HARPSIE'S WEBSITE -
HOME OF THE
WALKING VETERINARY ENCYCLOPAEDIA
Arthritis is inflammation of a joint. It comes in many forms, but the type of arthritis discussed here is osteoarthritis, which is commonly seen as a cat ages. It is sometimes referred to as degenerative joint disease.
In a cat with arthritis, the cartilage within the joint thins and becomes scarred. This means bones can rub together (which they are not designed to do), leading to pain, swelling and restricted movement. New bone spurs may also form and inflame the nerves, causing additional pain.
Darwin Vets offers a good overview of arthritis.
Pet Place has a summary of arthritis in cats.
The symptoms of arthritis in cats can be quite subtle, and since they may also come on gradually, you may not immediately realise that there is a problem. You may notice that your cat no longer jumps, and then later that s/he is struggling with stairs. When getting out of bed after a nap, your cat may move more stiffly at first, and then appear to loosen up.
Arthritis is usually diagnosed by x-ray. The cat may need to be sedated or anaesthetised in order for this to be done, but this is not always necessary.
The goals of arthritis treatments are primarily to control pain and to reduce swelling.
Vet Info briefly discusses the main treatments for arthritis in cats.
Veterinary Partner also has an overview of various arthritis treatments.
It is important for an arthritic cat not to be overweight, because this adds stress to the joints and worsens the damage done to them; plus it makes the cat less mobile, which then leads to stiffness. If your cat is overweight, speak to your vet about a gentle weight loss programme.
Cats with arthritis are usually stiffer when they first get up after lying down for a while. Thus encouraging movement and exercise is important for keeping the joints as loose as possible. Harpsie enjoyed playing with Cat Dancer, he did not move much but he could lie on the floor hitting it. Some people also gently massage their cats's joints.
Products containing glucosamine sulfate and chondroitin are commonly prescribed for arthritis in cats. The former is essential to the construction of cartilage in the body and is supposed to help lubricate the joints, and the latter is supposed to help cartilage heal.
Glucosamine contains glucose, so may be a problem for diabetic cats. Chondroitin comes from chitin, which comes from the shells of crabs, and may therefore not be suitable for cats who cannot tolerate shellfish. Some brands contain potassium, which is not advisable for cats taking ACE inhibitors.
Glucosamine for osteoarthritis: magic, hype or confusion? (2001) Chard J & Dieppe P British Medical Journal 322 pp1439-1440 concludes that whilst much of the evidence indicates that glucosamine is probably a safe and effective treatment for arthritis, more research is needed.
National Institutes of Health National Center for Complementary and Alternative Medicine is a more recent study which concluded that glucosamine appears to be helpful for humans with arthritis who are experiencing moderate to severe pain.
The Pet Center has a good overview of both glucosamine and chondroitin.
Mar Vista Vet has information on these types of product.
University of Maryland Medical Center has an overview of glucosamine.
PDR Health provides an overview of glucosamine.
PDR Health provides an overview of chondroitin.
One commonly prescribed brand is Cosequin, which comes in a chicken and tuna flavoured formula designed especially for cats. You can open the capsules and sprinkle them on your cat's food. Uusally you start with one capsule twice a day for six weeks, then reduce to a maintenance dose of one capsule a day. Cosequin is a very effective treatment for many cats with arthritis.
Nutramax Laboratories is the website of the manufacturer of Cosequin.
Valley Vet sells 80 Cosequin tablets for US$17.95. Shipping is US$5, or free for orders over US$50.
Countryside Pet Supply sells 80 Cosequin tablets for US$17.95 plus shipping at cost.
Glycoflex contains chondroitin in the form of green lipped mussels, in a special feline formula.
Next Level is another glucosamine and chondroitin product which also has green lipped mussels. This product is designed for horses, so do not use it without your vet's knowledge and approval.
Adequan is an injectible arthritis treatment containing polysulfated glycosaminoglycan. It is intended for horses and dogs, and is supposed to be given intra-muscularly, which can be painful for cats. However, some people whose cats have severe arthritis which has not responded well to the standard glucosamine and chondroitin products have tried it off-label on their cats. They normally give it sub-cutaneously (an injection under the skin rather than into a muscle). Like Cosequin, Adequan is given as a loading dose: for the first month it is given once a week, and after that it only need to be given once monthly.
Mar Vista Vet has information about Adequan.
Adequan is the manufacturer's website for the equine version of Adequan. It has a good explanation of what cartilage does.
Adequan Canine is the manufacturer's website for the canine version of Adequan.
Drs Foster & Smith discusses the effects, risks and side effects of Adequan.
Cetyl myristoleate (CMO) is a type of fatty acid, and some studies indicate that it may be of benefit in treating arthritis in humans. I am not aware of any studies in cats to date, nor do I know of anybody who has used it for their cat. Please do not use this without speaking to your vet first.
Cetylated fatty acids improve knee function in patients with osteoarthritis (2002) Hesslink R Jr, Armstrong D 3rd, Nagendran MV, Sreevatsan S, Barathur R Journal of Rheumatology 29(8) pp1708-12 discusses how CFA may improve function and movement in humans with arthritic knees.
The Arthritis and Glucosamine Information Center discusses recent studies on the use of CMO in humans with arthritis.
Animal Health Care Vet discusses the use of CMO in dogs.
Celadrin is one brand of CMO for human arthritis patients.
Aspirin is sometimes used in arthritic cats to reduce pain and swelling. Aspirin can be toxic to cats, who can only metabolise it very slowly, and should therefore only be given to a cat on veterinary advice; it is usually only given in very low doses once every three days. If the cat reacts badly even to this low dose, then aspirin has to be stopped.
has some information on using aspirin in cats with arthritis.
Mar Vista Vet has information on aspirin.
Metacam (meloxicam) is a non-steroidal anti-inflammatory drug (NSAID) available in both injectible and liquid (oral) form. It is approved for use in dogs in both forms, but since cats tend to metabolise NSAIDs very poorly, in the USA meloxicam is only approved for use in cats in its injectible form. This is because it is intended to be a one-off treatment as a painkilling injection following surgery.
This was also the case in Europe, but in June 2007, the oral form of Metacam was licensed for cats for longer term pain management e.g. for use in cats with arthritis. The new feline version of Metacam is a 0.5mg/ml oral suspension compared to the canine version which is a 1.5mg/ml suspension.
In the USA, meloxicam also appears to be being used more and more frequently off-label for cats in its liquid (oral) form on an ongoing basis, but because there is no feline version available, vets are using the canine version at reduced doses.
Unfortunately meloxicam is nephrotoxic, i.e. toxic to the kidneys. In fact, it can cause permanent damage to the kidneys (papillary necrosis), with the result that a number of cats seem to have developed acute or chronic renal failure after taking meloxicam. I am therefore mystified as to why the drug has been approved for ongoing use in cats in Europe.
Although meloxicam is very effective at controlling pain, I would not recommend its use in a cat who already has CRF, and I would be very cautious about using it in cats generally.Having said that, we did use it for Harpsie as a last resort when his arthritis flared up acutely in 2004 following a fall and he was in dreadful pain which other pain medications did not seem to help (he was literally screaming). It worked very well and caused no long term problems for him, but since Harpsie has PKD, we only used it at a very low dose, and much less frequently than normally recommended, and it still controlled the pain effectively. We checked his kidney values a month later. You can read more about our experiences here. However, I would be very nervous about using it on an ongoing basis for a cat.
I would recommend only using Metacam in exceptional circumstances. If you do use it, and your cat develops renal failure, please see below for information on how best to treat it.
Metacam may interact with ACE inhibitors such as benazepril (Fortekor or Lotensin) or enalapril (Enacard) so do not give both medications to your cat without checking with your vet first.
Dealing with Adverse Reactions to Metacam in the USA
If you believe your cat has developed renal failure as a result of using Metacam, you should report this to the manufacturers. The number to call is 1-866-METACAM (638-2226). You will probably find yourself speaking to Dr Schwarzer, but if not, ask for him by name. Dr Schwarzer will work with your vet to devise a treatment plan.
Most cats who suffer renal failure as a result of using Metacam are suffering from acute renal failure (ARF) and their bloodwork may be extremely high, with creatinine often in the high teens. Do not give up hope! Acute renal failure is difficult to treat, but not impossible: an aggressive treatment plan should see those numbers dramatically reduce in most cases, so don't opt for euthanasia immediately.
A treatment programme which includes 4-5 days of IV fluid therapy (hospitalisation), followed by 4-6 weeks of sub-Q fluids at home, is often recommended by the manufacturers, but talk to them and see what they suggest for your cat. I would also suggest that you ask the manufacturers to pay your veterinary costs - I know they have done this for some people, although they have not necessarily paid the full costs.
You should also make a report to the Food & Drug Administration. Apparently the manufacturers are not obliged to report any cases of renal failure to the FDA because renal failure is already listed in the package insert as a possible side effect (see the second link below). But I believe it is very important for the FDA to be fully aware of the scale of the problem. FDA Consumer Complaints Co-ordinator has details of the relevant contacts for each state.
Metacam Reference Page is a summary by the manufacturer of the approval for the use of Metacam in cats, which states that it is approved for one-off injectible use only.
The Metacam Professional Insert, approved by the US Food and Drug Administration, states (page 2): "renal failure has been reported as an outcome of repeated oral dosing of cats".
Freedom of Information Summary (2004) from the US Food and Drug Administration mentions on page 23 that, following the use of Metacam for post-operative pain, 8.3% of the cats in the study had elevated BUN levels, and 12.5% had anaemia. In comparison, there were no cases of elevated BUN levels in cats in the study given another post-operative painkiller, although 6.1% of them did have anaemia (one possible cause of anaemia is inflammation, which may partly explain this finding). The paper concludes: "Meloxicam, when initially dosed as a subcutaneous injection followed by oral dosing for nine days at > 0.3 mg/kg was associated with severe adverse effects, including death."
The US Food and Drug Administration reprimanded the manufacturers of Metacam in 2003 for misleading claims for the product and omission of important safety claims.
The European Medicines Agency states (P36) "do not use in animals suffering from gastrointestinal disorders such as irritation and haemorrhage, impaired hepatic, cardiac or renal function." It also says (P103) that the use of Metacam should be avoided in dehydrated animals "as there is a potential risk of renal toxicity", and warns that the oral form of Metacam should not be used following use of the injectible form. Even if the injectible form of Metacam is used post-operatively, this has only been tested on cats given one particular type of anaesthesia.
Pet Place has some information on Metacam, and advises against using it in cats until further tests have been completed.
Mar Vista Vet also has some information about Metacam and recommends avoiding its use in cats with kidney, liver or heart disease, as well as in cats who are dehydrated or who have stomach ulcers.
Provet has some warnings about the use of Metacam.
Metacam Risks in Cats is an article by Persian and Himalayan Cat Rescue.
Arthritis in Cats and Dogs Pet Forum contains some postings from members who experienced problems when using Metacam on their cats (although some, like us, had good results).
Metacam UK this is the manufacturer's British website about the use of Metacam in dogs.
Metacam USA this is the manufacturer's American website about the use of Metacam in dogs.
There are two classes of steroids, corticosteroids and anabolic steroids. Corticosteroids are sometimes used to treat arthritis because they are anti-inflammatory, which can help reduce joint pain. A commonly used corticosteroid in cats is pred (prednisone or prednisolone). Cats metabolise prednisolone better than prednisone (they have to convert prednisone into prednisolone in their bodies anyway before they can use it) so it is usually better to give prednisolone in the first place. Vet Contact reports on a study entitled Bioavailability and activity of prednisone and prednisolone in the feline patient (2004) Graham-Mize CA & Rosser EJ Veterinary Dermatology 15 (s1), pp 10 which supports this view.
Your vet may want to start at a higher dose to reduce the inflammation, then reduce to a maintenance dose. If your cat can eventually come off the steroids, they should not be stopped suddenly, but ratherthe dose must be tapered. This is because using corticosteroids may suppress the adrenal glands' ability to produce cortisone naturally; so tapering the dose minimises the risk of adrenal insufficiency occurring as a result.
Unfortunately cortico-steroids can have serious side effects with long-term use (including triggering diabetes, fluid retention and resulting hypertension, and masking infections). Corticosteroids cannot normally be used in diabetic cats. If your cat develops congestive heart failure (CHF) within a week of starting corticosteroids, the steroids may be the cause. One study, Corticosteroid-associated congestive heart failure in 12 cats (2004) Smith SA, Tobias AH, Fine DM, Jacob KA, Ployngam T The International Journal of Applied Research in Veterinary Medicine 2 (3) pp159-170 found that some cats developed a unique form of congestive heart failure within seven days of starting steroids. Five of the cats died, but the seven that survived did much better than the typical CHF patient once taken off the steroids.
Newman Veterinary has helpful information about steroids.
Veterinary Partner discusses pred and explains how corticosteroids work.
Mar Vista Vet discusses the potential problems of ongoing steroid use.
This is probably the best treatment we have found overall for Harpsie's arthritis. Downsides are the cost (we pay US$75 a treatment) and having to take Harpsie to the vet every two weeks. But it really helps him, so it is worth it.
Harpsie's acupuncturist (who is also his neurologist) recommends weekly sessions for 3-6 weeks to start with. He said we would know by week 6, if not earlier, if the acupuncture was helping. If you can afford it, I'd therefore recommend you give acupuncture a try for at least six weeks. Apparently some cats only need to go every 3-4 weeks thereafter, but Harpsie starts limping a bit around Day 13, so we go fortnightly. You can read more about Harpsie's experiences with acupuncture and see more photographs here.
Washington State University has an article on veterinary acupuncture.
Introduction to Veterinary Acupuncture (2001) is an article by Phil Rogers, an Irish vet, presented to the World Small Animal Veterinary Association Congress 2001.
International Veterinary Acupuncture Society enables you to search for a veterinary acupuncturist near you.
American Academy of Veterinary Acupuncture can help you find an acupuncturist in the USA.
The Veterinary Acupuncture Page has information on and links to veterinary acupuncture sites.
The Association of British Veterinary Acupuncturists allows you to search for a UK veterinary acupuncturist.
This is the simplest treatment we gave Harpsie, and it was a massive hit with him, particularly in cold or damp weather. A heat pad is a small flat heated pad with a fleecy cover - it looks like a little flat cat-sized bed. You just plug the heat pad into the mains and then the pad stays at the chosen temperature constantly, unlike a hot water bottle. You must of course keep an eye on your cat while he or she is using this since it is electrical equipment, but certainly we never had any problems with overheating, and Harpsie used his almost constantly in winter.
Drs Foster and Smith sell a variety of heated beds.
Boots the Chemist in UK sells a heatpad for £21.99 - this is the one we used for Thomas when he had anaemia.
It is a real effort for arthritic cats to do certain simple things like jumping onto beds or climbing stairs. Whilst you do want your cat to take exercise, it is a kindness if you can minimise the effort required to do simple tasks like visiting the litter tray. If you have a litter tray downstairs but your cat prefers to stay upstairs, for example, place an extra litter tray upstairs so your cat does not have to tackle the stairs.
Also try to reduce the amount of climbing your cat has to do, because s/he could easily fall and hurt her/himself, as happened to Harpsie once while we were out.
Pet Planet in the UK sells a small folding ramp for £49.99.
House of Bath in the UK sells standard ramps for £59.95; search for "ramp".
Drs Foster and Smith sell ramps and steps
Harpsie began exhibiting subtle signs of arthritis when he was around the age of nine. He moved a little more slowly, and took a while to get going whenever he got out of bed. He could still jump on the back of the sofa though, as shown on the left. By the time he was ten, the vet was convinced Harpsie had arthritis but he would have needed an x-ray to confirm it, and the vet did not want to risk sedation or anaesthesia in view of Harpsie's supposed heart issues. Harpsie was finally formally diagnosed with arthritis in April 2004 at the age of twelve when we came home after a short outing to find him limping and screaming. An x-ray (performed without anaesthesia) confirmed he had arthritis in his left front elbow, and it therefore seemed likely that the pain and limping were caused by a flare up of the arthritis, probably following a bad jump or fall from the bed while we were out.
Harpsie was in such dreadful pain which other pain medications did not seem to help (he was literally screaming and unable to walk properly) that we nervously (in view of his PKD) and only after consultation with several vets gave him Metacam. However, we gave a tiny dose, less frequently than recommended (three tiny doses over the course of a week), and even with this low dose he was able to walk again; he was also much happier, so he must have been in a lot of pain. We did check Harpsie's kidney values a month later, to make sure his kidneys were unharmed.
At this time we had just moved to an apartment, so we do not know how Harpsie would have managed stairs in his later years, but we suspect he would have simply given up using them (so it was a blessing that we had moved). After his fall, he stopped jumping onto things, and also stopped "having a lean", as he is doing in the photo. We presume it was simply no longer comfortable for him to lie like this.
Once Harpsie's acute episode had been brought under control, we used Cosequin to control the arthritis. It did make a difference, but unfortunately I had to stop using it after about a year because it caused Harpsie's skin allergies to flare up, resulting in skin infections requiring antibiotics. I think the Cosequin did help Harpsie's arthritis though.
We looked around for another way to help Harpsie, and we decided to try acupuncture, which his neurologist could provide. He recommends weekly sessions for 3-6 weeks to start with, and said we'd know by week 6, if not earlier, if the acupuncture was helping. In fact, we knew after one session that it had helped Harpsie, because he was walking better almost immediately. He slept almost all day the day after his first session (which apparently is fairly common), so he wasn't eating much then, but it did seem to act as an appetite stimulant too.
Harpsie did have six sessions of acupuncture, and we decided to continue because it helped him so much. He continues to have treatment every two weeks, and has done so since February 2005 (he initially began acupuncture in January 2005). Apparently some cats only need to go every 3-4 weeks, but Harpsie starts limping a bit around Day 13, so we stick with fortnightly.
Harpsie loves it! He growls a little whilst the needles are being inserted, but once they are in, he goes into a trance. Apparently animals who react this way tend to get better results from the acupuncture. We had to stop Harpsie's Cosequin because of his limited ingredient allergy diet, but his arthritis has remained under control thanks to the acupuncture. Sometimes "point burnout" is seen in those who receive regular acupuncture, but it's uncommon in cats, so we hope Harpsie will continue to benefit from his treatments.
Here are some photos of Harpsie having acupuncture:
Needles are in, Harpsie is zoned out. Cats who respond like this to acupuncture tend to benefit from it more.
It's hard to see the golden needles on the golden boy, but if you look hard at this photo, you can see a needle sticking out of the top of Harpsie's head (in the middle of his head, between his ears, pointing west).
Needle removal time. The vet has to hold Harpsie pretty firmly because he is annoyed at having his reverie interrupted!
This photo was taken after Harpsie had been having acupuncture for seven months. He was feeling pretty pleased with himself, because he had managed to jump from the desk in the right background to the stereo front left. This was even more of an achievement than it might appear in this photo, because Harpsie actually had to leap around the pillar.
In 2005 Harpsie gained weight because he liked his new hypoallergenic diet so much, and we noticed he became less active, probably because the additional weight was adding stress to his joints. Once his weight reduced to a normal level, he became more active, and looked less uncomfortable.
When winter set in, we bought Harpsie a heated bed, and he absolutely loved it, and it clearly made him more comfortable. This also encouraged him to use his own bed rather than try to get on the furniture, which was risky because by the age of thirteen, Harpsie could no longer jump on to sofas and such like. He could still jump down from them, albeit often landing clumsily which was jarring for his joints, so we encouraged him to wait for us to lift him down - he soon learned what "hang on!" meant, and would wait for us to come and lift him down. It was sad to see this boy who once loved climbing trees so stiff and unable to jump. But overall he was managing relatively well, and we are eternally grateful to acupuncture for making the last 17 months of Harpsie's life much more comfortable than it would have been otherwise.
This page last updated: 13 February 2008
Links on this page last checked: 2 February 2008
Copyright © Harpsie's Site 2005-2008. All rights reserved