B. Duncan X. Lascelles

Evaluation of Client‐Specific Outcome Measures and Activity Monitoring to Measure Pain Relief in Cats with Osteoarthritis

BACKGROUND There are no validated systems for measuring pain from osteoarthritis in cats. HYPOTHESIS Owner subjective assessments and an activity monitor (AM) can be used to detect pain in cats with osteoarthritis and to assess efficacy of treatments. ANIMALS Thirteen cats older than 10 years old, with owner-assessed decreases in activity, painful arthritic joints, and clinically normal blood work were included and evaluated for 3 weeks. METHODS A collar-mounted AM measured activity and a client-specific outcome measure (CSOM) questionnaire characterized the severity of impairment. Overall global quality of life was also evaluated for each treatment. In weeks 2 and 3, meloxicam (0.1 mg/kg, day 1; 0.05 mg/kg, days 2-5) or a placebo was administered in a blinded, randomized, cross-over manner to test the assessment systems. RESULTS The cats had a median of 4 arthritic appendicular joints. Activity counts for the week when cats (complete data on activity; n=9) were administered meloxicam were significantly higher than at baseline (P = .02) but not after placebo (P = .06). Baseline activity counts were not significantly different from placebo (P = .6). The CSOM data (n=13) showed that owners considered their cats to be more active on meloxicam compared with baseline (P = .001) and placebo (P < .004), and more active on placebo than at baseline (P < .01). Global quality of life improved significantly with meloxicam (P < .042). CONCLUSIONS AND CLINICAL IMPORTANCE Both an AM and a CSOM system can detect behavior associated with pain relief in cats that are arthritic. Objective activity data might allow subjective assessment systems to be validated for use in clinical studies.

Proposed Definitions and Criteria for Reporting Time Frame, Outcome, and Complications For Clinical Orthopedic Studies in Veterinary Medicine

Outcome, and Complications For Clinical Orthopedic Studies in Veterinary Medicine James L. Cook, DVM, PhD, Diplomate ACVS, Richard Evans, PhD, Michael G. Conzemius, DVM, PhD, Diplomate ACVS, B. Duncan X. Lascelles, BVSc, PhD, Diplomate ECVS, Diplomate ACVS, C. Wayne McIlwraith, BVSc, PhD, Diplomate ACVS, Antonio Pozzi, DMV, MS, Diplomate ACVS, Peter Clegg, MA, VetMB, PhD, Diplomate ECVS, MRCVS, John Innes, BVSc, PhD, DSAS (Orth), MRCVS, Kurt Schulz, DVM, Diplomate ACVS, John Houlton, MA, VetMB, DVR, DSAO, MRCVS, Diplomate ECVS, Lisa Fortier, DVM, PhD, Diplomate ACVS, Alan R. Cross, DVM, Diplomate ACVS, Kei Hayashi, DVM, PhD, Diplomate ACVS, Amy Kapatkin, DVM, MS, Diplomate ACVS, Dorothy Cimino Brown, DVM, MSCE, Diplomate ACVS, and Allison Stewart, DVM, MS, Diplomate ACVS Comparative Orthopaedic Laboratory, University of Missouri, Columbia, MO, College of Veterinary Medicine, University of Illinois, Urbana, IL, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, Comparative Pain Research Laboratory, North Carolina State University,

Improved survival associated with postoperative wound infection in dogs treated with limb-salvage surgery for osteosarcoma.

BackgroundLimb-salvage surgery and adjuvant chemotherapy are performed as a treatment of appendicular osteosarcoma in dogs. Approximately 50% of dogs that undergo limb-salvage surgery develop postoperative surgical wound infections. Postoperative surgical infections may affect survival in cancer patients. The purposes of this study were to examine the effect of surgical wound infection on survival, local recurrence, and metastasis in relation to other prognostic factors for dogs with spontaneous osteosarcoma treated with limb-salvage surgery.MethodsForty-seven client-owned dogs with osteosarcoma of the distal radius were treated with limb-salvage surgery and adjuvant chemotherapy—either carboplatin or carboplatin and doxorubicin. Hazard ratios were estimated by using the Cox proportional hazard model, and survival functions were estimated by using the Kaplan-Meier product-limit life-table method.ResultsOf the 47 dogs in this study, 32 (68%) developed a postoperative wound infection. Infection, dog weight, and extent of the primary tumor (percentage of length) significantly affected survival, and infection and percentage of length significantly affected time to metastasis. None of the variables considered in this study affected local recurrence. Dogs that were diagnosed with an infection were less likely to die (hazard ratio, .446), and dogs with greater body weight and greater percentage length involvement were more likely to die (hazard ratios of 3.37 and 3.66, respectively).ConclusionsIn dogs with osteosarcoma treated with limb-salvage surgery, infection has a positive influence on survival, as does a smaller initial length of radius involved and lower body weight.

Cross‐Sectional Study of the Prevalence of Radiographic Degenerative Joint Disease in Domesticated Cats

OBJECTIVE To determine the prevalence of radiographic signs of degenerative joint disease (DJD) in a randomly selected sample of domestic cats. STUDY DESIGN Prospective observational study. ANIMALS Client-owned cats. METHODS Cats (n=100) from a single practice and equally distributed across 4 age groups (0-5; 5-10; 10-15, and 15-20 years old) were randomly selected (regardless of heath status) and sedated for orthogonal radiographic projections of all joints and the spine. Quasi-Poisson regression analysis was used to investigate the relationship between patient demographics, blood biochemistry, hematologic and urine analysis variables, and DJD severity. RESULTS Most (92%) cats had radiographic evidence of DJD; 91% had at least 1 site of appendicular DJD and 55% had > or = 1 site of axial column DJD. Affected joints in descending order of frequency were hip, stifle, tarsus, and elbow. The thoracic segment of the spine was more frequently affected than the lumbosacral segment. Although many variables were significantly associated with DJD, when variables were combined, only the association between age and DJD was significant (P<.0001). For each 1-year increase in cat age, the expected total DJD score increases by an estimated 13.6% (95% confidence interval: 10.6%, 16.8%). CONCLUSION Radiographically visible DJD is very common in domesticated cats, even in young animals and is strongly associated with age. CLINICAL RELEVANCE DJD is a common disease of domesticated cats that requires further investigation of its associated clinical signs.

Feline Degenerative Joint Disease

OBJECTIVE To critically review and collate published information on feline degenerative joint disease (DJD) and identify areas in which information is lacking. STUDY DESIGN Critical literature review. METHODS Literature search through Pub Med, Commonwealth Agricultural Bureau Abstracts published in the English Language, or translated into English (January 1940-August 2008). RESULTS Although there are no prospective studies, the prevalence of radiographic DJD appears to be high and can be associated with clinical signs of decreased mobility. There appears to be a mismatch between radiographic and clinical examination findings (pain response). There is little information on the cause of DJD in different joints. There are no fully validated subjective or objective assessment systems for the measurement of chronic DJD-associated pain in the cat. Development of a feline model of chronic DJD-associated pain may speed the development and evaluation of candidate pain-alleviating compounds and treatments. CONCLUSIONS The high prevalence of feline DJD and lack of information about it, suggests further investigation is needed. CLINICAL RELEVANCE Feline DJD occurs with high frequency, and yet there is little to guide the clinician on prevention or treatment.

ISFM AND AAFP CONSENSUS GUIDELINES Long-term use of NSAIDs in cats

NSAIDs and cats Non-steroidal anti-inflammatory drugs (NSAIDs) are an important class of drug in feline medicine, having analgesic, anti-inflammatory and antipyretic activity. While most published data on their use in this species relate to short-term (often perioperative) therapy, there is increasing evidence of the value of these drugs in treating chronic pain in cats (for example, that associated with degenerative joint disease), and some NSAIDs have now become licensed for long-term use in cats in some geographies. Most of our knowledge of therapeutic mechanisms or adverse drug reactions associated with NSAIDs is extrapolated from work in other species, and there is a paucity of published data relating to cats. Guidelines These guidelines have been drawn together by an expert panel, which have reviewed the current literature on long-term NSAID use in cats and other species, and developed guidance on their use based on this information. The aim is to provide practical information for veterinarians to encourage appropriate NSAID therapy whenever cats will benefit from the use of these drugs.

Item generation and design testing of a questionnaire to assess degenerative joint disease-associated pain in cats

OBJECTIVE To determine the items (question topics) for a subjective instrument to assess degenerative joint disease (DJD)-associated chronic pain in cats and determine the instrument design most appropriate for use by cat owners. ANIMALS 100 randomly selected client-owned cats from 6 months to 20 years old. PROCEDURES Cats were evaluated to determine degree of radiographic DJD and signs of pain throughout the skeletal system. Two groups were identified: high DJD pain and low DJD pain. Owner-answered questions about activity and signs of pain were compared between the 2 groups to define items relating to chronic DJD pain. Interviews with 45 cat owners were performed to generate items. Fifty-three cat owners who had not been involved in any other part of the study, 19 veterinarians, and 2 statisticians assessed 6 preliminary instrument designs. RESULTS 22 cats were selected for each group; 19 important items were identified, resulting in 12 potential items for the instrument; and 3 additional items were identified from owner interviews. Owners and veterinarians selected a 5-point descriptive instrument design over 11-point or visual analogue scale formats. CONCLUSIONS AND CLINICAL RELEVANCE Behaviors relating to activity were substantially different between healthy cats and cats with signs of DJD-associated pain. Fifteen items were identified as being potentially useful, and the preferred instrument design was identified. This information could be used to construct an owner-based questionnaire to assess feline DJD-associated pain. Once validated, such a questionnaire would assist in evaluating potential analgesic treatments for these patients.

Prevalence and classification of chronic kidney disease in cats randomly selected from four age groups and in cats recruited for degenerative joint disease studies

Chronic kidney disease (CKD) and degenerative joint disease are both considered common in older cats. Information on the co-prevalence of these two diseases is lacking. This retrospective study was designed to determine the prevalence of CKD in two cohorts of cats: cats randomly selected from four evenly distributed age groups (RS group) and cats recruited for degenerative joint disease studies (DJD group), and to evaluate the concurrence of CKD and DJD in these cohorts. The RS group was randomly selected from four age groups from 6 months to 20 years, and the DJD group comprised cats recruited to four previous DJD studies, with the DJD group excluding cats with a blood urea nitrogen and/or serum creatinine concentration >20% (the upper end of normal) for two studies and cats with CKD stages 3 and 4 for the other two studies. The prevalence of CKD in the RS and DJD groups was higher than expected at 50% and 68.8%, respectively. CKD was common in cats between 1 and 15 years of age, with a similar prevalence of CKD stages 1 and 2 across age groups in both the RS and DJD cats, respectively. We found significant concurrence between CKD and DJD in cats of all ages, indicating the need for increased screening for CKD when selecting DJD treatments. Additionally, this study offers the idea of a relationship and causal commonality between CKD and DJD owing to the striking concurrence across age groups and life stages.

Relationship of orthopedic examination, goniometric measurements, and radiographic signs of degenerative joint disease in cats

BackgroundAvailable information suggests a mismatch between radiographic and orthopedic examination findings in cats with DJD. However, the extent of the discrepancy between clinical and radiographic signs of OA in companion animals has not been described in detail. This study aimed to evaluate the relationship between orthopedic examination findings, joint goniometry, and radiographic signs of DJD in 100 cats, in a prospective observational design. Cat temperament, pain response to palpation, joint crepitus, effusion and thickening were graded. Radiographs of appendicular joints and the axial skeleton were made under sedation. Joint motion was measured by use of a plastic goniometer before and after sedation. Associations between radiographic degenerative joint disease (DJD) and examination findings were assessed to determine sensitivity, specificity and likelihood estimations.ResultsPain response to palpation was elicited in 0-67% of the joints with DJD, with a specificity ranging from 62-99%; crepitus was detected in 0-56% of the joints and its specificity varied between 87 and 99%; for effusion, values ranged between 6 and 38% (specificity, 82-100%), and thickening, 0-59% (specificity, 74-99%). Joints with DJD tended to have a decreased range of motion. The presence of pain increased the odds of having DJD in the elbow (right: 5.5; left: 4.5); the presence of pain in the lower back increased the odds of spinal DJD being present (2.97 for lumbar; 4.67 for lumbo-sacral).ConclusionsRadiographic DJD cannot be diagnosed with certainty using palpation or goniometry. However, negative findings tend to predict radiographically normal joints. Palpation and goniometry may be used as a tool to help to screen cats, mostly to rule out DJD.

DJD-Associated Pain in Cats What Can We Do to Promote Patient Comfort?

Practical relevance Degenerative joint disease (DJD) has a high prevalence in domestic cats and can be associated with pain. This pain should be addressed wherever possible. Audience All practitioners are faced with cats that are mobility impaired due to DJD-associated pain. Patient group Cats of all ages and breeds, and either sex, can experience DJD-associated discomfort. Clinical challenges Recognizing DJD and assessing DJD-associated pain in cats is a challenge. Owner observations of activity and behavior, careful observation and a logical and thorough orthopedic evaluation are key. Current understanding of the etiology of feline DJD and the mechanisms of DJD-associated pain is incomplete, making the rational choice of treatments a further challenge. Evidence base Evidence is emerging on the prevalence of feline DJD, and on how to assess the associated pain and mobility impairment. There is a lack of information on the etiology of feline DJD and a relative lack of data on the efficacy of putative treatments.