Arthritis Pain Management for Dogs and Cats in Tequesta, FL

(Osteoarthritis or Degenerative Joint Disease)

Revolutionary arthritis treatment available for dogs and cats!

We are excited to announce that the new once monthly arthritis treatment for dogs is nearly here! We expect to get Librela in October 2023!  We’ve been eagerly anticipating it for several years.  When Solensia (the kitty version of this medication) became available in October 2022 it was life altering for many arthritic kitties here in Tequesta.
Monoclonal antibodies are the wave of the future for medicine. Many of you are familiar with Cytopoint, the monoclonal antibody injection for dogs that has improved the lives of South Florida dogs for 6 years now.  Many of you may remember early in the pandemic when folks with Covid were getting infusions in tents. Those were monoclonal antibodies for the earlier variants of Covid.
My own 20 year old cat has been on the kitty version of Librela (called Solensia for cats) for one year now. She has horrible arthritis. The manufacturer said it might take 2 doses for her to get arthritis relief, but she was back to chasing lizards by the pool and jumping onto my bed and vaulting over the baby gate in our doctors’ office all within a week of her first dose.  I had tried nearly every joint supplement and treatment for her arthritis over the last decade, but nothing comes even close to Solensia for response to treatment.  I get a bit misty when I think about her response to therapy as she is my best friend who goes nearly everywhere with me.  I know many of you feel the same way about your pets.
The manufacturer has priced Librela to be competitive with the cost of a month of Galliprant.  Galliprant has the best safety profile of any of the NSAIDs for dogs (ie Rimadyl, Metacam, Previcox, Deramaxx, etc).  NSAIDs have until now been the most effective arthritis treatment but do carry some risk regarding liver and kidney function when given long term.  We do not need to worry about liver nor kidney injury with Librela nor Solensia.
We do require (per the manufacturer) that the first injection be given by a doctor so we can discuss your pet’s arthritis and what to expect. Thereafter, you can make the monthly injection appointments with one of our veterinary nurses. We are not allowed to send injections out the door for owners to administer.  It must be given by trained veterinary staff.

Key quotes from the manufacturer:

“Nerve growth factor, or NGF, is a signaling protein that is produced
by injured tissues. NGF is necessary for the nervous system
development in animals during growth, but once the nervous
system is fully developed in an adult animal, NGF takes on a
different function—one that plays an important role in initiating and
perpetuating pain. Compared with healthy joints, dogs with OA
have elevated NGF in the synovial fluid in their affected joints.”
“Librela is approved as safe and effective. It functions like naturally produced antibodies and is eliminated via normal protein degradation pathways with minimal metabolism by the liver or kidneys.  In clinical studies, adverse events were similar to what would be expected for the population of dogs with osteoarthritis (that are not on Librela).  The most common adverse events reported in the Librela-treated dogs in those studies were urinary tract infection, bacterial skin infection, dermatitis, and elevated blood urea nitrogen (BUN).
Librela should not be administered to breeding, pregnant, or lactating dogs, or dogs with hypersensitivity or known allergy to bedinvetmab.  Safety and effectiveness have not been evaluated in dogs under 12 months of age.”
Here is a brief summary of information from the manufacturer:
The first and only monthly monoclonal antibody injection to provide long-term canine osteoarthritis pain control.
• Binds excessive NGF decreasing pain and inflammation.  Reduced pain equates to more comfort and increased activity.
• The 2022 American Animal Hospital Association Pain Management Guidelines (2022 AAHA Pain Management Guidelines for Dogs and Cats) list Librela as a first line of treatment for chronic pain of osteoarthritis in dogs.
• 5 sizes available
• Monthly SQ injection
European Data Screening and Monitoring
• 6 million doses administered
• 75% use it as a sole agent for arthritis management
• Minimally metabolized like other monoclonal antibodies by liver/ kidneys (which is the metabolism routes of NSAIDs such as Galliprant, Rimadyl, Meloxicam, Previcox and Deramaxx)
• Not evaluated in pregnant / nursing animals (but we at TVC advise against it)
Caution: Veterinary staff not to handle if pregnant, breast feeding, trying to conceive. (NGF is needed in a developing fetus.)
Not indicated for:
• Acute pain.
• Immune Mediated Polyarthritis
• Adolescent pets
• Not evaluated for intervertebral disk disease
Doctor to Administer Initial Dose
• Review onset of action with owner (most dogs need two dose to see benefits, some respond within 7 days).
Second dose:
• Review response to therapy.
• Consider discontinuing the other medications.
• Consider joint supplements if indication.
• Schedule the subsequent dose with a veterinary nurse. Subsequent doses with nurses as long as the exam is within 6 months.
Common signs of arthritis include:
-Changes in mood (including increased irritability)
-Pain when being pet
-Difficulty posturing for urinations/defecations
-Decreased mobility/movement
-Limping, lameness, and gait changes
-Changes in social relationships (with other pets and humans)
-Sleep alterations
If you feel your pet is experiencing any of these signs, please make an appointment with one of our doctors!  And please review the manufacturer’s website links!       Solensia | Zoetis Petcare and Librela | Zoetis Petcare
Other good websites on arthritis written for pet owners (followed by information written by our TVC doctors below):
FAQs regarding arthritis (written by the TVC doctor team):

What is a degenerative joint disease (more commonly known as osteoarthritis)?
Osteoarthritis (OA) is a complex disease process involving inflammation and degeneration of one or more joints. Dogs with OA experience pain that can interfere with daily life.

How is osteoarthritis diagnosed?
OA is diagnosed by a veterinarian via a thorough physical examination and diagnostic imaging such as x-rays. The veterinarian will palpate joints to try and localize pain. Once the pain is localized then imaging of that area is then recommended.

What are the causes of OA?
Osteoarthritis has many factors involved in its development and most dogs experience a combination of these factors as OA develops and progresses. It is not just a simple process of aging. Factors include but are not limited to:

  • Body conformation
  • Genetic predisposal
  • Body condition/weight
  • Abnormal joint development
  • Activity history
  • Previous trauma/injury
  • Previous orthopedic surgery

Nutritional history

What are the clinical signs (symptoms) of OA?

There are many signs that are indicative for OA in a dog. A dog can demonstrate some and not necessarily all at the same time. The most common signs include but are not limited to:

  • Limping (lameness) in one or more limbs
  • Difficulty or reluctance to get up or get down (rising, laying down)
  • Walking stiffly
  • Difficulty or reluctance going up and down stair
  • Difficulty or reluctance to jump (on/off furniture or in/out of the car)
  • Stiff/swollen/sore joint(s)
  • Reluctance to be touched on a particular part of the body
  • Loss of stamina
  • Unexpected aggression
  • How is arthritis medically managed?

There is no one magical go-to treatment for OA. Once OA has been diagnosed, we are more managing the disease that treating for OA cannot be cured. Since OA is a complex disease, managing it is also a complex process involving combining multiple modalities. Common multimodal management of arthritis includes but is not limited to:

Weight management
Non-steroidal anti-inflammatory drugs (NSAIDS)
INSTEAD of an NSAID sometimes a corticosteroid is prescribed as an anti-inflammatory although this is case dependent.
Adjunctive medications (medications that can have a synergistic effect for pain control)
Nutraceuticals (joint supplements)

Monoclonal antibodies to Nerve Growth Factor—See the discussion above and check out these links:  Solensia | Zoetis Petcare and Librela | Zoetis Petcare

Laser therapy
Physical therapy
Referral to a surgeon for surgical options
Stem Cell Therapy
CBD products Note: this is a controversial subject within the veterinary medical field and veterinarians cannot legally prescribe nor recommend CBD beyond “use per package instructions”. However, Dr Joi has had her senior arthritic cat on CBD since 2017 and feels it has significantly improved her quality of life. CBD decreases pain signaling. We carry Hemp RX brand of CBD chews and oil as we’ve found it to be the best product on the market and not bitter tasting as many OTC CBD products can be. The more refined the CBD oil, the less bitter aftertaste. Clearly, we don’t want our patients to refuse a treat or oil due to the taste.
Non-steroidal anti-inflammatory drugs (NSAIDS)

Common NSAIDs prescribed include: Galliprant, Carprofen, Meloxicam, and for cats, Onsior. Onsior is also FDA approved for dogs. Other less common NSAIDS are Deramaxx and Previcox. NSAIDs are generally used as the first choice of treatment for the pain of OA. Nonetheless, we typically couple an NSAID with other options for “multi-modal” analgesia so that we can lessen the dose of NSAID needed. This is also often helpful to your pocketbook as NSAIDS can be expensive. Of the NSAIDs for dogs, Galliprant is our favorite as it is theoretically the safest NSAID on the market. Please note though that not all patients are candidates for NSAIDs and this should only be determined and prescribed by a licensed veterinarian.

Human over the counter pain relievers: (ibuprofen, Tylenol, Aleve, etc…) should NEVER be used in animals for most are toxic to dogs and cats. Rarely, a corticosteroid such as prednisone is used as an anti-inflammatory treatment. We NEVER use a corticosteroid and an NSAID together at the same time in animals. If your pet is prescribed an NSAID for long term pain management of OA, bloodwork is recommended every 6 to 12 months to monitor for any effects on kidney and liver function. The most common side effect of NSAIDs is GI upset (vomiting and/or diarrhea). These side effects should always be alerted to the veterinarian if they develop and the medication should be stopped in the interim. Most often these side effects are mild and temporary and can be managed symptomatically.

Onsior is a non-steroidal anti-inflammatory that is prescribed in cats for acute pain. It is not prescribed for long term management of chronic pain. Cats don’t have the same liver enzymes as humans and dogs and don’t tolerate long-term anti-inflammatories. We try other options such as turmeric, laser therapy, omega 3 fatty acids, gabapentin, joint supplements for cats. Using an NSAID long-term in a cat is often our last resort.

Adjunctive therapies
Adjunctive therapies are treatments that address chronic pain differently from NSAIDs or corticosteroids and complements those medications. These are also helpful in patients that cannot be given NSAIDs or corticosteroids. Common adjunctive therapies include but are not limited to:

Gabapentin has been shown to be very useful in treating chronic pain especially neuropathic pain in small animals. Gabapentin has come into favor by most veterinarians due to the wonderful effects seen in pain management but also due to the minimal side effects. Most often the only side effect seen is mild drowsiness. Gabapentin is very cost-effective and can be sprinkled onto the pet’s food as it has virtually no taste. Some clients don’t like that gabapentin can make some pets drowsy. If your pet is one of the pets that acts drowsy on gabapentin we can lower the dose. Additionally, we can have you give it at night only. Pets who sleep better at night feel better! Gabapentin is the best to use two or 3 times per day, but if your pet gets drowsy on gabapentin, a night-time dose can be very helpful for the overall analgesia and quality of sleep and quality of life.


Amantadine is an NMDA antagonist that has been shown to be useful in treating chronic pain and neuropathic pain as an adjunctive therapy. Amantadine can be used long-term. Or, if your pet has been on pain meds long term and doesn’t seem to be responding as well, we can use amantadine intermittently to help reset pain signals that have gone awry.

Tramadol is an opioid and has recently fallen out of favor for use in treating acute or chronic pain. Studies have shown that dogs lack receptors for tramadol and therefore it has no or minimal effect on pain. Though some cases have shown improvement with tramadol, therefore this again should be determined and prescribed by a licensed veterinarian on a case by case basis.

Muscle relaxers
Common muscle relaxers that are prescribed as an adjunctive therapy to manage pain include diazepam (valium) or methocarbamol. When a dog or cat is in pain they can become very tense and stiff to prevent them from moving an affected joint and thus causing pain. The constant tension in itself then becomes painful further adding to the overall pain sensation of the patient. Relaxing the muscles can help alleviate pain from muscle tension. This is most commonly prescribed in patients suffering from conditions of the neck or back.

Nutraceuticals are nutritional supplements that have medicinal effects. Nutraceuticals that are specifically targeted for joint health are more commonly referred to as joint supplements. The most common known components of joint supplements are Glucosamine and Chondroitin. Other components that have recently become popular include turmeric, marine lipids, and eggshell membrane. Several of the nutraceuticals now contain a combination of these components all in one product.

There are many of these products available but not all are of the same quality. As with most supplements, they do not have to undergo FDA approval therefore they may not contain an adequate amount of the medicinal product to actually have an effect. We, therefore, recommend that the veterinarian suggest which nutraceuticals to add in to the treatment protocol. The most common nutraceuticals recommended among veterinarians include but are not limited to:

  • Dasuquin and Dasuquin advanced
  • Movoflex
  • Cosequin
  • Glycoflex
  • Curcumin

Omega – 3 fatty acids (Antinol and Wellactin are our favorite brands)
Dr. Joi’s cat is on feline Dasuquin, canine Movoflex, RX Vitamin turmeric, and Antinol in addition to Adequan and laser therapy and gabapentin.

Adequan is a chondroprotectant that reduces inflammation and restores synovial i.e. joint fluid. It is given as a series of injections over a period of time. This is often prescribed as an additional treatment to help restore the function of the joints. It is FDA approved for dogs, but we can use it off-label for cats.

Adequan is an expensive injectible. We give it twice weekly for the first month as the induction period. Giving Adequan at cost is one of Dr. Joi’s gifts to our clients. We sell you the box (2 bottles) of Adequan for $150 and you can bring your pet in for us to give the injections at no charge. Adequan induction (the first month) pairs nicely with laser therapy induction!

Laser Therapy
Cold laser therapy sounds like VooDoo. And yet, it works. It concentrates light energy to promote healing, decrease pain signals, decrease inflammation, and edema. Dr. Joi brings her cat to work with her not only for Twinkle’s good company but so Twinkle can have therapy laser 3 times per week. Dr. Joi is developing a smidge of lumbar arthritis and has started using the therapy laser on her own back!

Our class 4 therapy laser is a 28 thousand dollar machine. This is the same laser that many chiropractors use! We charge minimally for laser therapy because we want all of our patients to benefit from this amazing technology. Laser sessions start at $15 in our hospital.

Acupuncture has been around for centuries and is a popular practice in eastern medicine, but recently has become commonplace here in the western part of the world. Veterinarians can now become certified acupuncturists for animals. This allows another method to help manage chronic conditions such as OA. Here at TVC, we do not offer acupuncture, but please be aware we are actively looking for a certified veterinary acupuncturist to add to our crew.

Physical Therapy
Physical Therapy is another field of veterinary medicine that is growing and applies techniques from human medicine to animal patients. These techniques include but are not limited to:

  • Therapeutic LASER (which we offer in the clinic!) see above
  • Therapeutic exercise
  • Joint mobilization
  • Hydrotherapy (using an underwater treadmill)
  • Jupiter Pet Emergency Specialty Center is our local referral hospital with board-certified specialists that offer physical therapy.

Other things that an owner can provide to a dog with OA that can help with comfort and mobility are:

  • Soft, padded bedding
  • Raised food and water dishes (elbow height)
  • Non-skid floor surfaces
  • Ramps
  • Adhering to prescribed treatment recommendations by your veterinarian.

If you have any further questions please do not hesitate to contact us here at Tequesta Vet Clinic.


The TVC doctor team

twinkle in box