Veterinary Medicine - November 2008 - (Page 613)

to jump as high as before, and soiling outside the litter box should prompt the veterinarian to look for sources of chronic pain (Table 1). Other changes that owners report are altered sleeping habits (an increase or decrease), withdrawing from human interaction, hiding, and a dislike of being stroked or brushed. Inactivity, which may result from chronic joint pain, is much more difcult to determine in cats than in dogs since cats naturally sleep a lot and are often solitary. In many cases, the owners are not home all day to monitor their cats’ activity levels and may not know whether they have changed. Activity monitors attached to cat collars and harnesses have been used to monitor daily movement in cats,6,7 including in cats with osteoarthritis during treatment with oral meloxicam or placebo.7 In that study, the activity counts increased with ve days of nonsteroidal anti-in ammatory drug (NSAID) treatment, suggesting alleviation of musculoskeletal discomfort. It is common for owners and veterinarians not to realize how affected a cat was until they see dramatic improvements after treatment, emphasizing that analgesic trials may sometimes be the only way to con rm that pain was present. can be encouraged in cats. Chronic pain may prevent some cats from grooming, and owners must perform this task, although the cats may resent this until pain is reduced to a tolerable level. Environmental modi cations can simplify a cat’s daily routine, such as placing food bowls and litter boxes in positions that do not require leaping or jumping. If cats cannot leap onto favorite resting places such as window ledges and cat towers, it impacts their quality of life. Owners can construct ramps and steps so cats may still reach these spots. Pharmacological intervention Any drug prescribed to treat chronic pain must be in a formulation that is simple to administer and well-accepted by cats to ensure optimal owner compliance. NSAIDs. The mainstay of drug therapy for osteoarthritis in most species is an NSAID. These drugs pose a challenge in cats because of cats’ susceptibility to NSAID toxicosis, especially with longterm dosing. Pharmacokinetic data are only readily available for single doses of NSAIDs in cats.* Most NSAIDs have a relatively long half-life in cats, and repeated dosing must be administered and monitored carefully to avoid toxicosis. For example, gastrointestinal toxicosis has been reported with carprofen,8 and based on clinical experience, toxicosis is generally associated with concurrent disease and prolonged administration of the oral formulation. Problems with repeated dosing are likely a result of individual variation in pharmacokinetics because the half-life of carprofen in cats can vary from nine to more than 40 hours.9,10 One NSAID sometimes used to treat the pain and in ammation associated with osteoarthritis in cats is meloxicam, a COX-2 selective NSAID available as *For a comprehensive review of NSAIDs in cats see Lascelles BD, Court MH, Hardie EM, et al. Nonsteroidal anti-inﬂammatory drugs in cats: a review. Vet Anaesth Analg 2007;34(4):228-250. TREATING OSTEOARTHRITIS Osteoarthritis treatment falls into three categories: lifestyle changes, pharmacological intervention, and nonpharmacological intervention. Lifestyle changes Much of the supportive management recommended for osteoarthritis in dogs, such as weight loss and controlled exercise, is applicable in cats but is often more dif cult to implement. Overweight cats should be placed on a carefully monitored weight-loss program; several good commercial diets are available to achieve set goals. With creative use of toys and owner participation, exercise VETERINARY MEDICINE November 2008 613 http://www.stokespharmacy.com http://www.stokespharmacy.com

Table of Contents Feed for the Digital Edition of Veterinary Medicine - November 2008

Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

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