Feline Osteoarthritis

Management
Kelly Deabold, DVM, CCRV CVAa, Christina Montalbano, VMD, DACVSMR, CCRP, CVA
b
,
Erin Miscioscia, DVM, DACVSMR, CVAa,*

KEYWORDS
 Feline  Osteoarthritis  Integrative veterinary medicine  Rehabilitation
 Acupuncture  Nutrition  Supplement

KEY POINTS
 Feline osteoarthritis (OA) is common, with prevalence increasing with age. The most
commonly affected joints include the elbow, hip, stifle, and shoulder; degenerative
changes to the thoracolumbar spine are also common. Clinical signs are often vague
and a combination of owner questionnaires, orthopedic examination, and radiography
are recommended for identification.
 An integrative and multimodal approach to feline OA management is recommended to
maintain quality of life. Considerations include anti-inflammatory and analgesic medica-
tions, dietary modifications, nutraceuticals, environmental modifications, and physical
rehabilitation.
 Acupuncture and regenerative medicine may also be considered, although additional
high-quality studies are indicated for these in feline OA.

BACKGROUND
Prevalence of Feline Osteoarthritis and Commonly Affected Joints
Osteoarthritis (OA) of the cat is a common disease, which may cause subtle changes in
a cat’s behavior but significantly affect quality of life (QOL). Reports of prevalence of OA
in cat populations vary widely from 22% to 92%.1–5 It is frequently considered a primary
or idiopathic disease in cats3,6 with a significant association between increasing age
and the presence of radiographic signs of OA.1–3,5,6 One study of cats aged older
than 12 years found 90% of cats in this population had radiographic signs of OA.4
Secondary OA is most commonly due to fractures or hip dysplasia.6 Feline joints that
are most commonly affected include elbows, hips, and to a lesser extent stifles and
shoulders.1–3,5,6 Bilateral joint disease is common.1 Degenerative changes to the spine

a
Department of Comparative, Diagnostic and Population Medicine, College of Veterinary
Medicine, University of Florida, 2015 SW 16th Avenue, Gainesville, FL 32608, USA; b NorthStar
VETS, 315 Robbinsville-Allentown Road, Robbinsville, NJ 08691, USA
* Corresponding author.
E-mail address: emiscioscia@ufl.edu

Vet Clin Small Anim 53 (2023) 879–896

https://doi.org/10.1016/j.cvsm.2023.02.015 vetsmall.theclinics.com
0195-5616/23/ª 2023 Elsevier Inc. All rights reserved.
880 Deabold et al

are also common, with reports of approximately 40% of cats having spondylosis
deformans in the thoracic, lumbar, or lumbosacral spine.1,7

Diagnosis of Feline Osteoarthritis

Physical examination findings
Orthopedic and neurologic examination in cats is challenging in the veterinary environ-
ment and may be low yielding in the identification of OA. A quiet environment should
be available, with a dedicated room for examination of cats when possible. The room
should offer opportunities for cats to jump, and lack areas where cats could hide. Cats
should be allowed to exit their carriers voluntarily, or should be gently removed to mini-
mize discomfort and stress before examination. Examination may be performed with
the cat remaining in its carrier with the top removed or through a top-opening door
when feasible. Assessment of the cat’s posture, gait, jumping ability, and other move-
ments should be assessed before joint manipulations when possible. Nervous cats
may adopt a crouched posture and refuse to ambulate, obscuring meaningful informa-
tion. For this reason, owner-provided home videos are advantageous to allow obser-
vation of movement when walking on flat surfaces, on stairs, and jumping onto
furniture in a stress-free environment. Regardless of whether gait analysis is per-
formed in hospital or through home-video assessment, lameness is an uncommon
finding.1,2,6 Joint pain, crepitus, joint effusion, joint thickening, and abnormal range
of motion (ROM) are hallmarks of OA in dogs but not all are consistent findings in feline
OA.8 Rather, palpation and goniometry may be more useful as a screening tool to
identify joints that are likely unaffected by OA because lack of pain and higher ROM
measurements tend to predict radiographically normal joints.8 Whole limb manipula-
tions can be assessed initially, with individual joint assessment performed where
pain or abnormal ROM is identified. Assessment for spinal pain should follow joint
evaluation; further neurologic assessment may be unreliable in a hospital setting
even in neurologically normal cats.9

Radiographic findings
Where OA is suspected, survey orthogonal radiographs should be performed for
confirmation and further characterization. Hallmark radiographic findings in cats differ
from those in dogs, with joint effusion, osteophytes, and subchondral bone changes
seen less frequently and periarticular new bone formation and joint-associated miner-
alization noted most commonly (Figs. 1–3).10

Subjective Assessment of Osteoarthritis Impairment

Clinical metrology instruments (CMIs) are questionnaires completed by the owner to
evaluate changes in behavior and mobility in the home environment. These question-
naires are suggested as diagnostic tools for OA in cats, as well as to monitor response
to treatment. The Feline Musculoskeletal Pain Index (FMPI) is the most developed tool
to date assessing activity, pain intensity, and overall QOL. The FMPI is repeatable and
reliable in identifying normal cats versus those affected by pain from OA, although it is
unable to discriminate OA disease severity and has not been validated for monitoring
response to treatment.11,12 For this purpose, client-specific outcome measure
(CSOM) questionnaires may better characterize impairment in individual cats and
allow monitoring of treatment response.13

Objective Assessment of Osteoarthritis Impairment

Several methods of objective mobility impairment quantification in cats with OA have
been assessed. These methods are typically reserved for research and are not likely
 Feline Osteoarthritis Management 881

Fig. 1. (A and B) Orthogonal elbow radiographs of a 15-year-old female spayed Domestic

Shorthair (DSH) demonstrating moderate right elbow periarticular osseous proliferation.

Fig. 2. (A and B): Stifle radiographs from a 9-year-old female spayed DSH demonstrating a
patellar ligament enthesopathy and meniscal ossicle. (C and D): Stifle radiographs from a 12-
year-old female spayed DSH demonstrating a mild medial meniscal ossification.
882 Deabold et al

Fig. 3. Pelvic radiographs of a 14-year-old female spayed DSH demonstrating mild lumbosa-
cral spondylosis deformans.

feasible for clinical use. Collar-mounted accelerometers can be used for activity moni-
toring and improvements in activity counts have been shown in cats with OA undergo-
ing successful treatment.13 Thermal and sensory threshold testing are demonstrated
to be able to differentiate healthy limbs from those affected by OA.14 Kinetic gait anal-
ysis, which is frequently used as a gold standard for objective lameness assessment in
dogs, was not able to differentiate limbs affected by OA versus those free of disease,
and therefore may not be useful in cats as an assessment or monitoring tool.14

INTEGRATIVE MANAGEMENT OF FELINE OSTEOARTHRITIS

In addition to causing pain and decreased mobility, feline OA can lead to behavioral
problems such as aggression, house-soiling, altered social interactions, and loss of
the human-animal bond.15 All of these effects can contribute to QOL concerns and
consideration of humane euthanasia. Multimodal intervention should be considered
to alleviate clinical signs and slow progression of feline OA, often including analgesic
medications, dietary modifications, nutraceuticals, environmental modifications, and
physical rehabilitation. Regenerative medicine and acupuncture (AP) can also be
considered, although research is lacking for feline OA.
Pharmacologic Management
Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first analgesic choice for
OA pain across species. NSAIDs have been shown to improve activity and behavior in
cats with chronic musculoskeletal diseases; however, there is less efficacy and safety
data in cats compared with humans and dogs.16 As of March 2021, only 2 NSAIDs,
meloxicam and robenacoxib, were registered for long-term use (7 days) in cats in
Europe, and none was registered in the United States.16,17 Clinical data for these
NSAIDs are summarized in Table 1. The high prevalence of chronic kidney disease
(CKD) among geriatric cats is one of the most common concerns for chronic NSAID
use in feline OA. Clinicians must therefore weigh the potential risks versus benefits
in felines with these concurrent diseases.
Table 1
Common analgesics for feline chronic pain

Medication Dose Notes References

Meloxicam Initial: 0.3 mg/kg SC once OR Only labeled in the United States for cats as a single 6,15,16,18,20,22
0.1–0.2 mg/kg PO once dose.
Maintenance: 0.01–0.05 mg/kg PO q24–48h Improved activity and ability to jump after 4–6 wk.
Safe with stable CKD but monitor for new/worsening
azotemia and proteinuria
Robenacoxib SC: 2 mg/kg SC q24 h for a max of 3 d Well-tolerated, including cats with stable CKD 16,17,19,23
PO: 1–2.4 mg/kg PO q24 h  6d for acute pain Improvements in both objective and subjective
 28d for OA outcome measures after 3–6 wk
Effective in both acute and chronic pain conditions and
demonstrates wide safety margin after short-term
and long-term administration
Pulsed therapy or titrate to lowest effective doses given
every 2–3 d
Gabapentin 10 mg/kg PO q8–12 h Most commonly prescribed medication for the 24–26
treatment of chronic musculoskeletal pain in cats
Improved activity, higher pain thresholds, and
improved QOL

Feline Osteoarthritis Management

Side effects: reduced activity, sedation, ataxia,
weakness, muscle tremors
Tramadol 1–4 mg/kg PO q12 h 2mg/kg improved weight-bearing, mobility, comfort, Guedes et al,27 2018 &
and QOL Monteiro et al,28 2017
Dose–dependent side effects: mydriasis, euphoria,
dysphoria, sedation, hyporexia, diarrhea
Amantadine 3–5 mg/kg PO q24 h Improved activity and QOL after 2–3 wk Shipley et al,29 2021
Side effects: self-limiting vomiting
21
Frunevetmab 1 - 2.8 mg/kg SC q3-4 wk Blocks receptor-mediated signaling cascade induced by Gruen 2021
NGF
Improved mobility in cats with OA in 6–8 wk
Repeated dosing well-tolerated

883
884 Deabold et al

Clinics care points

For cats with concurrent OA and stable CKD.
 Use the lowest effective NSAID dose as part of a multimodal analgesic approach,
pulsed therapy can be considered.15,18,19
 Maintenance of proper hydration is paramount.20
 Routine monitoring (recommended every 6 months) should be performed and the
risks of chronic NSAID administration should be discussed with owners.15
Additional analgesics
Multimodal analgesia is becoming increasingly common for feline patients suffering
from chronic pain conditions including OA. Common second-line oral analgesics
include gabapentin, tramadol, and amantadine. More recently, Frunevetmab, an
injectable felinized monoclonal antibody that binds to nerve growth factor (NGF),
has been approved in the United States for use in cats with OA.21 Table 1 summarizes
current research and recommendations for these analgesics in feline OA. Other oral
analgesics, such as buprenorphine, amitriptyline, and grapiprant, lack clinical evi-
dence for chronic feline pain and, therefore, will not be discussed.
Regenerative Medicine
There are only 2 studies evaluating the properties of platelet-rich plasma (PRP) prod-
ucts using feline blood. One study demonstrated a decrease in red and white blood
cell (RBC and WBC) concentrations for 2 commercial systems but neither system
showed adequate platelet concentrations.30 Another study, using a different commer-
cial system, reported significantly increased platelet concentrations and decreased
RBC and WBC concentrations.31 Currently, there are no prospective clinical trials
investigating the efficacy of PRP for feline OA but it could be a promising therapeutic
option based on human, equine, and canine literature. Similarly, no prospective
studies have evaluated the use of stem cells in feline OA, although studies have shown
promise for stem cell use in other chronic inflammatory feline conditions, such as in-
flammatory bowel disease and gingivostomatitis.32 More feline studies are indicated
to evaluate the clinical efficacy and safety of regenerative medical techniques in feline
OA.
Dietary Considerations
Several studies have detected significant, positive associations between cats being
overweight and having musculoskeletal conditions, including OA.33 These findings
are consistent with those in humans and dogs, for which being overweight is a well-
known risk factor for OA and even modest weight loss, 6.1% body weight or more,
has been demonstrated to significantly lower clinical signs associated with OA.33,34
The contribution of adipose tissue to an inflammatory state through elevation of proin-
flammatory adipokines has been established in humans, and feline research also
shows a correlation between adiposity and adipokine concentration.33,35 Although
further research is indicated to elucidate the relationship between overweight condi-
tion and feline OA, given the current evidence, weight loss should be a primary goal
for overweight cats with concurrent OA.36 Although a thorough discussion on feline
weight loss is outside the scope of this article, Table 2 summarizes dietary strategies
to consider for cats with OA, including weight loss if indicated. In addition to caloric
restriction, choosing a diet that supports the maintenance of lean body mass (LBM)
and a feeding strategy to increase physical activity are advantageous weight-loss
strategies.35,37 Therapeutic diets supplemented with nutraceuticals or herbals will
be discussed in the next section.
 Feline Osteoarthritis Management 885

Table 2
Dietary strategies for feline osteoarthritis

Goal Dietary Strategy

Weight loss Restricted feeding of a moderate-high protein,
Indicated for cats with a body high-fiber diet formulated for weight loss:37,40
condition score of 61/9 Feed 80% of cat’s current daily caloric intake
(overweight or obese) (often w200 kcal/d)
OR feed 80% of resting energy requirement for
ideal body weight
Goal weight loss rate: 1.5% body weight/week
Tips for success:37
Use a gram scale to measure meal portions
Allow 10% of daily calories from treats/pill
pockets/supplements
Feed cats in household separately
Divide daily diet into 21 meals per day
Regular weight checks and caloric adjustment
Continue diet formulated for weight loss to
prevent rebound weight gain
Increase/maintain muscle mass Provide adequate calories and dietary protein, especially
Especially for sarcopenic or leucine (branched chain amino acid)39
cachexic cats For sarcopenic, disease-free cats: 120–160g
protein/1000 kcal
Consider addition of high-leucine protein sources (eg,
whey, egg white, low-fat cottage cheese, chicken
breast, soy)
Manage concurrent diseases to minimize cachexia
(eg, CKD, cardiac disease, hyperthyroidism, cancer)38,39
Provide adequate marine-sourced omega-3 fatty acids
and vitamin D, and consider an alkalinizing diet for
sarcopenic cats39,41
0.4–1.5 g combined EPA and DHA/1000 kcal
Increase physical activity Increase social interaction with humans surrounding
feeding and feeding frequency (2–4 meals/d)42–44
Consider: puzzle feeders, feeding at varied elevations to
promote climbing37

Although young and middle-age domestic cats have a propensity for weight gain,
middle-age and geriatric cats often lose weight and LBM concurrent with chronic dis-
ease processes (cachexia) or advancing age (sarcopenia).37–39 This subset of cats with
OA will require dietary intervention primarily to optimize maintenance or gain of LBM,
in order to reduce muscle weakness and optimize mobility.38 Incorporating feeding
strategies to increase physical activity is advantageous in cats with both decreased
LBM and OA, to promote regular, controlled exercise and muscle strengthening.38

Herbals and Supplements

There is a paucity of literature evaluating the use of herbals and supplements for the
management of feline OA, with more robust research available in dogs and
humans.36,45 Table 3 summarizes the current feline literature, inclusive of studies eval-
uating supplements, herbals, and supplemented therapeutic diets. There is growing
evidence in feline OA for the use of omega-3 fatty acids (q-3 FA), such as fish oil
and green-lipped mussel (GLM) containing eicosapentaenoic acid (EPA) and docosa-
hexaenoic acid (DHA), including high-quality trials evaluating objective outcome
 886
Deabold et al
Table 3
Evidence for herbals and supplements in feline osteoarthritis

Study Designc,
Ref.a nb Control (C) Supplementd Dosee, Duration OMsf Outcomesg (vs C) Adverse Events
Corbee et al, 47
24 RCT(crossover), q-3 FA (Fish Oil) 1.8 g E 1 D/Mcal, CMI Sign.: CMI (some items) Vomiting (4/24),
2013 C: corn oil 10 wk NSD: CMI (some items) dislike taste (3/24)
(with fish smell)
Lascelles et al,46 43 RCT (parallel group), Test diet: 1.9 g E 1 D/Mcal, CMI, AC, SOS Sign.: AC, CMI (VAS) Vomiting (1/43),
2010 C: control diet q-3 FA (Fish Oil 74 mg GLM/Mcal, NSD: CMI (CSOM, QOL), dislike taste (1/43)
and GLM), G 1 CS 0.25 g G 1 CS/Mcal, SOS
9 wk
48
Corbee 2022 26 RCT (crossover), SynopetCani-Syn 3mL/d, CMI Sign.: CMI (some Dislike taste (6/26)
C: placebo (GLM, Curc, BLE) 10 wk items on HCPI)
NSD: CMI (overall
HCPI score)
Sul 49
2014 31 RCT (crossover and G 1 CS, Vit C, Zinc 250 mg G CMI NSD Vomiting (1/31)
parallel group) 175 mg CS SOS
C: placebo and pos. 25 mg Vit C
control (meloxicam) 15 mg Zinc,
2X/day X42 d
followed by
1X/day X28 d
a
Reference number.
b
n, number of cats in trial.
c
RCT, randomized controlled trial.
d
BLE, blackcurrant leaf extract; CS, chondroitin sulfate; Curc, curcumin; G, glucosamine; Vit, vitamin.
e
E 1 D, EPA 1 DHA; mcal, Megacalories.
f
AC, activity count; CMI, clinical metrology instrument (client completed); SOS, subjective orthopedic score (veterinarian completed).
g
CSOM, client-specific outcome measures; HCPI, helsinki chronic pain index; NSD, no significant difference in all or specified OM between groups; QOL, quality of
life; Sign, statistically significant improvement in specified OM for the intervention group vs control; VAS, visual analog scale.
 Feline Osteoarthritis Management 887

measures.45–47 More evidences are needed to support the use of other herbals and
supplements in feline OA.45,48,49
When recommending herbals and supplements, it is important to not only consider
evidence of efficacy for a clinical indication but also evidence of bioavailability and
safety, including independent laboratory testing of products for active ingredient con-
centrations and potential contaminants.50–52 This information can be found in the pri-
mary literature, on product manufacturer websites (eg, a certificate of analysis), and in
product reports from independent laboratories.51 Veterinarians and consumers can
also look for quality seals on products, such as the National Animal Supplement Coun-
cil or ConsumerLab seal.
Although there are currently no studies evaluating the use of cannabidiol (CBD) for the
management of feline OA, there are several studies describing pharmacokinetics and
safety of CBD in cats, as well as evidence of efficacy of CBD for canine OA.45,53,54 Feline
CBD safety studies report overall tolerance of this herb, with a potential for mild side
effects, such as hypersalivation, licking, vomiting and head-shaking.53–55 Research
evaluating the efficacy of CBD as part of the multimodal analgesic management feline
OA is indicated.45,53
Clinics care points
 There is increasing evidence to support the use of fish oil for feline OA at a dose of
1.9 g combined EPA 1 DHA/Mcal (or 350–500 mg combined EPA 1 DHA per day
for most cats). The authors recommend gradual introduction of fish oil starting
with one-fourth to one-half the goal dose.
 More evidence is needed to support the use of other herbals and supplements in
feline OA, such as CBD and GLM.
 Veterinarians must consider evidence of efficacy, bioavailability, and safety for
herbals and supplements, including independent laboratory testing of products
for active ingredient concentrations and potential contaminants.
Acupuncture
AP has been around for thousands of years as part of traditional Chinese medicine and
is becoming more popular as an adjunct to Western medicine, especially for multimodal
analgesia. Traditionally, AP has been used to restore balance or health to the body via
local tissue stimulation and overall systemic effects.56,57 Neurotransmitters (eg, seroto-
nin, dopamine) and endogenous opioids are released in response to stimulation,
contributing to analgesic, sedative, and neurostimulatory effects.57 In addition, several
studies have evaluated the physiologic effects of AP on OA, demonstrating reduced
expression of inflammatory mediators and reduced cartilage matrix degeneration.58,59
A recent review reported 12 studies evaluating physiologic parameters and/or
analgesic effects of AP in cats, as well as 1 study and 5 case reports/series evaluating
AP for feline musculoskeletal conditions.60 This review concluded that additional high-
quality trials are indicated for further evaluation of AP efficacy in small animals.60 In the
authors’ experience, many cats tolerate AP well as an adjunctive analgesic (Fig. 4).
Table 4 summarizes common AP techniques utilized for feline patients. The authors
often begin with dry needle AP using acupoints along the back (Bladder meridian)
and then introduce electroacupuncture. If traditional needling is not well tolerated,
acupressure, laser AP, or aqua-AP can be used to stimulate points.
Physical Rehabilitation
Veterinary rehabilitation focuses on reducing pain, improving mobility, and returning
animals to proper function. This is a growing field with many techniques used in
888 Deabold et al

Fig. 4. A cat receiving electroacupuncture, an AP technique using electrical stimulation of

needles placed in acupoints.

humans adapted for veterinary use. Currently, there are limited clinical studies in fe-
line rehabilitation, with most recommendations translated from canine and human
literature.

Manual therapies
Manual therapies should be relaxing and stress free for the most beneficial effects.15,61
Some basic techniques include massage, passive movements, stretches, mobiliza-
tion, manipulation, thermotherapy (heat), and cryotherapy (ice).61 These techniques
can be taught to owners, and can help to alleviate muscle pain, improve owner-pet
interactions/bond, and improve QOL.15,62
Heat, massage, stretch, and passive ROM are generally well tolerated by cats in the
authors’ experience. We recommend performing these therapies in a quiet location
where they are most comfortable (eg, away from other patients, on a bed or blanket).
These therapies can help maintain joint health and improve muscle sensitivities.56
Cryotherapy is often less tolerated but can be attempted for acute injuries or following
exercise. Manipulative (chiropractic) therapies are minimally evidenced in small
animals and adverse effects are of potential concern.63 It has been recommended
to consider low-velocity/low-impact methods in small animal geriatric patients if
manipulative therapies are pursued.63

Table 4
Common techniques used to stimulate acupoints in cats

AP Technique Description
Dry needle AP Placement of small gauge needle into acupoints
Electroacupuncture Electric leads applied to needles placed into acupoints
Laser AP Application of therapeutic laser directly to an acupoint
Aqua-AP Injection of a sterile liquid into an acupoint (eg, vitamin B12)
Acupressure Manual pressure at an acupoint
 Feline Osteoarthritis Management 889

Modalities
Laser therapy. To the authors’ knowledge, no feline laser therapy studies for OA exist.
However, human and canine OA studies demonstrate potential benefit, especially
when applied at higher power densities (Table 5).64–66 Laser therapy is generally
well tolerated by cats because it is a relatively hands-off therapy delivered over a short
time span (Fig. 5). Research is indicated to determine efficacy, safety, and optimize
laser protocols for feline OA.
Therapeutic ultrasound. Therapeutic ultrasound is also well tolerated in feline patients
and can be used for a variety of conditions (see Table 5). It is important to consider
that cats have less dense soft tissues and smaller treatment areas than dogs; there-
fore, lower intensities should be used.67 Ensure that all ultrasound gel is removed
so large amounts are not ingested following therapy.
Electrical stimulation. Transcutaneous electrical nerve stimulation (TENS), similar to
AP, provides symptomatic pain relief by exciting sensory nerves, which stimulate the
pain gate mechanism and the release of endogenous opioids (see Table 5).61 Elec-
trodes can be placed over affected joints, spinal segments innervating affected joints,
and/or over myofascial trigger or AP points. Neuromuscular electrical stimulation
(NMES) is used to stimulate motor nerves and is useful in cats that cannot control volun-
tary movement or that cannot tolerate active exercise.68 Electrical pads are optimally
placed to elicit muscle contractions, contributing to muscle strengthening (see
Table 5). These modalities may be well tolerated by cats but do require the use of
gel and/or clipping of the haircoat, which may not be desirable. In addition, these
can be uncomfortable or elicit a foreign sensation, so it is best to start slow and use
low-intensity settings. An advantage of these modalities is they can be taught to owners
and performed at home, which is both cost-effective and low-stress to the patient.

Pulsed electromagnetic field therapy. Pulsed electromagnetic field (PEMF) therapy

can be used for acute and chronic injuries to improve cellular repair by increasing
the local perfusion to the capillary blood flow.68 Veterinary studies have demonstrated
benefits of PEMF treatment of canine OA, with reduced clinical signs following a series

Table 5
Common modalities for feline osteoarthritis management

Modality Indications References

Laser therapy Wound healing, pain management, 56,61,64–66,68
anti-inflammatory, fractures, tendon/ligament
injuries
Improve pain, lameness/stiffness, and function in
patients with OA
Therapeutic Restricted ROM, joint contracture, pain 56,61,67
ultrasound management, muscle spasm, remodeling of scar
tissue, tendon/ligament injuries, enhance tissue
repair, wound/fracture healing
TENS Pain control, decrease muscle spasm, decrease 56,61,68
edema
NMES Muscle strengthening, decrease muscle atrophy, Millis 56 2014 &
improve limb function Halkett 68 2017
PEMF Pain control, reduce inflammation/edema, tissue/ 56,68,69
wound healing
May reduce pain and signs of OA
890 Deabold et al

Fig. 5. A cat receiving laser therapy for pain management of stifle OA.

of treatments (9–20) of 18 to 60-minute duration.69 This modality is typically delivered

via a bed or small portable device and can be performed at home or during rehabili-
tation sessions. This treatment has no sensation and is well tolerated by felines.
Devices can be placed in the cat’s current bed or other frequented areas.

Therapeutic exercise
Therapeutic exercise, especially muscle strengthening, is one of the most important
parts of the rehabilitation process for cats with OA and should be personalized to in-
dividual needs.70 Exercise can be used to decrease pain, improve aerobic capacity,
endurance, agility, coordination, balance, gait, movement patterning, postural stabili-
zation, ROM, and strength.61 Exercise can be divided into 4 main types including
strengthening, flexibility, balance/proprioception, and endurance.61 Feline rehabilita-
tion poses a unique challenge; practitioners must understand the behaviors of cats
and how to motivate them without causing stress. Cats can be motivated by having
them follow a lure toy, laser pointer, food/treats, or by having them walk toward their
carriers. Creativity is very helpful when motivating cats to perform these exercises in
hospital and at home. Assistive devices or special equipment can be used to supple-
ment exercises as needed. Table 6 (Fig. 6) discusses specific examples of therapeutic
exercises commonly used for feline OA based on overall therapeutic goal.

Hydrotherapy
Underwater treadmill therapy and swimming can be well tolerated in cats with slow
introduction, short sessions, and positive reinforcement (Fig. 7).67 The natural proper-
ties of water (eg, density, buoyancy, viscosity, resistance, hydrostatic pressure, sur-
face tension) make water-based exercise one of the most useful forms of
rehabilitation therapy by reducing the concussive effects of active exercise and
improving limb mobility, strength, and joint ROM.56,61 Hydrotherapy can also be
used to relieve pain, reduce swelling and stiffness, aid in weight loss, and improve
blood circulation.57 If available, starting on a land treadmill may be beneficial to accli-
mate cats to the moving belt. If tolerated, transition to standing in water and then
 Feline Osteoarthritis Management 891

Table 6
Common therapeutic exercises for feline osteoarthritis

Goal Examples References

Strengthening Running (controlled), land treadmill, 56,61,68
up/down inclines, leg/body weights,
resistance bands, dancing
(forwards/backwards),
wheelbarrowing, hydrotherapy
Flexibility Crawling under, over, or through objects, Sharp 61 2012 &
weaving, reaching, cookie stretches, Halkett 68 2017
cavalettis
Balance/proprioception Balance on uneven surface (eg, wobble Sharp 61 2012 &
board, rocker board, peanut), walking Halkett 68 2017
over objects (cavalettis) (Fig. 7),
walking in circles, figure eights,
weaving, walking over different
textured surfaces, weight shifting,
rhythmic stabilization
61
Endurance Hydrotherapy or active exercise >15 min Sharp 2012
several times a week

slowly increase the speed of the treadmill so the patient is at a slow comfortable walk.
The authors’ recommend staging hydrotherapy introduction in this way, gradually
increasing the duration of therapy and discontinuing therapy if the patient seems
stressed.
Environmental Considerations
OA may cause impaired mobility and activity due to chronic pain. Cats should have
easy access to food, water, litter boxes, areas to hide, and resting spaces. Litter boxes

Fig. 6. A cat performing an obstacle course composed of balance discs and cavaletti poles.
892 Deabold et al

Fig. 7. A cat walking on the underwater treadmill for weight loss and hindlimb
strengthening.

with lower edges may be easier to step into.15,62 Enclosed boxes may assist owners in
dealing with abnormal elimination habits, such as cats eliminating while standing due
to a reluctance to posture.15 Access to heights, such as furniture and windows, is
important, and mobility-impaired cats may have a more difficult time accessing these
areas.15,62 Movement of furniture to provide “stepped” access, pet stairs, or ramps
can be used to provide easier access to preferred resting areas.15,62
A more complex home environment will also encourage more movement, which is
beneficial in maintaining joint health, muscle mass, promoting an ideal body condition,
and providing mental stimulation.15,22,62 Walking over uneven surfaces, providing
scratching posts, cat towers, toys, and hiding food will encourage natural behaviors
such as foraging, hunting, and playing.15,62 Regular periods of play with laser pointers,
toys, and catnip will also increase exercise levels.15,62

SUMMARY

Management of feline OA involves unique challenges in the timely identification of the

disease due to subtle or vague clinical signs and in formulation of a treatment plan.
Few analgesic medications are approved for long-term use in cats for the manage-
ment of OA; care must be taken when selecting analgesic medications in regards to
the presence of concurrent disease and consideration of possible side effects. Dietary
considerations include weight loss for overweight cats, appropriate protein intake to
maintain LBM, and feeding strategies to maintain light activity. A growing number of
nutraceuticals are marketed for feline OA with limited evidence of bioavailability, effi-
cacy, or safety; the greatest evidence currently exists for beneficial effects of marine-
sourced q-3 FAs. Physical rehabilitation incorporates manual therapies, therapeutic
modalities, and exercise to provide adjunctive pain relief, maximize joint ROM, and
strengthen muscles to support mobility; feline rehabilitation may be initially limited
 Feline Osteoarthritis Management 893

by patient tolerance but often can be accomplished with patience and creativity in
planning. Environmental modifications are recommended to reduce functional impair-
ments of OA by providing easier access to necessities (food, water, litterbox) and
resting places. Additional research is needed in the roles of AP and regenerative med-
icine for the management of feline OA. With numerous treatment options available, a
multimodal approach allows the practitioner and cat owner to find the best treatment
plan to maximize QOL.

DISCLOSURE

The authors have nothing to disclose.

DECLARATION OF INTERESTS

The authors have no conflict of interest to disclose.

REFERENCES

1. Kimura T, Kimura S, Okada J, et al. Retrospective radiographic study of degen-

erative joint disease in cats: prevalence based on orthogonal radiographs. Front
Vet Sci 2020;7:138.
2. Clarke SP, Mellor D, Clements DN, et al. Prevalence of radiographic signs of degen-
erative joint disease in a hospital population of cats. Vet Rec 2005;157(25):793–9.
3. Godfrey DR. Osteoarthritis in cats: a retrospective radiological study. J Small
Anim Pract 2005;46(9):425–9.
4. Hardie EM, Roe SC, Martin FR. Radiographic evidence of degenerative joint dis-
ease in geriatric cats: 100 cases (1994-1997). J Am Vet Med Assoc 2002;220(5):
628–32.
5. Lascelles BDX, Henry JB III, Brown J, et al. Cross-sectional study of the preva-
lence of radiographic degenerative joint disease in domesticated cats. Vet
Surg 2010;39(5):535–44.
6. Clarke SP, Bennett D. Feline osteoarthritis: a prospective study of 28 cases.
J Small Anim Pract 2006;47(8):439–45.
7. Kranenburg HC, Meij BP, van Hofwegen EML, et al. Prevalence of spondylosis
deformans in the feline spine and correlation with owner-perceived behavioral
changes. Vet Comp Orthop Traumatol 2012;25(3):217–23.
8. Lascelles BDX, Dong YH, Marcellin-Little DJ, et al. Relationship of orthopedic ex-
amination, goniometric measurements, and radiographic signs of degenerative
joint disease in cats. BMC Vet Res 2012;8:10.
9. Tsai CY, Chang YP. Assessment of the cutaneous trunci muscle reflex in healthy
cats: comparison of results acquired by clinicians and cat owners. J Fel Med
Surg 2022;24(8):e163–7.
10. Freire M, Robertson I, Bondell HD, et al. Radiographic evaluation of feline appen-
dicular degenerative joint disease vs. macroscopic appearance of articular carti-
lage. Vet Radiol Ultrasound 2011;52(3):239–47.
11. Benito J, Depuy V, Hardie E, et al. Reliability and discriminatory testing of a client-
based metrology instrument, feline musculoskeletal pain index (FMPI) for the
evaluation of degenerative joint disease-associated pain in cats. Vet J 2013;
196(3):368–73.
12. Benito J, Hansen B, Depuy V, et al. Feline musculoskeletal pain index: respon-
siveness and testing of criterion validity. J Vet Intern Med 2013;27(3):474–82.
894 Deabold et al

13. Lascelles BDX, Bernie HD, Roe S, et al. Evaluation of client-specific outcome
measures and activity monitoring to measure pain relief in cats with osteoarthritis.
J Vet Intern Med 2007;21(3):410–6.
14. Addison ES, Clements DN. Repeatability of quantitative sensory testing in healthy
cats in a clinical setting with comparison to cats with osteoarthritis. J Feline Med
Surg 2017;19(12):1274–82.
15. Perry K. Feline hip dysplasia: a challenge to recognize and treat. J Feline Med
Surg 2016;18(3):203–18.
16. King JN, Seewald W, Forster S, et al. Clinical safety of robenacoxib in cats with
chronic musculoskeletal disease. J Vet Intern Med 2021;35(5):2384–94.
17. Lees P, Toutain PL, Elliott J, et al. Pharmacology, safety, efficacy and clinical uses
of the COX-2 inhibitor robenacoxib. J Vet Pharmacol Ther 2022;45(4):325–51.
18. Gowan RA, Lingard AE, Johnston L, et al. Retrospective case-control study of the
effects of long-term dosing with meloxicam on renal function in aged cats with
degenerative joint disease. J Feline Med Surg 2011;13(10):752–61.
19. King JN, King S, Budsberg SC, et al. Clinical safety of robenacoxib in feline oste-
oarthritis: results of a randomized, blinded, placebo-controlled clinical trial.
J Feline Med Surg 2016;18(8):632–42.
20. KuKanich K, George C, Roush JK, et al. Effects of low-dose meloxicam in cats
with chronic kidney disease. J Feline Med Surg 2021;23(2):138–48.
21. Gruen ME, Myers JAE, Lascelles BDX. Efficacy and safety of an anti-nerve growth
factor antibody (frunevetmab) for the treatment of degenerative joint disease-
associated chronic pain in cats: a multi-site pilot field study. Front Vet Sci 2021;
8:610028.
22. Bennett D, Affrin S, Johnston P. Osteoarthritis in the cat: 2. how should it be
managed and treated? J Feline Med Surg 2012;14(1):76–84.
23. Adrian D, King JN, Parrish RS, et al. Robenacoxib shows efficacy for the treat-
ment of chronic degenerative joint disease-associated pain in cats: a randomized
and blinded pilot clinical trial. Sci Rep 2021;11(1):7721.
24. Guedes AGP, Meadows JM, Pypendop BH, et al. Assessment of the effects of ga-
bapentin on activity levels and owner-perceived mobility impairment and quality
of life in osteoarthritic geriatric cats. J Am Vet Med Assoc 2018;253(5):579–85.
25. Adrian D, Papich MG, Baynes R, et al. The pharmacokinetics of gabapentin in
cats. J Vet Intern Med 2018;32(6):1996–2002.
26. Klinck MP, Monteiro BP, Lussier B, et al. Refinement of the Montreal Instrument for
Cat Arthritis Testing, for Use by Veterinarians: detection of naturally occurring
osteoarthritis in laboratory cats. J Feline Med Surg 2018;20(8):728–40.
27. Guedes AGP, Meadows JM, Pypendop BH, et al. Evaluation of tramadol for treat-
ment of osteoarthritis in geriatric cats. J Am Vet Med Assoc 2018;252(5):565–71.
28. Monteiro BP, Klinck MP, Moreau M, et al. Analgesic efficacy of tramadol in cats
with naturally occurring osteoarthritis. PLoS One 2017;12(4):e0175565.
29. Shipley H, Flynn K, Tucker L, et al. Owner evaluation of quality of life and mobility
in osteoarthritic cats treated with amantadine or placebo. J Feline Med Surg
2021;23(6):568–74.
30. Ferrari JT, Schwartz P. Prospective evaluation of feline sourced platelet-rich
plasma using centrifuge-based systems. Front Vet Sci 2020 Jun;7:322.
31. Chun N, Canapp S, Carr BJ, et al. Validation and characterization of platelet-rich
plasma in the feline: a prospective analysis. Front Vet Sci 2020;7:512.
32. Webb TL. Stem cell therapy and cats: what do we know at this time? Vet Clin
North Am Small Anim Pract 2020;50(5):955–71.
 Feline Osteoarthritis Management 895

33. Teng KT, McGreevy PD, Toribio JL, et al. Strong associations of nine-point body
condition scoring with survival and lifespan in cats. J Feline Med Surg 2018;
20(12):1110–8.
34. Marshall WG, Hazewinkel HA, Mullen D, et al. The effect of weight loss on lame-
ness in obese dogs with osteoarthritis. Vet Res Commun 2010;34(3):241–53.
35. Frye CW, Shmalberg JW, Wakshlag JJ. Obesity, exercise and orthopedic dis-
ease. Vet Clin North Am Small Anim Pract 2016;46(5):831–41.
36. Johnson KA, Lee AH, Swanson KS. Nutrition and nutraceuticals in the changing
management of osteoarthritis for dogs and cats. J Am Vet Med Assoc 2020;
256(12):1335–41.
37. German AJ. Obesity prevention and weight maintenance after loss. Vet Clin North
Am Small Anim Pract 2016;46(5):913–29.
38. Freeman LM. Cachexia and sarcopenia: emerging syndromes of importance in
dogs and cats. J Vet Intern Med 2012;26(1):3–17.
39. Saker KE. Nutritional concerns for cancer, cachexia, frailty, and sarcopenia in
canine and feline pets. Vet Clin North Am Small Anim Pract 2021;51(3):729–44.
40. Pallotto MR, de Godoy MRC, Holscher HD, et al. Effects of weight loss with a
moderate-protein, high-fiber diet on body composition, voluntary physical activ-
ity, and fecal microbiota of obese cats. Am J Vet Res 2018;79(2):181–90.
41. Hall JA, Jackson MI, Farace G, et al. Influence of dietary ingredients on lean body
percent, uremic toxin concentrations, and kidney function in senior-adult cats.
Metabolites 2019;9(10):238.
42. de Godoy MR, Shoveller AK. Overweight adult cats have significantly lower
voluntary physical activity than adult lean cats. J Feline Med Surg 2017;19(12):
1267–73.
43. de Godoy MR, Ochi K, de Oliveira Mateus LF, et al. Feeding frequency, but not
dietary water content, affects voluntary physical activity in young lean adult fe-
male cats. J Anim Sci 2015;93(5):2597–601.
44. Deng P, Grant RW, Swanson KS. Physical activity level of adult cats with varied
feeding frequency. Br J Nutr 2011;106(S1):S166–9.
45. Barbeau-Grégoire M, Otis C, Cournoyer A, et al. 2022 systematic review and
meta-analysis of enriched therapeutic diets and nutraceuticals in canine and
feline osteoarthritis. Int J Mol Sci 2022;23(18):10384.
46. Lascelles BDX, DePuy V, Thomson A, et al. Evaluation of a therapeutic diet for
feline degenerative joint disease. J Vet Intern Med 2010;24(3):487–95.
47. Corbee RJ, Barnier MMC, van de Lest CHA, et al. The effect of dietary long-chain
omega-3 fatty acid supplementation on owner’s perception of behaviour and
locomotion in cats with naturally occurring osteoarthritis. J Anim Physiol Anim
Nutr 2013;97(5):846–53.
48. Corbee RJ. The efficacy of a nutritional supplement containing green-lipped
mussel, curcumin and blackcurrant leaf extract in dogs and cats with osteoar-
thritis. Vet Med Sci 2022;8(3):1025–35.
49. Sul RM, Chase D, Parkin T, et al. Comparison of meloxicam and a glucosamine-
chondroitin supplement in management of feline osteoarthritis. A double-blind
randomised, placebo-controlled, prospective trial. Vet Comp Orthop Traumatol
2014;27(1):20–6.
50. Lenox CE, Bauer JE. Potential adverse effects of omega-3 fatty acids in dogs and
cats. J Vet Intern Med 2013;27(2):217–26.
51. Wakshlag JJ, Cital S, Eaton SJ, et al. Cannabinoid, terpene, and heavy metal
analysis of 29 over-the-counter commercial veterinary hemp supplements. Vet
Med 2020;11:45–55.
896 Deabold et al

52. Miscioscia E, Shmalberg J, Scott KC. Measurement of 3-acetyl-11-keto-beta-bos-

wellic acid and 11-keto-beta-boswellic acid in Boswellia serrata supplements
administered to dogs. BMC Vet Res 2019;15(1):270.
53. Yu CHJ, Rupasinghe HPV. Cannabidiol-based natural health products for com-
panion animals: Recent advances in the management of anxiety, pain, and
inflammation. Res Vet Sci 2021;140:38–46.
54. Wang T, Zakharov A, Gomez B, et al. Serum cannabinoid 24 h and 1 week steady
state pharmacokinetic assessment in cats using a CBD/CBDA rich hemp paste.
Front Vet Sci 2022;9:895368.
55. Deabold KA, Schwark WS, Wolf L, et al. Single-dose pharmacokinetics and pre-
liminary safety assessment with use of CBD-rich hemp nutraceutical in healthy
dogs and cats. Animals 2019;9(10):832.
56. Millis DL, Levine D. Canine rehabilitation and physical therapy. 2nd edition. Phil-
adelphia, PA: Elsevier Saunders; 2014.
57. Romano L, Halkett EVC. Rehabilitation of the feline patient: acupuncture and hy-
drotherapy as part of a multidisciplinary team approach. Vet Nurse 2018;9(1):
26–31.
58. Zhang Y, Bao F, Wang Y, et al. Influence of acupuncture in treatment of knee oste-
oarthritis and cartilage repairing. Am J Transl Res 2016;8(9):3995–4002.
59. Wang DH, Bao F, Wu Z, et al. Influence of acupuncture on IL-1beta and TNF-
alpha expression in the cartilage of rats with knee arthritis. Zongguo Gu Shang
2011;24(9):775–8.
60. Rose WJ, Sargeant JM, Hanna WJB, et al. A scoping review of the evidence for
efficacy of acupuncture in companion animals. Anim Health Res Rev 2017;18(2):
177–85.
61. Sharp B. Feline physiotherapy and rehabilitation: 1. principles and potential.
J Feline Med Surg 2012;14(9):622–32.
62. Lascelles BDX, Robertson SA. DJD-associated pain in cats: what can we do to
promote patient comfort? J Feline Med Surg 2010;12(3):200–12.
63. Kidd JR. Alternative medicines for the geriatric veterinary patient. Vet Clin North
Am Small Anim Pract 2012;42(4):809–22, viii.
64. Looney AL, Huntingford JL, Blaeser LL, et al. A randomized blind placebo-
controlled trial investigating the effects of photobiomodulation therapy (PBMT)
on canine elbow osteoarthritis. Can Vet J 2018;59(9):959–66.
65. Barale L, Monticelli P, Raviola M, et al. Preliminary clinical experience of low-level
laser therapy for the treatment of canine osteoarthritis-associated pain: A retro-
spective investigation on 17 dogs. Open Vet J 2020;10(1):116–9.
66. Song HJ, Seo HJ, Kim D. Effectiveness of high-intensity laser therapy in the man-
agement of patients with knee osteoarthritis: A systematic review and meta-
analysis of randomized controlled trials. J Back Musculoskelet Rehabil 2020;
33(6):875–84.
67. Drum MG, Bockstahler B, Levine D, et al. Feline Rehabilitation. Vet Clin North Am
Small Anim Pract 2015;45(1):185–201.
68. Halkett EVC, Romano L. Rehabilitation of the feline patient: physiotherapy treat-
ment as part of a multidisciplinary team approach. Vet Nurse 2017;8(10):548–52.
69. Gaynor JS, Hagberg S, Gurfein BT. Veterinary applications of pulsed electromag-
netic field therapy. Res Vet Sci 2018;119:1–8.
70. Herzog W, Longino D, Clark A. The role of muscles in joint adaptation and degen-
eration. Langenbeck’s Arch Surg 2003;388(5):305–15.