commonly in the treatment of arthritis in pets. Since this type of arthritis is not merely scar tissue or abnormal bone development, I can't imagine it working. If there is significant enough remodeling of bone leading to spurs, then I could see a rationale for it, but this situation is not going to happen commonly. Also, it might be misleading to think of joint surgery as less invasive. Even if done arthroscopically it is going to involve general anesthesia and an incision into the joint. Depending on the joint, this may not even be logistically possible, especially in smaller dogs. I definitely wouldn't recommend it for most cases.

Cortisone injections have their place in treatment of arthritis, but it is a very limited place. The injections are basically just strong and long-lasting antiinflammatories. Their mechanism of action really isn't any different than giving prednisone or similar steroids. Steroids are great at reducing inflammation and itching, but have limited (if any) effectiveness against pain. That's why steroids aren't commonly used for treatment of arthritis, since NSAIDs are much better at controlling the pain of the disease. There are also side-effects of long-term steroid use, and the injections can't be used indefinitely. In my opinion, there are better ways of controlling the pain and inflammation of osteoarthritis.

As you can see, this isn't as simple as many think. Treating arthritis can be a difficult endeavor, and require multiple types of medications and supplements. It's also a disease that is progressive and generally irreversisble. At some point, treatments that once worked will no longer work as well. But we're learning more about the disease process all of the time, and continue to develop more options, which can give hope for our painful pets.