OARSI guidelines for the non-surgical management of osteoarthritis

Each month we will review a published article that relates to canine osteoarthritis. Most articles will be specifically about canine OA diagnosis and treatment, but we will also dig into the translational research, meaning we will occasionally review an article from a human or equine medical journal if the topic is relevant to canine OA. Articles we review may be hot off the press, or might be “oldies but goodies.” As always, you can find a long list of references, including the monthly articles of interest, here (dog owners), or veterinary professionals (here). 

Article of Interest – October 2020

Title: OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.

Authors: Bannuru RR, Osani MC, Vaysbrot EE, et al.

Journal: Osteoarthritis and Cartilage

Year: 2019

Background:  The Osteoarthritis Research Society International (OARSI) is an international group of researchers and clinicians dedicated to advancing OA research. This organization is primarily dedicated to the study and treatment of human OA, though animal models are often used as translational models of OA. The purpose of this study was to update and expand upon prior OARSI guidelines for the non-surgical management of OA in humans. While there are certainly differences between humans and dogs (and cats) in OA pathophysiology, symptoms, and functional implications, veterinarians can gain valuable insight from these evidence-based guidelines when developing treatment plans for their patients.

Study Design: Meta-analysis. Review of 407 randomized, controlled clinical trials meeting pre-determined search criteria.

Results: Individual OARSI guidelines were developed for knee, hip, and poly-articular OA, and additional sub-groupings were made based on comorbidities (gastrointestinal, cardiovascular, frailty, widespread pain/ depression). For each joint (or combination of joints), recommendations were divided into 4 levels. CORE recommendations were those deemed appropriate for the majority of patients. For all types of OA and comorbidities, CORE recommendations for OA management included patient education about OA, structured land-based exercise programs, and dietary weight management. Topical NSAIDs, intra-articular corticosteroids and HA, and aquatic exercises were recommended for knee OA. Oral and transdermal opioids were strongly not recommended.

Limitations: As this study relates to how we manage canine OA, the primary limitation is the translational nature of the guidelines which may not be directly applicable to veterinary patients. The development of canine and feline specific OA guidelines will likely be developed by a multi-disciplinary team of veterinarians in the future.

Conclusion/ Summary: These OARSI guidelines highlight the importance of patient/ client education about the OA disease process as this empowers the individual to take a pro-active role in their (their pet’s) condition. Authors of these guidelines specifically note that education about OA should “promote hope, optimism, and a positive expectation of benefits from treatment.” There is likely some degree of positive placebo effect or mind-body connection that would occur with an induvial (human) patient being provided such affirmations from their physician. Nonetheless, it is my (Kristin Kirkby Shaw) belief that pet owners should also be provided an optimistic and hopeful outlook on their pet’s OA diagnosis, so long as they take a pro-active role in their pet’s condition. Owner education, weight management, and land-based exercise programs should form the basis of our management of canine (and feline) OA until proven otherwise.