Osteoarthritis (OA) represents at least 80% of the lameness and joint disease cases in companion animals. OA is affecting an expected growing number of animals worldwide, due to an increase in obesity rates and life expectancy1,2. Despite being commonly associated with older animals, a recent report looking at the prevalence of OA and associated clinical signs in young dogs (aged 8 months to 4 years old) found that 39.8% of animals had radiographic signs of OA in at least one joint. Also, 23.6% of dogs had clinical signs of OA, corresponding to an overlap of radiographic OA and joint pain in the same joint3. This means that the actual prevalence of OA may be underrepresented in available reports. Since osteoarthritis is a chronic progressive condition, clinicians should be aware of this reality to be able to evaluate each patient and detect OA early on, where a better response to treatment is expected.
To diagnose these patients early, and to evaluate their response to treatment, clinicians need to have proper tools available. While there are several instruments available to aid the clinician, objective lameness assessment are very important tool5, as subtle changes in posture or weight-bearing, while occuring early in the development of the disease, which can be easily missed when visual assessment alone is used6,7. Weight distribution and off-loading or limb favoring at the stance are commonly used subjective assessments8,9. Stance analysis has been reported as a sensitive method for detecting dog lameness10, and has been proven as repeatable and sensitive for detecting lameness in dogs, with a pressure-sensitive walkway as a reference5,11. Compared to a standard force plate, it has the advantage of not requiring as much skill for data acquisition12. Importantly, stance analysis results have been shown to correlate with the results obtained with several clinical metrology instruments or client-report outcome measures, showing that results obtained with the Stance Analyzer correlate with the patient’s overall condition13. Correlations with other clinical assessments, such as joint goniometry, some radiographic findings, and the results of digital thermography, have also been found14.
We recently ran an evaluation of what constitutes the minimal change that represents a clinical improvement with a weight-bearing evaluation platform using different methodologies. We presented estimates of -1 for deviation and -10 for symmetry index in dogs with OA15.
Platelet-rich plasma (PRP) has also gained significant attention, as several studies in animal models have demonstrated the efficacy of PRP in accelerating the healing process after injuries in muscles, ligaments, joints, and tendons16–22. The rationale behind its use is to stimulate the natural healing cascade and regeneration of tissues by a supraphysiologic release of platelet-derived factors directly at the treatment site, without the risk of immune rejection or disease transmission23–25. In joints, platelet growth factors appear to produce a wide range of effects in the joint environment, targeting multiple pathways of the joint metabolism. It has chondroinductive effects, with transforming growth factor-β contributing to chondrocyte phenotype expression and mesenchymal stem cell chondrogenic proliferation.
Similar to what we experienced with PBMT, intra-articular PRP has a beneficial effect in dogs with OA, even highly active dogs, and in cases of severe OA. In most cases, the improvements are noticeable even before the second recommended administration and last from 120 to 180 days, depending on the patient and evaluation modality considered. Our results also showed that dogs with severe OA show a 2.96 and 3.02-fold probability of returning to the pre-treatment clinical level, compared to dogs with moderate OA. This finding stresses the relevance of early intervention, as it leads to a better outcome.
Recently, we evaluated the combined use of PBMT and PRP and compared it to their isolated use. While both isolated treatments produced clinically significant improvements compared to the assessment on treatment day, the combined treatment produced greater, longer-lasting, clinically significant improvements. These findings support the combined use of the two therapies in the management of OA. Moving forward, it will be interesting to evaluate how they influence disease progression, as an improvement in the overall joint environment is expected with both therapies.
References
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