Remember the excitement of bringing your kitten home? Watching them explore their new environment, learning as they grow up, pouncing on every stray piece of fluff floating around. Sharing their lives with you as they progress through young adulthood, sharing your bed and lap on cold nights, sleeping on your book/computer when you need to work, hanging around for any stray scraps of chicken when you’re in the kitchen.
Then you notice they are sleeping more than usual, happier to hang around inside, not running through the house like an elephant at 3am any longer. They stop leaping up the climbing frame in two bounds, but rather take it slowly, level by level. I hear many people say “they are just slowing down with age” but why do cats slow down as they age? Often it may be because everything starts to hurt and stiffen up. The energy and spirit are still there, the body just isn’t quite as willing as it used to be.
Rather than accepting this as our cats are getting older, we can intervene to reduce this stiffness and soreness to provide a better quality of life for our cats in their advancing years.
What is Osteoarthritis?
Many of our older feline companions suffer from osteoarthritis (OA) – over 90% of cats over 12 years of age in one study and over 61% over 6 years old in another. OA or degenerative joint disease is an ageing change associated with degradation of joints. This causes reduced mobility and flexibility of joints, joint swelling, bony changes around the joints and subsequent muscle loss due to reduced movement of the affected body part/s. Because it is a degenerative disease, the prevalence increases with age.
What are the Clinical Signs of Osteoarthritis in Cats?
Cats often don’t show the classical clinical signs of OA. Instead, they adapt their lifestyle and behaviour to cope. This makes OA in cats very hard to diagnose, with the associated changes being extremely subtle. And despite being sore, they may still run in short bursts without obvious pain, lameness or change in gait which may give the impression that everything is fine.
Some behaviours can give us a clue that our cats really are hurting:
- Changes in jumping behaviour – rather than jumping straight up to the table top, they may use intermediate objects to get up in steps. They may not jump up as high or as frequently; you may notice them considering or hesitating before jumping. They may misjudge the effort required to jump up on something and end up scrambling, pulling themselves up or falling. They may also be more reluctant to jump down from objects and walk their front legs down the table leg rather than just leaping off.
- Reluctant to use stairs or slower going up and down stairs
- Choosing to rest in lower or easier to access spots
- Change in temperament – aggression when patted in certain areas or when being picked up, increased vocalisation
- Reduced grooming activity because of the pain associated with their usual grooming contortions
- Changes in toileting behaviour because it may hurt getting into or out of the litter tray or squatting to go to the toilet
- Muscle loss over the hind legs because they are not using the muscles as much – not as active and smaller steps.
The clinical signs will vary considerably between different cats and older cats may often have other age-related diseases that complicate the diagnosis further.
If you think your cat might be suffering from OA, the first stop is a thorough checkup by your veterinarian. Xrays can help with the diagnosis but because of the typically subtle changes associated with feline arthritis, I believe that the information provided by an attentive owner is probably the best means of diagnosis – if you think there is a problem, there probably is. You know your cat best and know what’s normal and what isn’t.
Treatment of Osteoarthritis in Cats
OA is a chronic disease and as such, treatment is usually life-long. Treatment of OA requires both lifestyle changes and combinations of medications to minimise side effects and maximise benefits.
Probably the biggest factor in management is weight control – every extra 100g is putting excess strain on already sore joints. Moderate activity should be encouraged, to maintain flexibility and movement in joints and to prevent muscle loss. Physiotherapy in cats is challenging – although you can try encouraging play activity or throwing biscuits across the room to make them run. Make sure they have sleeping places lower down that they don’t have to jump up to get to and provide ramps.
There are a number of different classes of medications used to control chronic pain in cats. The best response is to a combination of different treatments. Before starting medications, it is advisable to check for any concurrent diseases, especially kidney disease, since this can influence treatment considerably.
- Joint protectants – Safe, cheap and easy to give, they are useful for early or mild disease and in combination with pain relief. They increase the lubrication and therefore flexibility of joints and many animals respond very well to these medications. Joint protectants include fish oil, glucosamine, chondroitin and specially formulated arthritis diets e.g. Hills Joint Diet or Royal Canin mobility support. I have also found pentosan injections to be very useful, so it is worth discussing this option with your vet.
- Non-steroidal anti-inflammatory drugs (NSAIDs) – These are the mainstay of OA treatment -they provide excellent pain relief and also reduce swelling and inflammation in diseased joints. However they have the potential for serious side effects (including kidney damage, ulceration in the gut and bleeding tendencies) if not used correctly, especially if concurrent disease such as kidney disease is present. It is worth being aware of these side effects but this should not discourage their use.
The use of NSAIDs in chronic kidney disease is controversial, but many feline specialists are now comfortable using these drugs in cats with stable disease and at reduced doses. I personally do not believe that the presence of kidney disease is justification for leaving a cat in chronic pain from OA. As a general rule, it is best to be conservative with NSAIDs and gradually reduce the dose to the lowest effective dose. NSAIDs should not be given if your cat is unwell and accurate dosing is critical. They should be given with a full meal to reduce the risk of gut ulceration and cats on chronic treatment should receive regular check ups and monitoring from your veterinarian, both by examination and blood and urine tests. The frequency of check ups varies depending on whether your cat has concurrent disease.
- Other medications – Other pain relief medications are also available for more severe disease, such as opiates (similar to morphine) and others. These medications can also have side effects, especially drowsiness, and are not formulated properly for cats so can be fiddly to give and bitter tasting. It is best to discuss these options with your vet and use them in conjunction with lifestyle changes, joint protectants and NSAIDs.
So what’s the short answer?
Osteoarthritis is common in cats and difficult to pick up. I personally believe that since we can’t ask our cats if they’re sore, we are best off erring on the side of caution and providing pain relief on any suspicion of pain (if in doubt, do a short-term treatment trial). Imagine being constantly in pain with no way to communicate that and never getting any relief.
However I know that other vets disagree with this opinion and think NSAIDs should only be used when obvious pain exists. OA should be treated from multiple angles, including weight loss, moderate activity, joint protectants and NSAIDs if suitable.
Older cats should receive regular check ups from their veterinarian and if on any long-term medications, should additionally have regular monitoring via blood and urine tests. Pay attention to what your cat is telling you and know that there are options available to manage this insidious condition and maintain your cat’s quality of life through their senior years.
Check out the short video below:
Disclaimer: The opinions expressed here are my own and I am only providing generic information based on my knowledge and experiences. This information is not a substitute for a consultation between you and your veterinarian.
Dr Robyn Hall is a Sydney based veterinarian with a strong interest in feline medicine and well-being. She shares her life with two beautiful tabby domestic shorthairs, Elara and Callista, who she adopted from a vet clinic whilst living in Perth.