How quickly should we see improvements?
Management of OA requires a comprehensive plan that often includes
- NSAIDs and adjunctive pain medications
- Weight loss
- Adequan
- Supplements
- Exercise
- Other rehabilitation techniques
Many times more than one treatment is started at the same time, and it can be challenging to tell exactly which product is working. In reality, it is likely the synergy of a multi-modal approach that is expected to produce the best results. Some treatments can result in nearly immediate response, whereas others will take longer to take effect.
Here is a summary of when you should start seeing the effects of different OA treatments:
When you start seeing effects of different OA treatments
Some treatments can result in nearly immediate response, whereas others will take longer to take effect. This chart will help you know the approximate timeline to look for signs of improvement| OA Treatment | Onset of action | Notes |
|---|---|---|
| Ice | Minutes | Cryotherapy, or ice packing, achieves the quickest onset of pain relief and anti-inflammatory action. Decreased tissue temperatures are seen within a few minutes of application. 20 minutes is the recommended time of application; tissue cooling continues for up to 1 hour. See more under the Rehab section on CARE. |
| NSAIDs | Hours-Days | A clinical response to the drug should be seen within 2 weeks of starting therapy (though often some relief is seen after a single dose). Studies have shown that continued improvement should be expected week after week for at least the first 4 weeks of daily treatment, and some dogs show continued improvement for up to a year after starting an NSAID (Autefage A, Vet Rec 2011). If no improvement is seen after 4 weeks, it may be worth trying an alternative NSAID or anti-NGF mAb prior to adding a second pharmacological agent. See more in the Pain Management section of CARE. |
| Amantadine | Hours to weeks | A small pharmacokinetic study (n= 5) in healthy Greyhounds found that peak drug concentrations were reached within 1-4 hours after a single oral dose. (Norkus C, et al. 2015) A study in dogs found that following once daily dosing, significant improvement was seen after 3 weeks; these investigators did not collect results prior to 3 weeks after starting the drug. You can read more on Amantadine in the Pain Management section of CARE. |
| Gabapentin | Hours to weeks | Peak plasma levels occur about 2 hours after dosing. Oral antacids may decrease the absorption and should be separated by 2 hours. Studies have not been done looking at gabapentin for OA, thus expectations for improvement are not fully known. Sedation is common, and starting at a low dose and working up is typically recommended to potentially decrease this effect. Therefore, clinical effects in pain relief may take days to weeks if a subtherapeutic dose is initially started. You can read more about Gabapentin in the Pain Management section of CARE. |
| Adequan | Days to weeks | Following IM administration, Adequan reaches synovial tissue within 2 hours, and persists in the joint for at least 72 hours. Significant improvement has been shown after 4 weeks of treatment, but studies have not evaluated efficacy before this time point. Based on the mechanism of action, it is possible that improvement may be seen earlier than 4 weeks. It is not known how SQ administration differs in pharmacokinetics or efficacy, but clinical experience suggests that results are similar to those seen with IM administration. You can read more about Adequan in the Pain Management section of CARE. |
| Weight Loss | Weeks to months | Dogs that are overweight should lose approximately 0.5-1.5% BW per week. Therefore, depending on the amount of weight loss needed, it will take weeks to many months to achieve ideal body weight. However, decreased lameness should be expected after about 6 weeks of weight loss or about 6% BW loss and 80% improvement in lameness has been reported after 4.5 months. You can learn more about safe and effective weight loss in the Nutrition section of CARE. |
| Omega 3 Fatty Acids | 2-3 months | It takes time for omega 3 fatty acids to integrate into cell membranes, and it will take a few weeks before doses reach therapeutic levels. Therefore, clinical effects are not expected to be seen before 2 months. Clinical trials with joint diets supplemented with omega 3s have shown significant responses after 3 months of eating the test diet. You can learn more about Omega 3s in the Nutrition section. |
| Hyaluronic acid + triamcinolone | 1-4 weeks | One study showed equivalent results of HA plus steroids vs. ACP (Arthrex brand of PRP). Improvements were seen as soon as 1 week after injection and lasted at least 12 weeks You can learn more in the Pain Management section of CARE. |
| Platelet Rich Plasma | 1-3 months post injection | Three studies (with 3 different PRP products) have shown that improvement with PRP should be expected between 6-12 weeks post injection. Some dogs may begin to exhibit improvement earlier than 6 weeks, though onset of action is not expected to be within the first 1-2 weeks. You can learn more about PRP in the Pain Management section of CARE. |
| Stem Cell Therapy | 1-2 months post injection | Studies with adipose-derived autologous stem cell therapy showed clinical improvement after 30 days. Some dogs may continue to improve over subsequent months. You can learn more about Stem Cell Therapy in the Pain Management section of CARE. |
| Oral joint supplements | Months | The time to peak effect may vary depending on the type of joint supplement (glucosamine, chondroitin, GLM, UCII, etc.), but in general, expectations for improvement should not be expected before 1 month. Studies with GLM and UCII suggest effects are seen at 2 months, and continued supplementation with UCII may result in even further improvement month after month. You can learn more about joint supplements in the Nutrition section of CARE. |
| Anti-NGF mAbs | Weeks | Significant improvement compared to placebo was seen between 1 and 6 weeks after starting Librela. If no improvement is seen after the second monthly injection, it is unlikely to be seen and the diagnosis of OA should be confirmed/ other conditions such as CCLR ruled out. |
| Exercise | Days-weeks-months | The positive effects of exercise can be seen after a single workout; but optimal results come from continued exercise. Gains in strength, flexibility, and cardiovascular stamina take weeks to months to achieve. Initial gains are typically seen after 2 weeks, then further improvement is seen about every 4-6 weeks. You can learn more about good exercises and recommended duration in the Nutrition section of CARE. |