Can I use prednisolone in chronic arthritis?

RE: Can I use prednisolone in chronic arthritis?

Stephen Courtney — Wed, 16 Sep 2020 15:20:12 GMT

We use a lot of multimodal pain relief - so not uncommon to have a dog on NSAID ( whatever flavour) plus paracetamol plus gabapentin, plus amantadine, and sometimes though its. last choice for me these days, tramadol.

Amantadine has been conspicuously helpful as an add on, especially in dogs that can't tolerate NSAIDs

And to answer the original question, I used to mix prednisolone and NSAIDs occasionally after discussing issues with the client, years ago - like 20-25! haven't done it for ages but the comments above remind me that corticosteroids have their place especially in end stage disease where there is nothing to lose

RE: Can I use prednisolone in chronic arthritis?

Arlo Guthrie — Mon, 07 Sep 2020 07:38:52 GMT

[quote userid="6897" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/29332/can-i-use-prednisolone-in-chronic-arthritis/225286#225286"]

Malcolm Ness said:
The apparent efficacy of many drugs and more fanciful therapies in OA is a consequence of this episodic flaring of OA. New treatments are most often instigated in response to one of these flares and when the flare-up settles (as it was destined so to do) a success is claimed for the therapy. There is no reason why that won't happen with pred.

As someone who has suffered greatly with OA myself, I fully concur with Malcolm's comments. Makes it virtually impossible to assess the genuine efficacy of therapy given at the time of a flare up when natural regression is more than likely going to occur anyway - in my case just by resting the affected joint(s) for a few days.

Always made me dubious about claims re efficacy of the likes of Cartrophen.

[/quote]

I was reading this and thinking ... 'yeah, you could say EXACTLY the same about epilepsy treatments'.

Come to think of it, you could say exactly the same about homeopathy and the ailments that millions of people think it is effective for. In fact, whenever someone presents me with the argument that 'lots of people say that drug x worked', my stock reply is: 'yeah, they said that about homeopathy too'.

It's also something I think is quite dangerous about Facebook - that it is a feeding ground for anecdote. Whilst I appreciate that in some cases, anecdote is all there is, Facebook seems to actively select for it!

RE: Can I use prednisolone in chronic arthritis?

Julian Earl — Sun, 06 Sep 2020 20:48:29 GMT

Have many people used intra-articular steroids for degenerative arthritis? The medics seem to like this eg for knees, shoulders and maybe other joints. But what abut in dogs? If the articular cartilage is eroded how do steroids help? Intra-articular local anaesthetic would probably n be more beneficial in the very short term at least?

I have had a combined steroid/lignocaine into my shoulders a couple of times for rotator cuff syndrome which is really a tendinitis within the joint I believe and it has been extremely effective working for months in fact!

In particular...

Would it be a suitable approach for a ruptured cruciate when surgery might not be possible? Simply to alleviate inflammation in the torn ligament and possibly help the resultant arthritic degeneration in the joint?

Thanks for your views on this.

RE: Can I use prednisolone in chronic arthritis?

bob lehner — Sun, 06 Sep 2020 13:30:30 GMT

[quote userid="3607" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/29332/can-i-use-prednisolone-in-chronic-arthritis/225266#225266"]The apparent efficacy of many drugs and more fanciful therapies in OA is a consequence of this episodic flaring of OA. New treatments are most often instigated in response to one of these flares and when the flare-up settles (as it was destined so to do) a success is claimed for the therapy. There is no reason why that won't happen with pred.[/quote]

Always made me dubious about claims re efficacy of the likes of Cartrophen.

RE: Can I use prednisolone in chronic arthritis?

Malcolm Ness — Sun, 06 Sep 2020 10:21:54 GMT

[quote userid="2235" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/29332/can-i-use-prednisolone-in-chronic-arthritis/225273#225273"]Any thoughts on PRP injections[/quote]

PRP and with other forms of regenerative medicine have been shown to be effective in selected conditions in certain species. Bolstered by that documented success, its use has exploded and expanded into species and conditions where the benefits lie somewhere between speculative and unproven. PRP is not something that I have used, simply because I am yet to see any half-convincing evidence of its efficacy in OA in client-owned dogs. It has become massively popular as an easy add-on 'profit-centre' with many clinicians/salespeople eager to share their anecdotes. Bear in mind that much of the use is in cases of chronic OA that have presented because of a recent flare-up and most of those cases are destined to improve in spite of whatever therapy is sold.

Aside from that reason, I have a fundamental problem with the 'underpinning theory' which relies heavily, far too heavily, on the assumption that failures of cartilage biochemistry are the main problem in OA. There is more, very much more to OA in dogs than failing cartilage chemistry and it is notable, for example, that a near universal feature of arthritic joints in dogs is the proliferation of osteophytes which are bony protuberances covered with newly formed and usually pristine articular cartilage. Consequently, the implication that arthritic joints cannot make cartilage is spurious and even if true in any part, the suggestion that any deficiency can be remedied by injecting the stimulatory goodness of a range of cartilage stimulating factors assumed to be present in an indeterminate dose of platelet rich plasma seems, to me far-fetched, if not completely wrong-headed. Still, as I indicated earlier, PRP has many advocate and its popularity can be expected to remain until another, more profitable therapy comes along.

RE: Can I use prednisolone in chronic arthritis?

Rob Davis — Sat, 05 Sep 2020 08:37:13 GMT

[quote userid="3607" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/29332/can-i-use-prednisolone-in-chronic-arthritis/225266#225266"]The problem is that despite the bravado of some surgeons and the extensive range of therapeutics available to us, we simply do not have a good response for these knackered elbows.[/quote]

Any thoughts on PRP injections, or are they in the category of "Daily massages with Ginseng and Camels' Piss"?

RE: Can I use prednisolone in chronic arthritis?

Malcolm Ness — Fri, 04 Sep 2020 14:15:13 GMT

[quote userid="8958" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/29332/can-i-use-prednisolone-in-chronic-arthritis"]wherever Malcolm is lurking[/quote]

I have been lurking up some hills in Northumberland, enjoying the last bits of summer.

[quote userid="8958" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/29332/can-i-use-prednisolone-in-chronic-arthritis"] 'Can we try preds as I had these from my doctor and seemed to do wonders.'[/quote]

The answer to this question is clearly, "Yes, you can". A better question would be, "Is it a good idea to use preds?" That one is more difficult to answer.

I very rarely use preds in OA for the simple reason that I have not found them to be useful. Added to that, their unwanted effects of weight loss and ultimately muscle-weakening will worsen an OA case. I am totally unpersuaded by the anecdotes of 'I used them and the dog did good". We hear this all the time about remedies from the latest NSAID, through acupuncture, herbalism, homeopathy, crystal therapy, Reike, Tramadol and up to laser therapy or daily massages with Ginseng and Camels' Piss.

While OA probably did play a major part in the pathogenesis of this dogs elbows, it sounds like the current problems are pain, restricted joint motion, stiffness and disability - these are end-stage elbows. I note that you say the dog "has had" a range of drugs. From that, I infer that it is not currently on medication and the number of different drugs tried make me wonder whether any has been used for an appropriately long time or with a realistic expectation of outcome. These dogs can usually be kept comfortable and reasonably happy, but never returned to being athletes.

I would use a long course of NSAID - 3 months or so initially - during which time the dog's weight is reduced to something like 'quite skinny'. (In my experience, almost all middle-aged arthritic dogs are overweight) Gentle, frequent activity should be encouraged. After three months, stop the medication but be ready to start another lengthy course at the first or second sign of any relapse.

Occasional 'flares' are to be expected in these chronic OA cases and these can usually be controlled with the addition of Paracetamol or perhaps opiates/gabapentin etc though these have become drugs of therapeutic abuse by clinicians who use the phrase, "We could try .... " more often than they should. The apparent efficacy of many drugs and more fanciful therapies in OA is a consequence of this episodic flaring of OA. New treatments are most often instigated in response to one of these flares and when the flare-up settles (as it was destined so to do) a success is claimed for the therapy. There is no reason why that won't happen with pred.

For genuine end-stage elbows, I see no hurt in experimenting with the addition of Pred though I can't see it appropriate to use it as an alternative to NSAIDs with proven pain control effects. My problem comes with how a case is determined to be 'end-stage'. Certainly, we saw many cases classified as such that we were able to manage effectively for prolonged periods.

Joyce raised the question of total elbow replacement (TER). Currently, there is no good TER system available. None of the cemented systems have been shown to be useful and there are fundamental reasons to avoid their use. The Biomedtrix company developed a cement less TER system (TATE elbow) over ten years ago. Although some very good outcomes were achieved by a few surgeons, the surgery was very demanding technically (if hip replacement is 5/10 difficult, then TATE is 9/10). For most surgeons, the technical complexity of the TATE procedure was too much and high complication/failure rates were seen and the procedure has fallen from favour.

The problem is that despite the bravado of some surgeons and the extensive range of therapeutics available to us, we simply do not have a good response for these knackered elbows.

RE: Can I use prednisolone in chronic arthritis?

Andreas Ege — Fri, 04 Sep 2020 00:15:20 GMT

Used to use steroids, mainly depo medrone or predni tablets quite frequently about 11-12 years back, for arthritis if metacam or carprophen didn't do "the trick". A lot of vets in Germany at the time did. Often bought quite a bit more time, though I couldn't tell you how much, but I'd think in average a few months.

Certainly would try, even in combination with nsaid, if the alternative is euthanasia. After all, what has the animal to loose? (I know, it's not a cat, but no cat should die without steroids ;-) )

Another, possibly additional, option is acupuncture.

RE: Can I use prednisolone in chronic arthritis?

Michael Woodhouse — Thu, 03 Sep 2020 18:02:45 GMT

Yes, I've also used preds for arthritis with good success. Sometimes with paracetamol. Sometimes (shock horror) with NSAIDs with off licence consent from owner.

I would try NSAID + paracetamol first (at Pardale dose). Have used it for years.

Found steroids also work very well for cats and would have used them first line for arthritis before cat meloxicam came along.....

RE: Can I use prednisolone in chronic arthritis?

Chris Barker — Thu, 03 Sep 2020 17:53:37 GMT

I have often used Pred as a treatment of last resort when nsaids have become ineffective and euthanasia looms. Consistently I have found it to give a minimum of 2-3 months of relief/increased mobility, often far longer, with all the requisite warnings being given to the owner ( final throw of dice, once started cannot retreat from course of treatment, not a pain killer but a true anti-inflammatory, etc etc) Even for the animals with gross joint deformity I would undoubtedly give it a go.

RE: Can I use prednisolone in chronic arthritis?

Tomas Hansen — Thu, 03 Sep 2020 16:22:01 GMT

No orthopaedic either... It might be too late for him, for Gabapentin to work, otherwise I see a lot of chronic OA patients improve when Gaba is added to a NSAID, starting at 10-20 mg/kg divided in 2-3 doses, then increased in steps according to effect. In any case it can help determine how much neuropathic pain is at play as part of the total pain response, which can be very hard to evaluate otherwise. But again, if the amount of joint damage is too severe, you're gonna need the 'heavier' stuff, like you already consider..

RE: Can I use prednisolone in chronic arthritis?

Bob Russell — Thu, 03 Sep 2020 16:02:05 GMT

Sadly no sign of it returning to the market as far as I am aware.

Bloody wonderful drug!

RE: Can I use prednisolone in chronic arthritis?

bob lehner — Thu, 03 Sep 2020 15:12:03 GMT

PLT often seemed to work well back in the dark ages befoe NSAIDS were invented - not sure if it's still available:

Prednisolone 1mg, Cinchophen 200mg

RE: Can I use prednisolone in chronic arthritis?

Joyce Whitehead — Thu, 03 Sep 2020 13:22:58 GMT

I’m definitely not an expert, and also not Malcolm, but anecdote alert, we have a Labrador of similar age with terrible elbows, not responsive to any great extent to any nsaid we tried, even with added Pardale. So as a trial we started prednisolone, and he is fantastic on 5mg daily (started on 10mg daily then reduced).

Another very elderly lab with even worse elbows, that tolerated no nsaid at all (vomited) we gave depomedrone once the paracetomol and gaba were not sufficient.

Neither were surgery candidates for financial reasons. On this note, if we get Malcolm on here, what is the state of play with elbow replacement these days? I remember when they were first done they had quite a high failure rate, and there isn’t a salvage procedure.

RE: Use of prednisolone in chronic arthritis

Neil Wheadon — Thu, 03 Sep 2020 11:05:48 GMT

You're the boss, so carry on

Neil

RE: Use of prednisolone in chronic arthritis

Arlo Guthrie — Thu, 03 Sep 2020 11:03:25 GMT

Neil Wheadon Nothing to stop you posting in both. They appear on different lists. Or posting in the expert forum, then opening it up for discussion after. Either way, though, you may have missed my earlier post about trying to frame forum titles as questions in order to get maximum response. In this case, would it be ok for me to change it to:

Can I use prednisolone in chronic arthritis?