From Stiff to Swift: Innovations in Feline Arthritis Management

 

Cats may have nine lives, but their joints still age! In this CE presentation, Dr. Ruelle will cover everything you need to know about feline arthritis, from the DJD timeline to those easy-to-miss clinical signs (and how to help caregivers spot them), plus a review of both old favorites and newer therapies to help our purrfect patients age gracefully.

What is Arthritis?

Arthritis (-itis = infllammatory) condition is inflammatory means inflammation or swelling of one or more joints. It describes more than 100 conditions that affect the joints, tissues around the joint, and other connective tissues. Specific symptoms vary depending on the type of arthritis, but usually include joint pain and stiffness. 

Symptoms: Medical swelling. 

Not all veterinarians share the same perspective or terminology. However, according to Dr. Ruelle, degenerative joint disease (DJD) and osteoarthritis (OA) are equivalent terms referring to the same chronic degenerative joint disease.

Dr. Ruelle distinguishes DJD/osteoarthritis from other forms of arthritis, including:

• Septic (infectious) arthritis – Arthritis caused by bacterial infection, such as bacteria entering a joint through a wound or bite, or by certain infectious agents such as calicivirus.

• Erosive polyarthritis – A form of inflammatory arthritis characterized by progressive destruction of joint structures.

• Immune-mediated polyarthritis (IMPA) – Arthritis caused by an abnormal immune response rather than joint degeneration.

Note: Immune-mediated polyarthritis has been reported to have a potential association with Mycoplasma infection in some cases, although the relationship is not fully understood and does not imply that Mycoplasma is the cause of all cases.

Can be appreciated with age:

 

Clinical signs that may become more apparent with age:

• Loss of function – Progressive joint degeneration results in stiffness, reduced flexibility, and decreased range of motion.
• Pain – Osteoarthritis is an inflammatory joint disease, and inflammation contributes to chronic pain, discomfort, and reduced mobility.

With aging, the body naturally becomes less hydrated, and joint tissues become less resilient. As cartilage loses water content, it becomes stiffer, less elastic, and more brittle. This reduces its ability to absorb shock and distribute forces across the joint, making it more susceptible to wear, damage, and the progressive changes associated with degenerative joint disease (osteoarthritis).

DJD & Pain

With progressive cartilage loss, joint damage triggers a secondary inflammatory response. This inflammatory environment is complex and involves multiple mediators often around 10–15 interacting chemical and cellular signals that contribute to pain and tissue changes.

Key contributors can include:

• Serotonin pathways

• Macrophages, which are immune cells involved in inflammation and tissue signaling

• Nerve Growth Factor (NGF)

• Substance P, a neuropeptide involved in pain transmission

• Prostaglandins, which are mediated in part through COX-2 activity

Because this inflammatory cascade involves multiple overlapping pathways, treatment response can vary significantly between individuals. As a result, management often requires a degree of trial and adjustment, since no single therapy is universally effective for all cases.

A key focus in modern understanding of osteoarthritis pain is nerve growth factor (NGF). Healthy cartilage has limited nerve supply; however, as cartilage deteriorates, abnormal nerve growth can occur within joint structures. These newly formed nerve fibers can become highly sensitized, meaning they may transmit pain signals even in response to mild or non-harmful movements, contributing to heightened joint sensitivity and discomfort.

Although there is significant sensory input coming from the periphery, the brain ultimately determines how much pain is perceived and how it is interpreted. Pain is not a direct measure of tissue damage alone, but rather a complex experience shaped by both biological and neurological processing.

Pain is highly individual. For example, two cats with very similar injuries may present with very different pain scores due to differences in how their nervous systems process and interpret pain signals.

This reflects the concept that pain perception is influenced by the brain’s overall state. When an animal is in a calmer, more stable “neurological environment,” pain may be perceived as less intense. Conversely, when the brain is under stress whether from anxiety, fear, or other physiological stressors the pain response may become amplified, resulting in a more exaggerated perception of discomfort even when the physical injury is similar.

This concept is particularly important in grooming, especially when handling older pets or animals with subtle, undiagnosed, or previously dismissed clinical signs.

Even when physical findings appear mild such as slight stiffness, reduced tolerance to positioning, or subtle behavioral changes these patients may still be experiencing a heightened pain state due to underlying degenerative or inflammatory processes. In senior pets, chronic conditions like osteoarthritis can lower the threshold for discomfort, meaning routine handling during grooming (lifting limbs, flexing joints, prolonged standing, or restraint) may feel significantly more stressful or painful than expected.

Additionally, the way pain is perceived is influenced by the animal’s neurological and emotional state. A calm, well-regulated pet may tolerate handling with minimal signs of distress, whereas a pet experiencing anxiety, fear, or environmental stress may exhibit amplified pain responses. This is due to central nervous system processing, where stress can increase sensitivity to peripheral input and lower the threshold for pain expression.

In grooming settings, this means that outwardly “minor” symptoms should not be interpreted as absence of discomfort. Pets with minimal visible signs can still have significant underlying pain, and their responses during grooming may reflect a combination of physical discomfort and emotional state rather than injury severity alone.

For this reason, gentle handling, slow assessment of tolerance, and ongoing observation of subtle behavioral cues are essential. Recognizing that pain is an individual experience helps guide safer, more compassionate grooming practices, particularly in geriatric or medically complex animals where symptoms may be underreported or not yet diagnosed.

As pets age or develop medical conditions, a key consideration becomes whether care practices are being adapted to the animal’s current comfort level, rather than continuing routines designed for a younger, healthier body.

Older pets or those with underlying pain may no longer tolerate prolonged handling, tight positioning, or styling practices aimed primarily at maintaining a youthful appearance. What was once comfortable can become physically demanding or even painful due to reduced joint flexibility, increased inflammation, or heightened pain sensitivity. In these cases, pushing for aesthetic consistency can unintentionally conflict with the animal’s welfare.

Adapting to the pet’s changing needs means prioritizing comfort, mobility, and emotional well-being over appearance standards. This may include shorter grooming sessions, modified positioning, reduced stress handling, or simplifying the groom to what the pet can safely and comfortably tolerate. These adjustments are not a reduction in care quality, but rather a shift toward care that reflects the animal’s current physiological state.

The goal is to recognize that aging and disease change what is appropriate and humane in grooming. Respecting these changes helps prevent unnecessary stress or pain and supports a more compassionate approach that aligns with the pet’s lived experience rather than an idealized or previous version of their condition.

Osteoarthritis is widely recognized as a degenerative “wear-and-tear” condition that can be associated with pain, stiffness, and reduced mobility. In many traditional approaches, radiographs (X-rays) are considered part of the standard diagnostic work-up, as they can help identify structural changes within joints and confirm the presence of degenerative disease.

However, a more functional and patient-centered perspective emphasizes that imaging findings do not always correlate well with clinical pain. In both human and veterinary medicine, there can be a poor relationship between radiographic severity and the actual level of discomfort experienced by the patient. Some individuals with relatively mild changes on X-rays may report significant pain and disability, while others with advanced or “dramatic” imaging findings such as marked osteoarthritic change or spinal spondylosis may show minimal or no outward signs of discomfort.

For this reason, while X-rays remain valuable for ruling out other important conditions such as fractures, osteosarcomas, osteoporosis, or other structural pathology, they are not a reliable standalone indicator of pain severity or functional impairment. Imaging provides information about structure, but it does not directly measure the subjective experience of pain or the functional impact on the individual.

This perspective supports a clinical approach that prioritizes the patient’s behavior, mobility, and response to handling over imaging alone when assessing pain and guiding treatment decisions.

 

Picture taken age: 17 years old

Choice of management: Solensia.

X-rays diagnositic: Spondylosis on spine

Movement is post injury from being playful

Movement observation:

Plantigrade gait pattern while ascending stairs, using the plantar surfaces of the hind feet for propulsion. Instead of maintaining a normal digitigrade stance, the paws are placed flatter against the surface, indicating altered weight distribution and reduced biomechanical efficiency during push-off.

This is particularly evident in the right hind limb, where the plantigrade positioning appears more pronounced. During stair ascent, the patient relies on the plantar region to generate force, suggesting compensatory movement likely associated with discomfort, weakness, or reduced joint function in that limb.

Such a gait change can be consistent with underlying orthopedic or neurological compromise, and may reflect reduced confidence or capability in normal limb flexion and extension during weight-bearing activities.

What do X-rays tell us?

Degenerative joint disease can affect any joint in the body, although clinical focus is often placed on the major load-bearing joints responsible for locomotion, such as the hips, knees, elbows, and spine.

In cats, musculoskeletal changes can present differently compared to other species due to their high degree of spinal flexibility and their tendency to distribute movement across multiple joints. As a result, degenerative changes are often more generalized and may appear relatively symmetrical across the body rather than isolated to a single joint.

This can lead to a clinical pattern described as shifting lameness. In these cases, owners may report that a cat is “limping on the left,” but a thorough examination may reveal subtle discomfort in multiple limbs, with the apparent lameness shifting depending on which joint is most painful at that moment. Because multiple joints may be affected simultaneously, the cat will often preferentially load the limb or region experiencing the least discomfort on a given day.

This variability reflects the multifocal nature of degenerative or inflammatory joint disease in cats and highlights the importance of full-body orthopedic assessment rather than focusing solely on a single reported limb of concern.

Clinical Signs 

Cats are often very subtle in how they express disease, especially chronic musculoskeletal discomfort. Many will continue to perform normal “cat behaviors,” but the quality, fluidity, and frequency of those movements may gradually change over time.

One of the earliest indicators can be seen in routine mobility and stretching behaviors. For example, when cats perform full-body stretches—extending the forelimbs forward while lengthening the spine and pushing the hindlimbs backward—the movement may become less fluid or appear partially completed. A reduction in the full extension of the hind end or a hesitant, abbreviated stretch can be an early indicator of discomfort in the hips, spine, or surrounding soft tissues.

Changes in activity can also be observed in everyday movement patterns. Cats may become slower when navigating stairs, pause midway during ascent or descent, or hesitate before jumping. Even when they still access preferred high surfaces such as kitchen counters, they may begin to modify their strategy such as using intermediate steps like chairs or furniture to reduce strain.

Grooming behavior is another important indicator. Reduced flexibility can lead to overgrown nails due to decreased scratching, and decreased grooming efficiency. This often results in focal matting, particularly over the hindquarters and lower back, where the cat must flex and rotate the spine to reach. In contrast, areas that are easily accessible, such as the forelimbs and chest, may remain well-groomed, highlighting a regional loss of mobility.

Pain perception can also manifest as allodynia, where normally non-painful stimuli such as light touch or temperature changes are perceived as painful due to altered nerve processing. This reflects a sensitized nervous system rather than a direct injury alone.

Changes in litter box behavior may also be observed. These can include elimination outside the litter box, constipation, or altered posture during urination. For example, urine spraying or “wall hitting” may occur when a cat is no longer able to squat fully, causing changes in aim. These signs can be associated with a range of underlying issues including urinary crystals, stones, joint pain, or osteoarthritis.

Overall, these changes tend to develop slowly and subtly. Because cats are highly adaptable and instinctively mask discomfort, owners may not notice early progression until mobility limitations or secondary behaviors become more pronounced.

Risk Factors 

As cats age, comorbid conditions are common, particularly chronic kidney disease (CKD) alongside degenerative joint disease such as osteoarthritis (OA). These conditions often coexist and can influence one another, both physiologically and in terms of how clinical signs are expressed.

In cases of kidney disease, systemic changes such as chronic inflammation, dehydration, muscle loss, and altered metabolic balance can contribute to a cat appearing more painful or less mobile. Reduced hydration status may also affect joint lubrication and overall tissue resilience, potentially exacerbating discomfort associated with osteoarthritis.

At the same time, cats with concurrent OA may show more pronounced signs of pain and reduced mobility due to the additive effect of multiple disease processes occurring simultaneously. This overlap can make clinical assessment more complex, as signs such as reduced activity, decreased grooming, weight loss, or altered posture may be attributed to either condition or both.

Because of this comorbidity, a multimodal approach to assessment is important. Recognizing that aging cats rarely present with a single isolated condition helps explain why pain levels, mobility changes, and overall quality of life can vary significantly between individuals with similar diagnoses.

Managing DJD

Chronic pain is debilitating and has a profound impact on a cat's quality of life. Unlike people, cats cannot verbalize their pain or advocate for their own needs. As caregivers and veterinary professionals, it is our responsibility to recognize subtle signs of discomfort, assess changes in behavior and mobility, and advocate for appropriate pain management.

The goal is not simply to extend a cat's lifespan, but to ensure those additional years are lived with comfort, mobility, and dignity. Early recognition and proactive management of chronic pain particularly conditions such as osteoarthritis can significantly improve a cat's quality of life, allowing them to continue performing normal feline behaviors and maintaining their independence for as long as possible.

Ultimately, successful pain management is about helping cats live longer, healthier, and as pain-free as possible, while preserving their physical function, emotional well-being, and overall quality of life.

Assessing pain in cats 

Treatment of Arthritis 

 Many owners are unaware that arthritis is extremely common in aging cats because the disease often develops gradually and the signs can be subtle. As a result, changes in mobility or behavior are frequently mistaken for "normal aging" rather than indicators of chronic pain.

For first-time cat owners, or for those who have never discussed arthritis with their veterinarian, it is understandable that they may not know what signs to watch for or when to seek further evaluation. Without awareness, gradual changes such as reduced jumping, altered grooming habits, stiffness, or decreased activity can easily go unnoticed.

Open conversations about osteoarthritis help caregivers recognize that joint disease is a common consequence of aging and that chronic pain is not something cats should simply "live with." By improving owner education and encouraging early recognition of subtle clinical signs, cats are more likely to receive timely assessment, appropriate pain management, and interventions that preserve their comfort, mobility, and overall quality of life.

Case example: Ehlers-Danlos Syndrome (cutaneous asthenia)

A patient presenting with unusually stretchy, fragile skin and recurrent lacerations to the ears was referred to a specialist for a second opinion after repeated episodes of injury.

The recurrent ear wounds were initially thought to be the result of self-trauma alone. However, further evaluation identified Ehlers-Danlos syndrome (cutaneous asthenia), a hereditary connective tissue disorder characterized by abnormal collagen formation. Affected animals have skin that is excessively elastic, fragile, and prone to tearing, even with minimal trauma or normal scratching.

In this case, the veterinarian recognized that the pattern and severity of the injuries were not consistent with self-trauma alone and warranted further investigation. Due to the owners' limited experience with this rare condition, they were unaware that their pet's unusually stretchy skin and recurrent injuries could be manifestations of an underlying connective tissue disorder.

This case highlights the importance of considering uncommon differential diagnoses when clinical signs are recurrent or disproportionate to the apparent cause. It also emphasizes the value of referral and specialist consultation when the presentation is atypical or when an underlying condition is suspected.

Many caregivers understandably find it difficult to hear that a veterinary professional may recognize health concerns that they themselves have not noticed. This is not because owners are inattentive or uncaring, but because they live with their pets every day and gradual changes can become normalized over time.

Veterinarians and other trained animal health professionals evaluate hundreds to thousands of patients throughout their careers and are trained to identify subtle clinical signs that may indicate pain or disease. Their observations are based on education, clinical experience, and pattern recognition rather than familiarity with an individual pet alone.

The most effective approach is a collaborative one. Caregivers contribute invaluable knowledge of their pet's normal routines, personality, and behavior, while veterinary professionals provide the medical expertise needed to interpret subtle changes and identify underlying disease. Together, this partnership leads to earlier recognition of health problems, more informed decision-making, and better outcomes for the animal.

Lifestyle is a frequently underappreciated component of osteoarthritis management in cats. While medications play an important role in controlling pain and inflammation, a cat's daily environment, activity level, body condition, and ability to comfortably perform normal behaviors have a significant impact on long-term mobility and quality of life.

Simple lifestyle modifications can reduce joint strain and improve comfort. These may include maintaining an ideal body weight, encouraging appropriate low-impact activity, providing ramps or steps to access favorite resting places, using low-entry litter boxes, ensuring food and water are easily accessible, and offering soft, supportive bedding. Reducing environmental stress and avoiding unnecessary physical demands can also help cats with chronic joint disease.

A multimodal approach that combines medical therapy with environmental and lifestyle adaptations often provides the greatest benefit. By tailoring a cat's surroundings to its changing physical abilities, caregivers can help preserve independence, reduce pain, and support a better quality of life throughout the aging process.

Owner Homework: Building an Effective Care Team

No one knows a pet's daily habits better than the caregiver. At the same time, veterinarians and veterinary professionals have years of education and clinical experience diagnosing and managing disease. The best outcomes happen when both forms of knowledge are respected.

Rather than viewing recommendations as criticism or assuming either party knows everything, approach appointments as a partnership.

Before your appointment:

• Keep a log of symptoms, including when they occur, how often, and any changes over time.
• Take clear photos or videos of unusual behavior, wounds, or skin changes when possible.
• Bring a list of medications, supplements, and diet.
• Write down your questions in advance.

During your appointment:

• Share observations honestly, even if they seem unimportant.
• Ask for clarification if you don't understand a diagnosis or treatment plan.
• Be open to the possibility that a condition may not be what it first appears to be.
• Remember that a specialist or second opinion is meant to gather more expertise not to prove anyone wrong.

When caregivers and veterinary professionals communicate openly and respect each other's roles, pets receive the safest, most effective care possible.

Owner Homework: Accepting Feline Preferences

Anyone who has lived with a cat knows they can be incredibly stubborn. Many cats would rather limp or awkwardly navigate furniture than use the stairs, ramps, or other accommodations thoughtfully provided for them. While this can be frustrating, it doesn't mean these modifications aren't worth trying.

The goal is to offer options not force them.

Cats should never be physically forced to use stairs, ramps, or mobility aids, as this can create fear, stress, and avoidance. Instead:

• Place ramps or steps where your cat already prefers to travel.

• Introduce new equipment gradually, using treats, toys, or familiar bedding to encourage exploration.

• Ensure surfaces are stable and non-slip.

• Be patient some cats adapt within days, while others may never fully accept the change.

Even if your cat ignores the accommodations at first, don't give up. Many cats begin using them only after pain progresses or they become more familiar with the environment. The objective is to make safe options available while respecting your cat's independence and natural behavior.

Owner Homework: Warm Towels for Comfort

A warm towel can be a simple way to provide comfort for many pets, especially senior animals, those with arthritis, or pets recovering from illness or surgery (when approved by your veterinarian).

How to use a warm towel safely:

• Warm the towel until it is comfortably warm, not hot. Always test it against the inside of your wrist before placing it on your pet.
• Place the towel over or beside your pet, allowing them to move away if they become too warm.
• Never wrap a pet tightly or leave them unattended with a heated towel.
• Avoid using excessively hot towels or applying heat directly to inflamed, swollen, bleeding, or recently injured areas unless instructed by your veterinarian.

Many pets find warmth soothing, but every animal is different. If your pet shows signs of discomfort, panting, restlessness, or tries to move away, remove the towel immediately.

Bonus tip: Commercial towel warmers can be a convenient way to keep towels at a consistent, comfortable temperature. They are especially useful for senior pets, newborns, grooming, bathing, or veterinary recovery, but should always be used with temperature checks and never as a substitute for monitoring your pet.

Owner Homework: Raised Food and Water Bowls

For many senior pets or those with arthritis, neck pain, or shoulder discomfort, raising food and water bowls can make mealtimes more comfortable.

An elevated bowl may:

• Reduce the need to bend the neck and shoulders as far to eat or drink.

• Improve comfort for pets with mobility limitations.

• Encourage pets that seem reluctant to eat because of discomfort.

The bowl should be raised only to a comfortable height—generally around chest level when your pet is standing naturally. Every pet is different, so observe whether your pet appears more relaxed and comfortable while eating.

While raised bowls are not a treatment for arthritis or other medical conditions, they are a simple environmental modification that can improve comfort and quality of life with very little effort.

Owner Homework: Age-Appropriate Litter Box Setup

As cats age, their needs change. A litter box that worked well when they were young may become difficult to access later in life, especially for cats with arthritis, mobility issues, or joint discomfort.

Consider making the litter box easier to use:

• Choose a shallow litter box with lower sides so senior cats can step in and out more easily.

• An uncovered litter box is often preferred, as it allows easier entry and exit while giving cats a clearer view of their surroundings.

• Avoid overfilling with litter. Too much litter can create an unstable surface, making it harder for older cats to balance and feel secure while eliminating.

Accessibility matters:

• If your home has multiple floors, provide litter boxes on each level so your cat does not have to navigate stairs unnecessarily.

• If using a baby gate or barrier to restrict access to certain areas, ensure your cat still has a safe and easy route to their litter box. A built-in cat opening may be necessary.

Caring for senior pets sometimes requires changes to the home environment. These adjustments may not always match current décor trends or aesthetic preferences, but comfort and accessibility should come first.

Aging pets often need us to adapt their environment not expect them to continue adapting to ours.

Owner Homework: Grooming Changes and Joint Health

Changes in grooming habits are often one of the earliest signs that a cat may be experiencing discomfort. Cats are naturally clean animals, so a decrease in grooming should not be dismissed as simply “getting older.”

Watch for:

• Decreased grooming or a less maintained coat.
• Focal matting (mats developing in specific areas), which can be associated with difficulty reaching certain areas due to degenerative joint disease (DJD), arthritis, or reduced mobility.
• Changes in scratching behavior.

When joints are painful or movement is limited, cats may struggle to twist, stretch, and reach the areas they once groomed easily.

Owner homework:

• Get the combs and brushes out regularly senior cats often need more assistance maintaining their coat.
• Check areas commonly missed, such as the back, hips, belly, and behind the legs.
• Monitor scratching habits. A decrease in scratching may mean your cat is uncomfortable, while changes in scratching patterns can also indicate mobility changes.
• Trim nails more frequently as cats age. The goal is not to cut nails shorter, but to maintain them more often because older cats may not wear their nails down as naturally through scratching and activity.

Small changes in grooming, scratching, and nail maintenance can provide important clues about your cat's comfort level. Helping with these tasks is not just cosmetic it can improve quality of life for aging cats. Be gentle, if you can't brush that area that day then try another day, make sure you are not in rush pet's can sense when your trying to rush them or get it over with the mood has to be calm.

Owner Homework: Understanding Supplements and Ingredients

Many supplements and supportive products can provide benefits for cats, especially when used appropriately. However, it is important to remember that every cat is an individual.

The biggest concern would be a cat that has an allergy or sensitivity to one of the non-medical ingredients, such as flavorings, additives, or specific protein sources. For example, cats with a shellfish allergy may react to ingredients derived from marine sources.

For cats without ingredient sensitivities, many of these products can offer valuable support and may contribute to improved comfort and overall quality of life.

Owner homework:

• Read ingredient lists carefully.
• Introduce new products gradually when possible.
• Monitor for changes such as itching, digestive upset, skin irritation, or changes in behavior.
• Discuss supplements with your veterinarian, especially if your cat has existing health conditions or takes medications.

The goal is not to avoid supportive care, but to choose products that are appropriate for your individual cat and their specific needs.

Owner Homework: Homemade Foods vs. Medical or Pet-Designed Supplements

Homemade foods and pet-specific supplements are not the same thing. While many owners prepare homemade foods with the best intentions, nutrition for cats is complex and requires very specific nutrient balance.

A homemade ingredient may contain a beneficial nutrient, but it does not automatically mean it provides the correct amount, form, or combination needed for a cat's health.

The difference comes down to formulation and purpose:

• Homemade foods are often made from individual ingredients and may lack essential nutrients if they are not properly formulated by a veterinary nutrition professional.

• Veterinary or pet-designed supplements are created with a specific purpose in mind and are formulated to provide controlled amounts of targeted ingredients.

• Medical diets and supplements often undergo research, quality control, and ingredient testing to ensure consistency and safety.

For example, adding a single food source that contains calcium, omega fatty acids, or other nutrients does not mean a pet is receiving the correct balance. Too much or too little of certain nutrients can create health problems over time.

Owner homework:

• Avoid assuming that a human food ingredient provides the same benefit as a veterinary-formulated product.

• Be cautious with internet recommendations that suggest one ingredient can “fix” a medical condition.

• Discuss homemade diets, supplements, and additives with your veterinarian—especially for senior pets or pets with kidney disease, heart disease, allergies, or other health concerns.

The goal is not to discourage owners from providing extra support, but to ensure that what is being added is safe, appropriate, and beneficial for that individual pet.

Omega fatty acids, particularly EPA and DHA from marine sources, may provide additional support for cats with kidney disease by helping address some of the secondary concerns that can occur alongside chronic kidney disease.

Potential benefits may include:

• Supporting a healthy inflammatory response.

• Supporting skin and coat health, which may decline as cats age or become ill.

• Providing nutritional support when kidney disease is accompanied by other health concerns (co-morbidities).

It is important to understand that omega fatty acids are supportive care, not a cure for kidney disease. They should be used as part of a complete management plan that may include appropriate nutrition, hydration support, monitoring of blood values, and veterinary guidance.

When selecting an omega supplement, consider:

• Ingredient quality and source.

• Appropriate dosing for cats.

• Additional ingredients that may not be suitable for every individual, such as potential allergens.

The goal is to choose supplements that complement medical care and support the individual needs of the cat.

Many people think of joint supplements as “rebuilding blocks” for the body. Since cartilage naturally contains compounds such as glucosamine and chondroitin, it seems logical that providing these ingredients back to the body may help support damaged joints.

The reality is a little more complex. These supplements do not simply replace lost cartilage or rebuild a damaged joint like repairing a broken part. However, they may provide supportive benefits by helping maintain cartilage health, supporting joint fluid, and contributing to a healthier inflammatory response in some pets.

The goal of joint supplements is not to reverse existing damage, but to support the remaining healthy tissue and improve comfort and mobility as part of a broader management plan.

Owner homework:

• Understand that supplements work best as supportive care, not as a replacement for veterinary treatment.

• Start supplements before mobility becomes severely limited when possible, as prevention and early support can be valuable.

• Choose products designed for pets, as quality, dosing, and ingredient combinations matter.

• Monitor your pet’s comfort, activity level, and mobility changes over time.

Supporting aging joints is about maintaining quality of life and helping pets stay comfortable as they move through different stages of life.

Some cats cannot tolerate oral joint supplements due to allergies, ingredient sensitivities, or difficulty accepting supplements by mouth. For example, some cats may have sensitivities to fish-based products commonly used as sources of omega fatty acids or other joint-support ingredients.

For these patients, injectable polysulfated glycosaminoglycans (PSGAGs) may be an alternative option to discuss with your veterinarian.

PSGAGs work by providing components related to the natural building blocks of cartilage and joint fluid. They may help by:

• Supporting cartilage structure and repair processes.

• Supporting production and quality of synovial (joint) fluid.

• Helping maintain joint health.

• Providing anti-inflammatory effects that may help reduce processes involved in cartilage breakdown.

Products such as Adequan® and Cartrophen® are commonly recognized in veterinary medicine for joint support. While labeled for use in certain species (such as dogs and horses), their use in cats is considered off-label and should only be done under veterinary guidance.

Why consider injectable options?

• Useful for cats that refuse oral supplements.

• Helpful for cats with ingredient sensitivities or allergies.

• Provides an option when owners are concerned about oral ingredients or additional dietary changes.

Every cat is different, and joint support should be tailored to the individual patient, considering their age, mobility, medical conditions, and overall health.

The goal is not just treating arthritis after mobility declines—it is identifying ways to support comfort and quality of life as cats age.

Vitamin B12 is an essential nutrient involved in multiple metabolic pathways in cats. It plays an important role in DNA synthesis, methylation reactions, red blood cell production, neurologic function, and energy metabolism.

Cats cannot synthesize B12 themselves and must obtain it through their diet, primarily from animal-based proteins. Unlike many nutrients, B12 absorption is highly dependent on the gastrointestinal tract and pancreas. The pancreas produces intrinsic factor, a protein required to bind B12 and allow absorption in the ileum (the final section of the small intestine).

When pancreatic function, intestinal health, or absorption is compromised, cats can develop hypocobalaminemia (low B12 levels).

Conditions Where B12 Deficiency Is Commonly Seen

B12 deficiency is frequently associated with:

• Chronic enteropathy or inflammatory bowel disease (IBD)
• Pancreatitis
• Exocrine pancreatic insufficiency (EPI)
• Diabetes mellitus (especially when concurrent gastrointestinal disease is present)
• Malabsorption and maldigestion syndromes

Clinical signs can be varied and may include:

• Weight loss
• Poor appetite
• Vomiting
• Diarrhea
• Poor body condition
• Lethargy
• Neurologic changes (in severe cases)

B12 is also important for enterocyte health (the cells lining the intestinal tract). A deficiency can contribute to impaired intestinal function, creating a cycle where poor absorption leads to further B12 depletion.

B12 as a Metabolic Cofactor

Vitamin B12 acts as a cofactor for two major enzyme systems:

1. Methylmalonyl-CoA Mutase

Requires: Adenosylcobalamin (active B12 form)

Reaction:

Methylmalonyl-CoA → Succinyl-CoA

This pathway is important in:

• Amino acid metabolism
• Odd-chain fatty acid metabolism
• Propionate metabolism

The production of succinyl-CoA connects B12 metabolism to the Krebs (TCA) cycle, where it can be used for cellular energy production.

When B12 is deficient:

• Methylmalonic acid (MMA) accumulates
• Succinyl-CoA production decreases
• Energy metabolism may be impaired

2. Methionine Synthase

Requires: Methylcobalamin (active B12 form)

Reaction:

Homocysteine → Methionine

This pathway supports:

• One-carbon metabolism
• DNA synthesis
• Methylation reactions
• Normal cellular function

Relationship to Major Metabolic Pathways

Pathway	Role of B12
Krebs (TCA) Cycle	Indirectly involved through methylmalonyl-CoA conversion to succinyl-CoA
Gluconeogenesis	Indirectly affected because succinyl-CoA availability can influence glucose production pathways
Urea Cycle	No direct B12-dependent enzyme; effects are indirect through overall protein metabolism
DNA synthesis	Directly supported through methionine synthase activity

Veterinary Importance

Cats with hypocobalaminemia often have:

• Increased methylmalonic acid (MMA)
• Reduced intestinal function
• Poor nutrient absorption
• Progressive weight loss despite adequate nutrition

Supplementing B12 is often considered a low-risk supportive therapy, especially in cats with chronic gastrointestinal disease, pancreatitis, or malabsorption.

Correcting B12 deficiency may help support:

• Intestinal repair
• Appetite and energy metabolism
• Normal cell turnover
• Overall quality of life

Key point: B12 is not a direct cofactor of the urea cycle or the Krebs cycle itself. Its strongest metabolic connection is through methylmalonyl-CoA mutase, which produces succinyl-CoA and links B12 status to the Krebs cycle and energy metabolism.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs provide analgesic (pain-relieving), anti-inflammatory, and antipyretic (fever-reducing) effects by inhibiting cyclooxygenase (COX) enzymes, which are responsible for prostaglandin production.

COX-1 (Constitutive or "Housekeeping" Isoform)

COX-1 is continuously present in most tissues and produces prostaglandins involved in normal physiologic functions, including:

• Protecting the stomach lining by promoting mucus and bicarbonate secretion

• Maintaining normal blood flow to the kidneys

• Supporting platelet function and blood clotting

• Maintaining gastrointestinal integrity

Because COX-1 has these protective roles, inhibition can increase the risk of gastrointestinal ulceration, bleeding, and kidney injury.

COX-2 (Inducible Isoform)

COX-2 is primarily induced in response to tissue injury, inflammation, and pain.

It produces prostaglandins that contribute to:

• Pain (hyperalgesia)

• Inflammation

• Swelling

• Fever

Many veterinary NSAIDs are designed to be relatively COX-2 selective, aiming to reduce inflammation while preserving as much normal COX-1 function as possible.

NSAIDs Have a Ceiling Effect

All NSAIDs exhibit a ceiling effect, meaning there is a maximum dose at which analgesic and anti-inflammatory benefits plateau.

Once this dose is reached:

• Increasing the dose does not provide additional pain relief.

• Instead, it increases the likelihood of adverse effects, particularly:

  • Gastrointestinal irritation, ulcers, or bleeding

  • Kidney injury

  • Liver toxicity (less common but possible with some NSAIDs)

Example

Ibuprofen (Advil®) demonstrates this principle well. After the recommended therapeutic dose is reached, taking additional tablets does not improve pain control. Instead, the excess drug increases the risk of stomach irritation, gastrointestinal ulcers, bleeding, and kidney damage.

The same principle applies to veterinary NSAIDs. Administering more than the prescribed dose will not improve analgesia but significantly increases the risk of serious adverse effects.

Key point: With NSAIDs, more is not better. Once the ceiling effect is reached, additional dosing primarily increases toxicity rather than pain relief.

Cats can be particularly challenging to medicate, especially when medications require frequent dosing. Over time, many cats learn to detect where medications are hidden or recognize the routine, making them less cooperative and increasingly resistant to administration. For this reason, it is important to have alternative administration strategies available, such as flavored compounded formulations, transdermal preparations (when appropriate), liquid formulations, pill pockets, treats, or training techniques. Having a backup plan can improve treatment compliance and reduce stress for both the cat and the owner.

Clinical pearl: Improving owner compliance is often just as important as selecting the right medication. Choosing a formulation that both the cat and owner can manage consistently greatly increases the likelihood of successful long-term treatment. 

Meloxicam provides effective analgesia and anti-inflammatory effects through preferential COX-2 inhibition, but like all NSAIDs, it can still cause gastrointestinal adverse effects, bleeding, and acute kidney injury if protective COX-1 pathways are sufficiently inhibited or if patient risk factors are present.

Body Condition Score (BCS) and Drug Dosing

Accurate assessment of a patient's Body Condition Score (BCS) is essential when determining medication doses. Clinicians should be diligent in estimating a patient's lean body weight (LBW), particularly in overweight or obese animals.

Many medications are dosed based on lean body weight rather than total body weight because excess adipose tissue does not contribute proportionally to the drug's distribution or metabolism. Using actual body weight in obese patients can result in overdosing and increase the risk of adverse effects.

For this reason, veterinarians should:

• Carefully evaluate the patient's Body Condition Score (BCS).
• Estimate an appropriate lean body weight when indicated.
• Calculate drug dosages using lean body weight when recommended for that specific medication.

Clinical pearl: Obesity can significantly affect drug pharmacokinetics. Dosing based on lean body weight helps maximize efficacy while minimizing toxicity.

Note: While many drugs are dosed using lean or ideal body weight in obese patients, not all medications are. Whether to use actual, ideal, or lean body weight depends on the drug's pharmacokinetic properties and veterinary dosing guidelines.

Robenacoxib (Onsior®)

Robenacoxib is a newer-generation NSAID that is more COX-2 selective than many older NSAIDs. Its greater COX-2 selectivity is intended to provide effective analgesia and anti-inflammatory effects while minimizing inhibition of the protective COX-1 enzyme.

One unique characteristic of robenacoxib is its very short plasma half-life. Despite this, it accumulates and persists longer at sites of inflammation, allowing continued therapeutic effects even after plasma concentrations have declined.

Clinical Considerations

• More COX-2 selective than many other veterinary NSAIDs.
• Short plasma half-life, but prolonged residence at inflamed tissues contributes to sustained analgesic and anti-inflammatory effects.
• Approved for short-term pain and inflammation management in cats and dogs, depending on the indication and country-specific labeling.

Renal Safety

Like all NSAIDs, robenacoxib can potentially affect renal perfusion by reducing prostaglandin production, particularly in patients that are:

• Dehydrated
• Hypotensive
• Hypovolemic
• Have pre-existing kidney disease

Although its COX-2 selectivity may offer theoretical advantages, whether it produces fewer renal adverse effects than other NSAIDs has not been conclusively established. Appropriate patient selection, hydration, and monitoring remain essential.

Key point: Robenacoxib is a newer, more COX-2 selective NSAID with a short plasma half-life but sustained activity at inflamed tissues. While its safety profile is favorable, it still carries the same class warnings regarding gastrointestinal and renal adverse effects, and renal safety advantages over other NSAIDs have not been definitively proven.

NSAIDs in Cats with Chronic Kidney Disease (CKD)

Meloxicam and Chronic Kidney Disease: Key Study Findings

A groundbreaking study evaluating long-term meloxicam use in cats with chronic kidney disease (CKD) challenged the assumption that NSAIDs should automatically be avoided in kidney patients.

The study found that, when appropriately dosed and monitored:

• Meloxicam did not accelerate progression of CKD in the studied population.
• Cats receiving meloxicam did not experience worsening kidney disease compared with untreated cats.
• In some measures, the meloxicam group showed slower progression of renal disease, suggesting that appropriate pain control may provide significant overall health benefits.

Clinical Take-Home Message

Pain management is an important component of chronic disease care. When pain is controlled, cats may:

• Eat better
• Maintain better hydration
• Have improved mobility and activity
• Experience improved quality of life

A cat that feels better is often more willing to engage in essential behaviors such as eating and drinking, which are critical in maintaining overall health.

Balancing NSAID Risk vs. Benefit in Kidney Patients

The kidneys require adequate:

• Hydration
• Blood flow
• Nutritional support

A painful cat that is not eating or drinking may experience additional health consequences, including worsening body condition and dehydration.

Therefore, the decision to use an NSAID in a cat with kidney disease involves careful risk-benefit assessment:

The potential renal risk of an NSAID must be weighed against the benefit of improved comfort, appetite, hydration, mobility, and quality of life.

NSAIDs should never be used casually in renal patients, but kidney disease alone does not automatically mean a cat cannot receive appropriate pain management.

Important considerations include:

• Correct dosing
• Patient hydration status
• Baseline kidney values
• Regular monitoring
• Individual patient response

Robenacoxib Studies in Cats

Studies evaluating robenacoxib (Onsior®) in cats with early-stage kidney disease have provided additional information regarding NSAID use.

In cats with IRIS Stage II and III chronic kidney disease, short-term robenacoxib administration (up to approximately 28 days in studied populations) was found to be well tolerated under controlled conditions.

As with all NSAIDs:

• Patient selection is critical.
• Hydration status must be considered.
• Renal monitoring remains important.

Overall Clinical Perspective

The modern approach to NSAID use in cats with kidney disease is not simply “NSAIDs are dangerous” or “NSAIDs are always safe.”

Instead:

The question becomes: Is the expected improvement in comfort, appetite, hydration, and quality of life greater than the potential risk when the medication is used appropriately and monitored?

For many cats, especially those experiencing chronic pain, appropriate analgesia can be an essential part of maintaining health and wellbeing.

NSAID Use and Acute Kidney Injury (AKI) Risk in Cats

When acute kidney injury (AKI) occurs during NSAID therapy, it is generally considered an individual patient response rather than a predictable species-wide reaction.

Not every cat receiving an NSAID will experience renal complications, and it is often difficult to predict exactly which individual patients may be more susceptible. Risk can be influenced by factors such as:

• Hydration status
• Existing kidney function
• Blood pressure and renal perfusion
• Concurrent medications
• Underlying disease processes
• Individual variation in drug metabolism

Because of this unpredictability, NSAID use involves a risk-versus-benefit assessment rather than a simple “safe” or “unsafe” decision.

The conversation with caregivers should include:

• The potential benefits of pain control and improved quality of life
• The possible risks, including gastrointestinal or renal adverse effects
• The importance of monitoring and follow-up testing
• The understanding that rare adverse events may occur despite appropriate use

Ultimately, the decision should be made collaboratively with the caregiver, considering the individual cat’s health status, comfort level, and quality-of-life goals.

Clinical takeaway: NSAIDs are not without risk, but uncontrolled pain also carries significant consequences. The goal is to provide appropriate analgesia while minimizing risk through patient selection, proper dosing, hydration, and monitoring.

Buprenorphine is often the analgesic of choice in cats. It is generally considered a good option for patients with kidney or liver disease when used appropriately and is well tolerated. Unlike in people, clinically significant addiction or dependence is not typically a concern in feline patients receiving buprenorphine for pain management.

One potential downside is constipation. Like other opioid medications, buprenorphine can reduce gastrointestinal motility. However, compared with other opioids, it is generally considered one of the least constipating options.

Pain control remains an important consideration. If a cat experiences pain during defecation, they may avoid passing stool altogether, which can worsen constipation. Therefore, the goal is to balance effective pain relief with the potential risk of decreased colonic motility, while monitoring bowel movements and providing supportive care if needed.

Buprenorphine Dosing in Senior (Geriatric) Cats

Geriatric cats are often more sensitive to the effects of opioid medications, including buprenorphine. As a result, dosing should be approached cautiously using the principle of "start low and titrate as needed."

The typical buprenorphine dose range is 0.005–0.02 mg/kg. However, in geriatric patients, many clinicians begin at the lowest end of the dosing range, often 0.005–0.01 mg/kg, and only increase the dose if adequate pain control is not achieved.

This approach is based on a simple principle: additional medication can always be administered if pain relief is insufficient, but an excessive dose cannot be reversed simply by taking it back once it has been given.

From a caregiver's perspective, excessive opioid dosing may cause senior cats to become excessively sedated, disoriented ("spacey"), or less interactive. These effects can interfere with normal behaviors such as eating, drinking, grooming, mobility, and participation in supportive therapies or recovery. Beginning with a conservative dose helps maintain comfort while minimizing adverse effects, allowing the dose to be adjusted based on the individual cat's response.

Gabapentin (Bunquate®) and Pregabalin for Arthritis Pain in Cats

Gabapentin (marketed in some veterinary formulations as Bunquate®) and pregabalin are commonly used to help manage chronic pain, including pain associated with osteoarthritis in cats.

Both medications work by binding to the α2δ (alpha-2-delta) subunit of voltage-gated calcium channels in the central nervous system. By reducing calcium influx into nerve cells, they decrease the release of excitatory neurotransmitters involved in pain signaling.

Although they do not directly block pain receptors, these medications reduce abnormal nerve transmission and help dampen pain processing within the brain and spinal cord. This makes them particularly useful for neuropathic pain and as part of a multimodal approach to managing chronic arthritis pain.

Key Points

• Gabapentin (Bunquate®) and pregabalin are commonly used adjunctive analgesics for chronic pain in cats.
• Both target the α2δ subunit of voltage-gated calcium channels.
• They decrease the release of excitatory neurotransmitters involved in pain transmission.
• They act on the central nervous system to reduce pain perception rather than directly blocking pain receptors.
• These medications are especially beneficial for neuropathic pain and chronic osteoarthritis when combined with other pain-management strategies.

Gabapentin Dosing in Geriatric Cats and Cats with Chronic Kidney Disease

Gabapentin is generally considered a kidney- and liver-friendly medication and is widely used to manage chronic pain in cats. However, research by Dr. Jessica Quimby has shown that gabapentin clearance is significantly reduced in cats with chronic kidney disease (CKD). Because the drug is eliminated primarily through the kidneys, it remains in the body longer in cats with impaired renal function.

As a result, geriatric cats and cats with CKD require lower doses and/or less frequent administration than younger, healthy cats. A conservative dosing strategy helps reduce the risk of drug accumulation and adverse effects.

For cats with comorbidities, a common starting dose is approximately 3 mg/kg once daily, with adjustments made based on the cat's response and the clinician's assessment. The guiding principle is to start low and titrate gradually additional medication can be given if pain control is inadequate, whereas an excessive dose cannot be immediately reversed.

Excessive gabapentin dosing may cause sedation, ataxia (stumbling), weakness, or incoordination. In geriatric cats, these effects can increase the risk of falls and injury, interfere with normal mobility, and reduce their ability to eat, drink, groom, or participate in recovery and supportive care.

Key Points

• Gabapentin is generally considered safe for the kidneys and liver.

• Cats with CKD clear gabapentin more slowly because it is primarily excreted by the kidneys.

• Geriatric cats and cats with kidney disease typically require lower doses and/or longer dosing intervals.

• A conservative starting dose (e.g., ~3 mg/kg once daily in cats with comorbidities) may be appropriate, with dose adjustments based on the individual patient's response.

• Monitor for sedation, weakness, or ataxia, particularly in senior cats, as these effects may increase the risk of falls and injury.

• Immune-mediated polyarthritis, including diseases similar to rheumatoid arthritis, is very rare in cats. Only a small number of confirmed cases have been reported. In those rare cases, corticosteroids (such as prednisolone) may be indicated because they suppress the abnormal immune response.
• Degenerative joint disease (DJD or osteoarthritis) is not purely "wear and tear." Research suggests that immune cells, particularly macrophages, contribute to the inflammation within affected joints. This inflammatory component can contribute to pain and disease progression.
• Cats tend to develop inflammatory diseases that are dominated by lymphocytes and plasma cells (types of white blood cells involved in immune responses). Examples include:
  • Lymphocytic-plasmacytic inflammatory bowel disease (IBD) affecting the gastrointestinal tract.
  • Lymphocytic-plasmacytic gingivostomatitis, a severe inflammatory disease of the mouth.
• Because many feline inflammatory conditions involve an overactive immune system, corticosteroids are often effective at reducing inflammation and improving the cat's comfort and quality of life. This is why prednisolone is commonly used for conditions such as:
  • Inflammatory bowel disease (IBD)
  • Feline chronic gingivostomatitis
  • Some skin diseases
  • Certain immune-mediated disorders

However, steroids are not routinely used for osteoarthritis alone. Modern pain management for feline DJD typically focuses on:

• Pain medications (when appropriate)
• Weight management
• Environmental modifications
• Joint-support therapies
• In some cats, anti-inflammatory treatment if there is evidence that inflammation is a significant component or another inflammatory disease is present.

The key message is that cats often develop diseases driven by excessive immune activation, particularly involving lymphocytes and plasma cells, so corticosteroids can be very effective in those conditions. In contrast, true rheumatoid-like arthritis is exceptionally uncommon in cats, even though immune cells may still contribute to inflammation in more common conditions like osteoarthritis.

Clinical response should guide therapy as much as laboratory values or published protocols.

Some cats benefit from microdoses of corticosteroids long-term and may never be able to discontinue them completely. In these cases, the goal is to use the lowest effective dose, which may be as little as one dose per week or a few doses per week.

This "microdosing" approach can provide just enough anti-inflammatory effect to keep chronic inflammation under control while minimizing the potential risks associated with higher or more frequent steroid dosing. The emphasis is always on balancing quality of life with medication safety and adjusting treatment based on the individual cat's response.

While this medication can be effective in cats, there are now much better therapeutic options available. Because of its significant potential for misuse and abuse in people, it is generally not considered a preferred option in feline medicine. When safer, more effective alternatives exist, they are typically chosen to provide better patient care while minimizing risks associated with the medication.

Solensia® is a monoclonal antibody that targets nerve growth factor (NGF), a key mediator of osteoarthritis pain in cats. By specifically blocking NGF, it provides targeted pain relief without the broader systemic effects seen with many traditional medications.

Solensia has a half-life of approximately 14 days but is administered once every 30 days (every 4 weeks) to maintain its therapeutic effect.

The medication is available in one vial size only. Larger ("chonky") cats may require 2 mL, which can make the injection less comfortable for some cats and increase the cost for caregivers.

One of the major advantages of monoclonal antibody therapy is that it is highly targeted. This makes it particularly useful for cats with multiple medical conditions (comorbidities) because it generally has few drug interactions and can be used alongside many other medications, including corticosteroids.

For example, a cat receiving steroids for inflammatory bowel disease (IBD) may have limited pain-management options due to potential interactions or cumulative side effects with other drugs. Solensia does not have these limitations, allowing clinicians greater flexibility to "mix and match" therapies for concurrent diseases.

The primary limitation is its duration of action. Solensia provides pain control for approximately one month, so ongoing treatment requires repeat injections every 4 weeks to maintain its benefit.

The most commonly reported adverse effects with Solensia® are mild dermatologic reactions, such as dermatitis or allergic-type skin reactions. In some cats, administering a single dose of dexamethasone on the same day as the Solensia injection has helped control the initial itchiness and skin irritation.

When deciding whether to continue treatment, it is important to weigh the severity of the adverse effect against the benefit of improved mobility and pain control. For example, if the dermatitis is mild but the improvement in joint function and quality of life is substantial, continuing therapy may be the most appropriate option.

Reported adverse reactions can vary between individuals:

• One cat experienced consistent vomiting after each administration, and treatment was discontinued due to concern for a possible hypersensitivity reaction, including the risk of anaphylaxis.
• Another cat appeared very lethargic and "spacey" for approximately the first 24 hours after each injection. Despite this transient effect, the marked improvement in mobility outweighed the temporary adverse reaction, and treatment was continued.
• In some cases, reducing the dose by half has resulted in improved tolerability while still providing clinical benefit.

Solensia has not been withdrawn from the market, and for many cats with severe osteoarthritis, it remains an important treatment option. Some cats with advanced mobility impairment may ultimately require euthanasia if adequate pain control cannot be achieved, making effective analgesia critical to maintaining quality of life.

It is also important to recognize that not all pain presenting as reduced mobility originates from osteoarthritis alone. Cats may have multiple concurrent conditions, and the source of discomfort can sometimes be misidentified. Differential diagnoses include:

• Osteoarthritis or degenerative joint disease
• Chronic widespread pain syndromes (e.g., fibromyalgia-like conditions)
• Abdominal or gastrointestinal pain and inflammation

Other inflammatory or systemic diseases that can alter posture, gait, or willingness to move

A thorough assessment is essential to ensure that the underlying source of pain is identified and treated appropriately, rather than assuming all mobility issues are solely due to arthritis.

No significant adverse reactions have been reported to date.

This therapy is designed to slow the body's normal protein degradation (recycling) pathways, allowing the therapeutic molecule to remain active for a much longer period. As a result, it has a duration of action of approximately 3 months, reducing the frequency of administration compared with monthly therapies.

The medication is available in two vial sizes, making dosing more practical across a range of body weights. This is particularly beneficial for larger ("chonky") cats, as it allows for more appropriate dosing without requiring excessive injection volumes.

Routine follow-up visits with ethically and up to date veterinary practitioners are important for more than just administering treatment they provide valuable opportunities to monitor a cat's overall health.

Regular weight tracking is especially important, as unintentional weight loss is a common and often early sign of disease in cats. Monitoring body weight over time helps clinicians detect changes that may indicate progression of existing conditions or the development of new diseases.

For cats with chronic illnesses such as chronic kidney disease, hyperthyroidism, or diabetes mellitus, maintaining a stable body weight is a positive indicator that these conditions are being well managed. Unexpected weight loss should prompt further investigation.

These routine visits under a thorough and practical clinic also allow the veterinary team to provide additional supportive care, including:

• Nail trimming
• Vitamin B12 (cobalamin) injections, when indicated
• Ongoing assessment of mobility, body condition, and overall quality of life

To date, no concerns regarding rapidly progressive osteoarthritis (RPOA) have been observed in treated patients. Continued monitoring remains important, but current clinical experience has not identified RPOA as a concern in these cases.

Owner reported improved mobility: the cat ascends stairs more quickly with smoother, more fluid movements and exhibits reduced plantigrade stance, consistent with improved hindlimb function and comfort.

A useful analogy is that gabapentin acts like a "glass of wine" after a stressful veterinary visit. It provides mild sedation and anxiolysis, helping cats feel calmer and more comfortable without necessarily treating the underlying medical condition.

Omega-3 Fatty Acids (EPA & DHA) in Cats

According to Plumb's Veterinary Drug Handbook, fish oil supplements are the preferred source of the omega-3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) in cats. These supplements may provide supportive benefits for a variety of conditions, including:

• Reducing inflammation
• Supporting skin and coat health
• Improving joint health and mobility
• Supporting cardiovascular function
• Benefiting kidney health
• Modulating immune function

A commonly recommended starting dose for a 10 lb (4.5 kg) cat is approximately 100–150 mg of combined EPA and DHA daily, although the ideal dose depends on the cat's weight and medical condition.

Administration recommendations:

• Start with a lower dose and gradually increase as tolerated.
• Select products based on their EPA and DHA content, not simply the total amount of fish oil.
• Store supplements properly to minimize oxidation.
• Administer by mixing with food or giving directly by mouth with a syringe or dropper if needed.

Fish oil supplementation is a supportive therapy not a replacement for medical treatment. As with any supplement, it should be used under veterinary guidance and monitored regularly.

Oral vs. Injectable Vitamin B12

When supplementation is needed, injectable vitamin B12 (cobalamin) is often preferred because it is administered only once weekly initially, making it a practical and reliable option for many cats.

Cobalequin® chewable tablets provide an oral alternative and may be appropriate for some patients, particularly those that tolerate oral medications well. However, injectable supplementation is often favored because of the reduced dosing frequency and predictable delivery, especially in cats with gastrointestinal disease where absorption may be impaired.

Diagnosing Osteoarthritis in Cats

History is one of the most valuable diagnostic tools in feline medicine. Caregivers often provide the majority of the information needed to suspect osteoarthritis, even if they cannot identify the condition by name.

Owners should commonly notice/ keep track:

• Drinking or urination changes associated with concurrent disease
• Stiffness after resting
• Reluctance to jump
• Jumping to lower surfaces first
• Missing jumps
• Reduced activity or play
• Difficulty using stairs
• Changes in grooming habits

Listening carefully to the caregiver's observations is a critical part of diagnosing many feline diseases, including osteoarthritis.

Physical Examination

Assessing mobility during a clinic visit can be challenging because many cats mask pain in an unfamiliar environment. The physical examination therefore focuses on subtle findings such as:

• Pelvic tilt or altered posture
• Focal muscle wasting, particularly of the quadriceps
• Sarcopenia (loss of muscle mass)
• Reduced joint range of motion
• Pain on joint manipulation
• Crepitus or joint thickening when present

The diagnosis of feline osteoarthritis is often based on combining a thorough caregiver history with targeted physical examination findings, rather than relying solely on observing the cat walk in the clinic.

Sunken quadriceps = a red flag for chronic mobility issues. Loss of thigh muscle mass (quadriceps atrophy/sarcopenia) often indicates decreased use of the hind limbs due to chronic pain, commonly associated with osteoarthritis in cats. It is an important physical exam clue, especially since cats frequently hide pain.

Physical Exam Clues for Feline Osteoarthritis

Even subtle muscle changes can provide important clues that arthritis or chronic pain may be present.

• Minimal muscle wasting or changes along the spine and hind limbs may indicate decreased activity due to discomfort.
• Cats experiencing chronic joint pain often move less, jump less, and avoid activities that aggravate painful joints, leading to gradual muscle loss (disuse atrophy/sarcopenia).
• Loss of muscle condition can be an early indicator of mobility changes before more obvious lameness is recognized. Assessing Mobility in Cats

When evaluating a cat for osteoarthritis:

• Joint range of motion and gentle flexion/manipulation can provide useful information, but the goal is to assess without causing unnecessary discomfort or injury.
• Cats may mask pain in a clinic environment, making mobility assessment challenging.
• A video recorded by the caregiver at home can be extremely valuable because it shows the cat in a familiar environment:
  • Walking normally
  • Going up or down stairs
  • Jumping on/off furniture
  • Interacting with their surroundings

Owner Homework: Home videos often provide a more accurate picture of daily mobility than a short clinic examination.

Assessing Mobility in Cats

When evaluating a cat for osteoarthritis:

• Joint range of motion and gentle flexion/manipulation can provide useful information, but the goal is to assess without causing unnecessary discomfort or injury.
• Cats may mask pain in a clinic environment, making mobility assessment challenging.
• A video recorded by the caregiver at home can be extremely valuable because it shows the cat in a familiar environment:
  • Walking normally
  • Going up or down stairs
  • Jumping on/off furniture
  • Interacting with their surroundings

Cartrophen® (Pentosan Polysulfate Sodium) Use in Cats

Cartrophen is sometimes used off-label in cats as part of a multimodal approach for osteoarthritis management.

A commonly used protocol:

• 0.03 mL/kg
• Once weekly for 4 weeks (loading phase)
• Then approximately once monthly for maintenance

Adequan® (Polysulfated Glycosaminoglycan)

Another injectable joint-support therapy used in some feline osteoarthritis protocols:

• 0.05 mL/kg

Both Cartrophen and Adequan are considered disease-modifying osteoarthritis therapies, aiming to support joint health rather than simply masking pain. They are often incorporated alongside other approaches such as weight management, environmental modification, supplements, and analgesic therapies when needed.

Two antibody therapies for cats and dogs living with arthritis. Built on the success

Of Librela and Solensia

Highly targeted - they can help reduce the use of off-target side effects and they are not metabolized by the liver and the kidneys like traditional small  molecule drugs are.

Rather they are broken down by protein degradation pathways which is a great option for

Geriatric pets who may have some organ compromise.

Engineered longer acting= less frequent administration which eases burden on pet owner and pet.

 

Less missed doses = Improves outcomes as well.

Monoclonal antibodies target nerve growth factor.

Nerve growth factor is released from damaged tissues when osteoarthritis is

Released from the damaged cartilage as well as from the subchrondal bone. Iut is a key mediator when it comes to inflammation as well as pain in osteo arthritis.

 

When using monoclonal antibody therapies to target nerve growth factor, the therapeutic goal

Is to reduce that elevated level of NGF- Nerve Growth Factor that is found in the arthritic joit back down to more normal, so lower levels= alleviate arthritis

Monoclonal antibody that targets NGF to provide 3 months of alleviation of pain for feline arthritis, targets nerve-growth factor, but it's unique antibody. Provides a feline-friendly approach to increase mobility and quality of life for those cats experiencing arthritis pain.