Arthritis (Osteoarthritis or Degenerative Joint Disease)

Overview

• Since many CKD cats are older, they may also suffer from arthritis.
• This page discusses how best to treat this in a CKD cat.

What Is Arthritis?

There are a number of forms of arthritis but the type of arthritis discussed here is osteoarthritis, which is one form of degenerative joint disease (DJD).

Arthritis is inflammation of a joint. In a cat with osteoarthritis, the cartilage within the joint thins and becomes scarred. Cartilage is supposed to cushion joints, but when it breaks down bones can rub together (which they are not designed to do), leading to pain, swelling and restricted movement. New bone spurs may also form and inflame the nerves, causing additional pain.

Painkillers may help block the pain caused by osteoarthritis but do not help with the breakdown of cartilage which causes the problem in the first place.

Inflammation is also caused by the damaged cartilage releasing messengers, one of which is nerve growth factor (NGF). NGF sensitises the nerve endings so they become ever more sensitive to pain. One goal of treatment therefore is to block NGF. Zoetis explains more about this. The role of NGF and how to control it is the basis for a new arthritis treatment for cats, released in Europe in 2021 and due for release in the USA in 2022, called frunevetmab (Solensia)

International Cat Care has a good overview of arthritis.

Frequency

Arthritis is common in cats so it is quite likely that you will be faced with this at some point. It can start at a relatively early age. Cross-sectional study of the prevalence and clinical features of osteoarthritis in 100 cats (2010) Slingerland LI, Hazewinkel HA, Meij BP, Picavet P & Voorhout G Veterinary Journal 187(3) pp304-9 looked at 100 cats over the age of six and found that 61% of them had osteoarthritis in at least one joint.

It is even more common in older cats. Feline degenerative joint disease (2010) Lascelles B Veterinary Surgery 39 pp2-13 found that more than 90% of cats over the age of 12 appear to have some form of degenerative joint disease.

Associations between early neutering, obesity, outdoor access, trauma and feline degenerative joint disease  (2021) Maniaki  E, Murrell J, Langley-Hobbs SJ & Blackwell EJ Journal of Feline Medicine and Surgery 23(10) pp965-975 found that obesity, outdoor access and trauma appeared to increase the risk of cats developing signs of arthritis-related mobility changes by the age of six, whereas neutering before six months of age appeared to reduce the risk.

Arthritis and CKD

There appears to be a correlation between arthritis and CKD, even in younger cats. Prevalence and classification of chronic kidney disease in cats randomly selected from four age groups and in cats recruited for degenerative joint disease studies (2014)  Marino CL, Lascelles BD, Vaden SL, Gruen ME & Marks SL Journal of Feline Medicine and Surgery 16(6) pp465-71 looked at cats at a feline-only practice in the USA and states “We found significant concurrence between CKD and DJD in cats of all ages, indicating the need for increased screening for CKD when selecting DJD treatments. Additionally, this study offers the idea of a relationship and causal commonality between CKD and DJD owing to the striking concurrence across age groups and life stages.”

IRIS stage influences pain level in cats with degenerative joint disease (DJD) (2019) Chiu K, Gruen M, Marino C et al. Veterinary Surgery 48 p1101 found that cats with both CKD and arthritis had more severe joint pain than cats with arthritis but without CKD.

Associations between early neutering, obesity, outdoor access, trauma and feline degenerative joint disease (2021) Maniaki  E, Murrell J, Langley-Hobbs SJ & Blackwell EJ Journal of Feline Medicine and Surgery 23(10) pp965-975 states “An association between the severity of dental disease – another chronic inflammatory process associated with age – and the development of CKD has also been suggested. These associations may support the concept of a common pathway linking chronic inflammatory processes such as dental disease, CKD and DJD.”

Therefore when your cat is diagnosed with CKD, it is worth considering whether arthritis may also be present, because the symptoms of arthritis are not always obvious.

Symptoms

The symptoms of arthritis in cats can be quite subtle, and since they may also come on gradually, you may not immediately realise that there is a problem. It does not help that cats instinctively try to hide pain.

You may notice that your cat no longer jumps, and then later that s/he is struggling with stairs. When getting out of bed after a nap, your cat may move more stiffly at first, and then appear to loosen up. Symptoms may worsen in cold weather.

Some cats play less, and some become a bit grumpy. Occasionally cats with arthritis exhibit inappropriate elimination, perhaps because the litter tray is upstairs and difficult to reach, or because it is too high to climb into with ease.

Evaluating aging in cats: how to determine what is healthy and what is disease (2016) Bellows J, Center S, Daristotle L, Estrada AH, Flickinger EA, Horwitz DF, Lascelles BDX, Lepine A, Perea S, Scherk M and Shoveller AK Journal of Feline Medicine and Surgery 18 pp551–570 mentions that “detectable loss of muscle mass” may be a sign of arthritis.

Recognising and managing degenerative joint disease in cats (2013) Galloway P Presentation to the World Small Animal Veterinary Association World Congress discusses the problems of recognising and diagnosing arthritis in cats.

Development of a checklist for the detection of degenerative joint disease-associated pain in cats (2020) Enomoto M, Lascelles BDX & Gruen ME Journal of Feline Medicine and Surgery 22(12) pp1137-1147 outlines the development of a checklist for detecting arthritic pain. A version of the checklist is provided by Zoetis.

Refinement of the feline muskuloskeletal pain index (FMPI) and development of the short-form FMPI  (2022) Enomoto M, Lascelles BDX, Robertson JB & Gruen ME Journal of Feline Medicine and Surgery 24(2) pp142-151 refined and enhanced the checklist. The nine items are: jump up; kitchen counter; jump down; toys; other pets;get up; sit down; stretch and groom.

Zoetis has a number of articles on detecting pain.

There is more information on possible symptoms of pain here.

Diagnosis

There is no standard test for osteoarthritis. Your vet will often gently palpate and manipulate the major joints, but since arthritis often occurs bilaterally (on both sides of the body), there is usually no healthy joint with which to compare. Therefore your vet may diagnose arthritis based on a description of your cat’s behaviour and a physical examination. Recording your cat walking at home may assist your vet with the diagnosis, as will completing the checklists mentioned under Symptoms. Sometimes x-rays will be performed, but these may not always show that there is a problem. Blood tests are not normally required.

Since arthritis is difficult to diagnose. your vet may suggest a treatment trial to see if your cat improves following treatment, especially if the checklists above support the likelihood of arthritis being present.

Exploring degenerative joint disease pain and hypersensitivity in cats (2020) Winn Feline Foundation reports on reasearch funded by Winn that has found that artemin, a neurotrophic factor, is much higher in the blood of cats with arthritis, and states “This finding was so striking, that they may have identified a useful biomarker of DJD pain in cats, which would be very helpful given how difficult it is to diagnose chronic pain in cats.”

Treatments Overview

It is not possible to cure arthritis, so treatments focus on managing the pain and inflammation and increasing mobility. The main choices are environmental changes, dietary changes, dietary supplements, physical therapy and medications. One new medication is frunevetmab (Solensia), which was approved in Europe in 2021 and in the USA in 2022.

Chronic pain in cats with degenerative joint disease (2013) Robertson SA Clinician’s Brief Sept 2013 has a good overview of possible treatment options for arthritis in cats.

Feline arthritis management (2014) Langley-Hobbs SJ Feline Update Online (University of Bristol Feline Centre) has helpful information.

Mar Vista Vet has some information on the types of treatment available.

Environmental Changes

Litter trays

You will need to consider the location of your cat’s litter trays. It is unkind to expect a stiff and achy cat to climb lots of stairs to reach the tray. Occasionally cats with arthritis exhibit inappropriate elimination, which may be because they cannot walk or climb to the tray quickly enough. Try to have a tray on each level of your home and close to where your cat likes to spend time.

You also need to consider the litter tray entry. Cats with arthritis may find the lip is now too high to climb over with ease. You can buy litter trays with low entry, or cut a piece out of your cat’s existing tray. Amazon sell a potting tray that might be suitable for small cats.

Minimising Effort

It can help keep your cat safer and more comfortable if you reduce the amount of effort needed for other basic tasks, e.g. by placing food and water sources in more than one location, and providing steps up to favoured sleeping areas. See Anaemia for more information.

Exercise

Although you want to reduce the risk of falls, keeping active (within the cat’s limitations) can help loosen the joints, increase mobility and reduce pain. If your cat goes outdoors, encourage him/her to continue to do so. If your cat is an indoor cat, you could consider taking him/her outside on a harness (some cats enjoy this) or introduce various indoor activities and toys that require stretching and mobility.

Heat Pads

Heat pads are a good idea for arthritic cats, particularly in cold or damp weather. See Anaemia for more information and sources.

Diet and Weight

Weight Management

Weight management is important for arthritic cats because surplus weight puts additional strain on the joints; but this is unlikely to be a problem for most CKD cats.

Therapeutic Diets

Hill’s k/d + Mobility and Royal Canin Mobility Support JS foods are therapeutic veterinary diets designed to help cats with arthritis, and, in the case of the Hill’s foods, also to help with kidney disease. These foods contain glucosamine and chondroitin (see below), increased levels of essential fatty acids, and are designed to help with weight control so as to reduce stress on the joints. The Hill’s canned contains 0.48% phosphorus and 29.60% protein on a dry matter analysis basis,  and the Hill’s dry contains 0.50% phosphorus and 28.9% protein.

Evaluation of a therapeutic diet for feline degenerative joint disease (2010) Lascelles BD, DePuy V, Thomson A, Hansen B, Marcellin-Little DJ, Biourge V & Bauer JE Journal of Veterinary Internal Medicine 24(3) pp487-95 assessed the effects of an earlier therapeutic diet (Hill’s j/d food). The study concludes “A diet high in EPA and DHA and supplemented with green-lipped mussel extract and glucosamine/chondroitin sulfate improved objective measures of mobility. Dietary modulation might be 1 method to use to improve mobility in cats with DJD-associated pain.”

Some members of Tanya’s CKD Support Group have used these foods and found them helpful, though one member’s cat lost weight (probably because these foods are optimised for weight control). One possible compromise would be to use a therapeutic kidney diet in conjunction with a diet designed to help with arthritis.

Dietary Supplements

There is a wide range of supplements available for cats with arthritis. Many people find these help their cats, particularly cats with early stage arthritis, but you will probably have to experiment to find which product works best for your cat, and keep in mind that these products can take 4-8 weeks before you see an effect.

There are some products available which contain more than one of these supplements, e.g. a product may contain both glucosamine and chondroitin and hyaluronic acid.

Chondroprotective agents: do they work? (2010) Maxwell LK DVM360 CVC in San Diego Proceedings has a good overview of the various supplements.

Many of these products should not be given to cats who are taking blood thinners.

Glucosamine and Chondroitin (e.g. Cosequin, Dasuquin)

Glucosamine sulfate is used by the body to create cartilage, but the ability to do this reduces with age. PennState Hershey has information on glucosamine.

Chondroitin sulfate is one of the components of cartilage. PennState Hershey has information on chondroitin.

Veterinary Partner also has some information.

Products containing glucosamine and chondroitin (often obtained from shellfish) have been shown in humans to help the body form new cartilage, and it is thought they may also have some anti-inflammatory effects. There is little research into the use of these products in cats, but some people find they do seem to help their cats, and the products are very safe, so I think they are worth a try. I used them in Harpsie and they did seem to help him.

These products do take some time to work, normally you have to give them for at least two months before you can expect to see any positive effects. It is also common to give a loading dose and then reduce the dose of frequency.

A common starting dose for cats is 125mg of glucosamine and 100mg of chondroitin per day. If this does not seem to be helping after eight weeks, you can increase the dose to 250mg of glucosamine & 200mg of chondroitin a day.

Many members of Tanya’s CKD Support Group use glucosamine and chondroitin products, and many find them helpful, either alone or in conjunction with other treatments.

Treatments containing glucosamine and chondroitin are usually safe for CKD cats, but as always, talk to your vet before using them. Chronic tubulointerstitial nephropathy induced by glucosamine: a case report and literature review (2016) Gueye S, Saint-Cricq M, Coulibaly M, Goumri N, Guilbeau-Frugier C, Quentin H, Ged E, Sidi Aly A & Rostaing L Clinical Nephrology 86(2) pp106-10 reports on a human case where the patient developed renal insufficiency and reduced GFR after taking glucosamine for three years. Stopping the glucosamine improved GFR. The study concludes “glucosamine was shown to cause renal toxicity. Referring to other reported cases, we conclude that toxicity is rare but may also be underreported.”

Early research indicated that glucosamine might cause elevated blood sugar and elevated blood pressure in humans. Glucosamine sulfate (2016) US National Library of Medicine discusses glucosamine sulfate. It says (with regard to humans) “Glucosamine appears to be safe for most people with diabetes, but blood sugar should be monitored closely. Early research suggests that glucosamine sulfate can increase insulin levels. This might cause blood pressure to increase. However, more reliable research suggests that glucosamine sulfate does not increase blood pressure. To be cautious, if you take glucosamine sulfate and have high blood pressure, monitor your blood pressure closely.”

There are countless products available containing glucosamine and chondroitin but I will briefly mention two here because they are veterinary products that are available in many countries throughout the world.

Cosequin

Cosequin is a product made for cats that contains glucosamine and chondroitin. There are several formulations available:

• Cosequin for Cats is available in capsules containing glucosamine 125mg and chondroitin 100mg, plus manganese. The recommended dose is one capsule a day for cats under 10 lbs (4.5kg) or two capsules a day for cats over that weight, for 4-6 weeks, then every other day. The capsules can be sprinkled on the cat’s food.
• Cosequin For Cats Maximum Strength contains the same amount of glucosamine, chondroitin and manganese as the other two products, so I have no idea where the “maximum strength” comes from. It can also be sprinkled on the cat’s food.
• Cosequin Maximum Strength Plus Boswellia contains the same amount of glucosamine and chondroitin, but also contains boswellia 10mg, an anti-inflammatory herbal extract. Healthline has some information about boswellia.

Cosequin is widely available from vets and online.

The most common side effect according to the manufacturer is gastrointestinal upsets, though this is rare.

Dasuquin

Dasuquin is a similar product to Cosequin (it is made by the same company) but it has an additional ingredient which is said to make the formula more effective. The ingredient is ASU, or avocado/soybean unsaponifiables 25mg and green tea extract.

• Dasuquin for cats is available in sprinkle capsules containing glucosamine 125mg and chondroitin 100mg and avocado/soybean unsaponifiables (ASU) 25mg. The recommended dose is one capsule a day for cats under 10 lbs (4.5kg) or two capsules a day for cats over that weight, for 4-6 weeks, then every other day.
• Dasuquin Advanced for cats is also available in sprinkle capsules containing glucosamine 125mg and chondroitin 100mg, but also contains a mix of avocado/soybean unsaponifiables (ASU), boswellia and green tea extract 28mg, and manganese. The recommended dose is one capsule a day for cats under 10 lbs (4.5kg) or two capsules a day for cats over that weight, for 4-6 weeks, then every other day.

Dasuquin is widely available from vets and online.

In Joint health: a roundtable discussion (sponsored By Nutramax Laboratories) (2010) Canapp SO, Millis DL, Lascelles DX, Juillerat DK & Fox D DVM360, Dr Lascelles (a feline pain specialist) says “Certainly there is one combination (glucosamine/chondroitin sulfate and avocado/soy unsaponifiables) that I’ve seen clinically make a big difference in cats.”

Evaluation of a nutritional supplement for the alleviation of pain associated with feline degenerative joint disease: a prospective, randomized, stratified, double-blind, placebo-controlled clinical trial (2021) Cunningham R, Gruen ME, Thomson A & Lascelles BDX Journal of Veterinary Internal  Medicine OnlineFirst Nov 2021 looked at the effectiveness of Dasuquin in arthritic cats, including some cats in Stages 1 or 2 CKD. The study found that more improvement appeared to be present in the cats given the placebo, though older cats receiving Dasuquin did show increased activity whilst on the supplement. The trial only lasted eight weeks and improvement may have been seen in the cats taking Dasuquin over a longer period. Two cats taking Dasuquin left the study because of problems giving the medication and vomiting.

There is also some debate as to whether avocado is safe for cats. Avocados contain a toxin known as persin. The Pet Poison Helpline says it is “likely” not poisonous to cats. Apparently the ASU used in Dasuquin is only one third avocado oil.

Synoquin

In the UK, you may be offered Synoquin. This contains higher amounts of glucosamine (225mg) and chondroitin (175mg) than Cosequin but also contains vitamin C, which is not normally recommended for CKD cats.

YuMOVE

YuMOVE is a product that is popular with British members of Tanya’s CKD Support Group. It contains 150mg glucosamine, but also contains 0.75mg hyaluronic acid, 1000mg green lipped mussel, 1.5mg manganese and 1mg vitamin E. It is phosphorus and vitamin C free. It is available in capsules containing a powder, so you can open the capsules and mix the powder with food if you wish.

VioVet sells 60 sprinkle capsules for £16.49.

Green Lipped Mussel (e.g. Moxxor, GlycoFlex)

Green lipped mussel is one source of chondroitin which some people think is more effective than other sources.

Moxxor

Moxxor is a product made from green lipped mussels, kiwifruit oil and grape seeds. I’m not convinced cats require the latter two ingredients.

You can buy Moxxor here. It costs US$29.99 for one bottle containing 30 capsules (the usual dose is one capsule daily), and five bottles cost US$27 each, plus shipping. If you are in Europe, it will be shipped from the USA, so you will be liable for import fees and VAT.

This product seems to be well liked on Tanya’s CKD Support Group. The capsules are small and easy to give to cats.

GlycoFlex

GlycoFlex is a range of supplements made by VetriScience which contain green-lipped mussel and glucosamine. They are available in chew form, though the chews can also be crumbled over food if preferred.

GlycoFlex Stage 2 contains 300mg of green-lipped mussel, 250mg of glucosamine and manganese. The usual dose is two chews per 10lbs (4.5kg) of cat per day for 4-6 weeks, then one chew daily.

GlycoFlex Stage 3 contains 300mg of green-lipped mussel and 250mg of glucosamine, together with 2.5mg of grape seed extract. It also contains vitamin C, which is not normally recommended for CKD cats.

Hyaluronic Acid (e.g. Hyaflex)

Hyaluronic acid in the form of hyaluronate sodium is sometimes injected into arthritic joints in humans. Some people choose to give oral supplements to their arthritic cats, though it is debatable how easily hyaluronic acid in this form can be absorbed.

HyaFlex

HyaFlex for Cats is a liquid form of hyaluronic acid which claims to be high in molecular weight so the body can use it more efficiently. A commonly used dose for cats is 1ml daily, which can be syringed into the cat’s mouth or mixed with food or baby food. I am told it has a slightly salty taste.

Pentosan (Cartrophen)

Pentosan polysulfate sodium is used to treat some cats with feline lower urinary tract disease. It works by repairing the lining of the bladder which is made of glycosaminoglycan (also known as the GAG layer). Since cartilage is also made of glycosaminoglycan, it is though that pentosan may also help some cats with arthritis.

Veterinary Partner has a good overview of pentosan.

Cartrophen Vet is one brand which is marketed for dogs and horses but used off-label for cats. It is usually given via subcutaneous injection once a week for four weeks (the usual dose for cats is 3 mg per kg body weight), and then given again as needed every 3-6 months. It is available in the UK, New Zealand, Australia and Canada, but is not available in the USA, although compounding pharmacies such as Wedgewood Pharmacy can compound pentosan in cat-sized doses. Vio Vet in the UK sells it.

Pentosan 100 is another brand which is available in Australia. It contains 100mg of pentosan per ml.

I have had mixed reports about pentosan. Some people think it helps their arthritic cats, others think it has made no difference, or has caused side effects such as vomiting.

Cartrophen Vet – a disease-modifying osteoarthritis drug (2006) Biopharm Australia Pty Ltd explains more about the medication.

Adequan

Adequan, or polysulfated glycosaminoglycan, is an injectable form of chondroitin which helps repair the damaged GAG layer. It is also anti-inflammatory. Like pentosan, it is also used for feline lower urinary tract disease.

Adequan is a prescription treatment approved for dogs but used off-label for cats.

Pet Place states “For cats, the dose is 0.5 mg to 2.5 mg per pound (1 to 5 mg/kg) in the muscle every 4 days for six doses. Other protocols include using PSGAG at 2.5 mg per pound twice a week for 4 weeks then weekly for 4 weeks then monthly.”

Although it is labelled as being an intramuscular injection, most people inject Adequan subcutaneously into their cats at home (or some people inject it into the sub-Q port). You attach a fine needle (size 25 upwards) to the syringe, draw up the Adequan, inject into your cat, press the plunger, and withdraw the needle.

Mar Vista Vet reports that when large doses (seven times the normal dose) were given to dogs, the dogs developed large kidneys. They therefore recommend being cautious when using Adequan in patients with CKD.

Valley Vet sells Adequan for around US$74 for a 5ml 100mg/ml vial, or two vials for around US$148.

MicroLactin (e.g. DuraLactin)

MicroLactin is a type of milk from cows who have been given immunostimulants. This appears to help reduce the symptoms of osteoarthritis. Examine explains more about it. There is a veterinary version called Duralactin which also contains omega 3 and omega 6 essential fatty acids.

Some people use microLactin for their cats with arthritis. The usual feline dose appears to be 200-300mg a day for cats below 13 lbs (6kg). Swanson Vitamins make a version.

Since MicroLactin is milk-based, you should keep an eye on your cat’s calcium levels if you are using it.

Physical Therapy

Some people choose physical therapy options for their arthritic cats. These are the treatments that I hear about most often.

Acupuncture

Acupuncture can be very effective for cats with arthritis. As a bonus for most CKD cats, acupuncture can also help with appetite.

2015 AAHA/AAFP pain management guidelines for dogs and cats (2015) Epstein ME, Rodan I, Griffenhagen G, Kadrlik J, Petty MC, Robertson SA & Simpson W Journal of Feline Medicine and Surgery 17 pp251–272 say “The Guidelines Task Force holds that acupuncture offers a compelling and safe method for pain management in veterinary patients and should be strongly considered as a part of multimodal pain management plans.”

Acupuncture: Our Experience

We had extraordinary success treating Harpsie’s arthritis with acupuncture (he did not have CKD, though he had PKD and frequent attacks of pyelonephritis).

His neurologist (Harpsie had a lot of “ologists”) recommended weekly sessions for 3-6 weeks to start with, and said we’d know by week 6, if not earlier, if the acupuncture was helping. In fact, we knew after one session that it had helped Harpsie, because he was walking better almost immediately. He slept almost all day the day after his first session (which apparently is fairly common), so he wasn’t eating much then, but it did seem to act as an appetite stimulant too.

After the sixth session we decided to continue because it helped Harpsie so much. He continued to have treatment every two weeks. Apparently some cats only need to go every 3-4 weeks, but Harpsie started limping a bit around Day 13, so we stuck with fortnightly.

He loved it! In fact, Harpsie was so keen to have his acupuncture that he used to take us to his carrying basket when it was time to go to his sessions!

He would growl a little whilst some of the needles were being inserted, but once they were in, he would go into a trance. Apparently animals who react this way tend to get better results from the acupuncture. We had to stop Harpsie’s Cosequin because of his limited ingredient allergy diet, but his arthritis remained under control thanks to the acupuncture.

Sometimes “point burnout” is seen in those who receive regular acupuncture, but it’s uncommon in cats, and we never saw it in Harpsie.

Here are some photos of Harpsie having acupuncture:

There is more information about acupuncture on the Holistic Treatments page.

Assisi Loop

The Assisi Loop provides targeted Pulsed Electromagnetic Field Therapy (targeted PEMF) in a small device that can be used at home. It is approved by the FDA for the treatment of post-operative swelling and pain in humans. Some members of Tanya’s Feline CKD Support Group have used it for their arthritic cats, often with good results.

For chronic conditions such as arthritis, you would normally use it for 3-4 fifteen minute treatments per day, for 2-4 weeks, though it may take longer to see results. Eventually, as your cat improves, you can taper down treatments to as little as 1-3 treatments per week.

The loop requires a vet prescription and costs US$329 including shipping. It lasts for 150 treatments, though I have heard from people who think it lasts longer.

Assisi portable tPEMF therapy for vets is a TV segment showing how to use the device on a dog.

Laser Therapy

Laser (light amplification by stimulated emission rays) therapy (also called low level laser therapy or LLLT) is available from some vets. It focuses a beam of light onto the affected area to reduce inflammation, relieve pain and stimulate healing.

Lasers are approved by the FDA for the treatment of arthritis in humans, and some people use lasers for their arthritic cats. Why fewer cats have laser therapy (2016) Catwatch, Newsletter of Cornell University College of Veterinary Medicine, says of the use of laser therapy in cats “in general, laser therapy treatment is safe, painless and brief.”

Lasers are a wand, and resemble the laser toys used for cats. The laser is held close to the area being targeted, and care is taken to prevent the cat looking at the laser beam.

Class III lasers are lower level, and are sometimes called cold lasers (because they do not get warm to the touch). Treatment with these lasers tends to take longer, up to half an hour. Class IV lasers are more high-powered, and the treatment may take as little as five minutes. However, some people believe cold laser therapy is safer for cats.

There is no real research into the use of lasers for arthritis in cats but Why fewer cats have laser therapy (2016) Catwatch, Newsletter of Cornell University College of Veterinary Medicine, says “About two-thirds of the veterinary patients at Cornell who undergo laser therapy demonstrate noticeably positive results. The best responses are seen in patients who undergo therapy two to three times a week for three consecutive weeks. Each session costs about $35.”

Laser therapy may help with kidney function. Low-level laser therapy decreases renal interstitial fibrosis (2012) Oliveira FA, Moraes AC, Paiva AP, Schinzel V, Correa-Costa M, Semedo P, Castoldi A, Cenedeze MA, Oliveira RS, Bastos MG, Câmara NO, Sanders-Pinheiro H Photomedicine and Laser Surgery 30(12) pp705–713 found that rats who received laser therapy on an artificially blocked kidney had less fibrosis and fewer inflammatory markers than rats who did not receive laser therapy.

One member of Tanya’s CKD Support Group found that laser therapy seemed to help her cat’s kidneys. Her cat received three minutes of laser therapy over the kidneys three times a week for three weeks and she saw small reductions in her cat’s BUN and creatinine levels.

Low level laser machines are also available for home use, e.g. LumaSoothe Light Therapy is available from Amazon for US$175. Please check with your vet before using.

Frunevetmab (Anti-Nerve Growth Factor Antibody): Solensia

Nerve growth factor (NGF) is present in the body where there is inflammation or injury, and contributes to pain from such conditions. Zoetis explains how NGF affects pain.

Previous research has shown that neutralising antibodies against nerve growth factor are effective painkillers for chronic pain in humans and arthritis in dogs, and newer research has found this also seems to be the case for arthritis in cats. 

Anti-nerve growth factor monoclonal antibodies (anti-NGF mAb) work by blocking the release of NGF in the joints. This helps to reduce both pain and inflammation. Solensia explains more about the mechanism.

Research in cats has focused on a felinized anti-nerve growth factor monoclonal antibody (anti-NGF mAb) called frunevetmab (initially referred to as NV-02). A feline-specific anti-nerve growth factor antibody improves mobility in cats with degenerative joint disease-associated pain: A pilot proof of concept study (2016) Gruen ME, Thomson AE, Griffith EH, Paradise H, Gearing DP & Lascelles BD Journal of Veterinary Internal Medicine 30(4) pp1138-1148 examined the efficacy of frunevetmab for arthritic pain and mobility problems in cats. The study concluded “These pilot data demonstrate a 6-week duration positive analgesic effect of this fully felinized anti-NGF antibody in cats suffering from DJD-associated pain.” The treatment appeared to have no side effects, with no apparent effect on kidney function.

In vitro and in vivo characterization of a fully felinized therapeutic anti-nerve growth factor monoclonal antibody for the treatment of pain in cats (2016) Gearing DP, Huebner M, Virtue ER, Knight K, Hansen P, Lascelles BDX, Gearing RP & Drew AC Journal of Veterinary Internal Medicine 30(4) pp1129-1137 induced temporary lameness in cats, which it then treated with anti-nerve growth factor antibody. It found that “Mean lameness scores on all days evaluated following initiation of treatment were significantly lower in the treatment group than in the control group.”

Anti-nerve growth factor monoclonal antibodies for the control of pain in dogs and cats (2019) Enomoto M, Mantyh PW, Murrell J, Innes JF & Lascelles BDX Veterinary Record 184(1) p23 explains more about this treatment and concludes “Overall, the rationale for using anti-NGF therapy in several pain conditions is strong.”

Efficacy and safety of an anti-nerve growth factor antibody (frunevetmab) for the treatment of degenerative joint disease-associated chronic pain in cats: a multisite pilot field study (2021) Gruen ME, Myers JAE & Lascelles BDX Frontiers in Veterinary Science. 8:610028. doi: 10.3389/fvets.2021.610028 looked at cats given two injections of frunevetmab or a placebo 28 days apart, either intravenously or subcutaneously. The study found that frunevetmab appeared to improve mobility in cats given the medication rather than the placebo; the method of administration did not make a statistical difference. Side effects were generally mild, including hair loss and itchiness at the injection site.

Pharmacokinetics and immunogenicity of frunevetmab in osteoarthitic cats following intravenous and subcutaneous administration (2021) Walters RR, Boucher JF & De Toni F Frontiers in Veterinary Science 8 looked at the mechanism of frunevetmab in three different studies, and found that after two doses 28 days apart concentrations of the medication were stable, and that less than 2.5% developed resistance to the medication.

Frunevetmab, under the name of Solensia, was approved in the UK, European Union and Switzerland in 2021 for the treatment of arthritis in cats. In May 2022 the manufacturer, Zoetis, announced the approval of Solensia by the FDA in the USA. The product is expected to be available in both the USA and Canada during the second half of 2022.

Solensia explains more about Solensia. It is a once monthly injection, with the dose being 1mL for cats weighing between 5.5 and 15.4 lbs and 2mL for cats weighing between 15.5 and 30.8 lbs (if your cat weighs more than this, please send me a photo). The medication must be stored in the fridge. The most common side effects seen are vomiting and pain at injection site.

Efficacy and safety of an anti-nerve growth factor antibody (frunevetmab) for the treatment of degenerative joint disease-associated chronic pain in cats: a multisite pilot field study (2021) Gruen ME, Myers JAE & Lascelles BDX Frontiers in Veterinary Science. 8:610028. doi: 10.3389/fvets.2021.610028 included cats in CKD stages 1 and 2, who did not appear to have any problems with frunevetmab. However, The European Medicines Agency says “The safety and efficacy of this product has not been investigated in cats with kidney disease IRIS stages 3 and 4. Use of the product in such cases should be based on a benefit-risk assessment performed by the responsible veterinarian.”

A few members of Tanya’s CKD Support Group have used Solensia. Many found it helped, a few felt their cats did not respond to it. If I had a cat in CKD Stages 1 or 2 with arthritis, I would certainly be prepared to give it a try, because pain is so debilitating and if it worked, it would make a real difference to quality of life.

Non-Steroidal Anti-Inflammatories (NSAIDs)

These medications can be extremely effective for cats with arthritis, reducing pain and inflammation.

Many people are very nervous about giving NSAIDs to their CKD cats because unfortunately cats do not metabolise NSAIDS very well, so the dosage must be very carefully calculated and often reduced for CKD cats. It can be very risky giving NSAIDs to dehydrated cats. Chronic renal insufficiency and its associated disorders kitty kidneys and the kitchen sink (2007) Scherk M The 2007 Nestlé Purina Veterinary Symposium on Companion Animal Medicine explains more about these issues.

Personally, having dealt with arthritis in three cats now, I would use an NSAID if appropriate. There is little point keeping your cat alive for longer if that life is full of pain. I held off on giving my Karma an NSAID because I was so worried about it damaging her kidneys (she was 16 but did not have CKD). I did eventually start giving it to her several months before her death and she was so much happier and more comfortable that I felt terrible for having left her in pain unnecessarily. The NSAID never caused damage to her kidneys.

Meloxicam (Metacam)

Meloxicam (Metacam) is a non-steroidal anti-inflammatory drug (NSAID) available in both injectable and liquid (oral) form. It is approved in Europe for the treatment of chronic pain caused by osteoarthritis. You can read more about it on the Antibiotics and Painkillers page.

A study of owner observed behavioural and lifestyle changes in cats with musculoskeletal disease before and after analgesic therapy (2009)  Bennett D & Morton C Journal of Feline Medicine and Surgery 11 pp997-1004 looked at the effects of meloxicam on signs of pain in cats (mobility, activity, grooming and temperament). It concludes “Both owners and veterinary surgeons reported significant changes in behavior and lifestyle after analgesic therapy. The authors conclude that the changes in behavior that occurred following analgesic intervention were the consequence of treatment of pain, though they could not exclude the possibility of a placebo effect.”

Comparison of meloxicam and a glucosamine-chondroitin supplement in management of feline osteoarthritis. A double-blind randomised placebo-controlled prospective trial (2014) Sul RM, Chase D, Parkin T & Bennett D Veterinary and Comparative Orthopaedics and Traumatology 27(1) pp20-26 looked at the use of meloxicam and glucosamine and chondroitin compared to a placebo. The study concludes “Treatment with meloxicam resulted in a significant improvement in mobility and activity levels of cats with OA.”

Characterization of osteoarthritis in cats and meloxicam efficacy using objective chronic pain evaluation tools (2013) Guillot M, Moreau M, Heit M, Martel-Pelletier J, Pelletier JP & Troncy E Veterinary Journal 196 pp360-7 evaluated the effects of different doses (0.025 mg/kg, 0.04 mg/kg, 0.05 mg/kg, and placebo) of meloxicam on cats with arthritis. The study concludes “daily low-dose meloxicam administered at 0.025 and 0.05 mg/kg for 4 weeks showed a significant improvement in physical activity in cats suffering from OA suggesting meloxicam provided clinically relevant pain relief.”

Analgesic efficacy of an oral transmucosal spray formulation of meloxicam alone or in combination with tramadol in cats with naturally occurring arthritis (2016) Monteiro BP,  Klinck MP, Moreau M, Guillot M, Steagall PM, Edge DK, Pelletier J-P, Martel-Pelletier J, Gauvin D, Del Castillo JR & Troncy E Veterinary Anaesthesia and Analgesia 43(6) pp643-651 found that combining meloxicam with tramadol appeared to provide better pain control than meloxicam alone.

Long-term safety, efficacy and palatability of oral meloxicam at 0.01-0.03mg/kg for treatment of osteoarthritic pain in cats (2008) Gunew MN, Menrath VH, Marshall RD Journal of Feline Medicine & Surgery 10(3) pp235-41 monitored forty cats who were given meloxicam for arthritis for almost six months, three of whom had pre-existing renal disease. The study found that “no deleterious effect on renal function was detected in cats studied.”

Retrospective case-control study of the effects of long-term dosing with meloxicam on renal function in aged cats with degenerative joint disease (2011) Gowan RA, Lingard AE, Johnston L, Stansen W, Brown SA & Malik R Journal of Feline Medicine & Surgery 13(10) pp752-761 retrospectively examined the records of a veterinary practice over a five year period and concluded that “long-term therapy with meloxicam at a median dose of 0.02 mg/kg/day can be administered safely to aged cats with CKD, provided they are clinically stable. The results further suggest that meloxicam may actually slow the progression of renal disease in cats with both DJD and CKD by direct or indirect  mechanisms.”

Robenacoxib (Onsior)

Robenacoxib is a non-steroidal anti-inflammatory drug that is registered in Europe and the USA for post-operative pain, and in Europe for short term use (up to six days) for pain and inflammation caused by musculoskeletal disorders such as arthritis. There is more about it here.

Clinical safety of robenacoxib in feline osteoarthritis: results of a randomized, blinded, placebo-controlled clinical trial (2016) King JN, King S, Budsberg SC, Lascelles BD, Bienhoff SE, Roycroft LM & Roberts ES Journal of Feline Medicine and Surgery 18(8) pp632642 looked at the safety of using robenacoxib longer term in 194 cats with arthritis, including some cats (40) with both arthritis and CKD. The cats who did not receive the placebo were given 1.0-2.4 mg/kg  of robenacoxib orally daily for 28 days. The study concludes “Robenacoxib was well tolerated when administered daily for 1 month in cats with osteoarthritis, including cats with evidence of concurrent CKD. There was no clinical indication of damage to the gastrointestinal tract, kidney or liver.”

Painkillers

Painkillers are sometimes used to help cats with arthritis. The following have been used by members of Tanya’s CKD Support Group. There is more information about painkillers here.

There is also some interest into whether cannabidiol might help cats with arthritis (there are already studies into its use in dogs for this purpose).

Gabapentin

Gabapentin is an anti-convulsant (used to prevent seizures), but although nobody actually knows why, it has also been found to help with pain, particularly arthritic or neuropathic pain.

Long-term use of gabapentin for musculoskeletal disease and trauma in three cats (2013) Lorenz ND, Comerford EJ & Iff I Journal of Feline Medicine and Surgery 15(6) pp507-12 looked at the use of gabapentin for arthritic pain in cats. Results “indicated that satisfactory pain management was achieved, administration was easy and no obvious side effects during the period of administration occurred.”

Prescribing practices of veterinarians in the treatment of chronic musculoskeletal pain in cats (2019) Adrian DE, Rishniw M, Scherk M & Lascelles BDX Journal of Feline Medicine and Surgery 21(6) pp495-506 found that gabapentin was the most prescribed medication in the survey, being prescribed by 71% of respondents.

In Assessment of the effects of gabapentin on activity levels and owner-perceived mobility inpairment and quality of life in osteoarthritic geriatric cats (2018) Guedes AGP, Meadows JM, Pypendop BH, Johnson EG & Zaffarano B Journal of the American Veterinary Medical Association 253(5) pp579-585, cats were given 10mg per kg of bodyweight of gabapentin twice a day for fourteen days. Owner questionnaires indicated that the cats seemed to be experiencing less pain but were also less active, presumably because of the sedating effect of gabapentin.

There is more information about gabapentin here, including information about commonly used dosages and possible side effects.

Tramadol

Analgesic efficacy of tramadol in cats with naturally occurring osteoarthritis (2017) Monteiro BP, Klinck MP, Moreau M, Guillot M, Steagall PVM, Pelletier J-P, Martel-Pelletier J, Gauvin D, del Castillo JRE & Troncy E PLoS ONE 12(4) e0175565 treated 20 cats twice daily with either tramadol (3 mg/kg) or a placebo given orally for 19 days. The study found that mobility “increased in OA cats with tramadol treatment.” It concludes “Long-term tramadol therapy of up to 19 days seems safe and most common adverse-events are mydriasis, sedation and euphoria. These results are encouraging for promoting tramadol as a treatment for pain in osteoarthritic cats.”

Evaluation of tramadol for treatment of osteoarthritis in geriatric cats (2018) Guedes AGP, Meadows JM, Pypendop BH & Johnson EG Journal of the American Veterinary Medical Association 252(5) pp565-571 assessed the use of tramadol in elderly cats with arthritis. The study concludes “Results suggested a beneficial effect of twice-daily oral administration of tramadol at a dosage of 2 mg/kg in geriatric cats with osteoarthritis. Adverse events were dose dependent, and caution should be exercised in cats that have concurrent disease or are receiving other drugs that may produce adverse gastrointestinal effects.”

Analgesic efficacy of an oral transmucosal spray formulation of meloxicam alone or in combination with tramadol in cats with naturally occurring arthritis (2016) Monteiro BP,  Klinck MP, Moreau M, Guillot M, Steagall PM, Edge DK, Pelletier J-P, Martel-Pelletier J, Gauvin D, Del Castillo JR & Troncy E Veterinary Anaesthesia and Analgesia 43(6) pp643-651 found that combining tramadol with meloxicam appeared to provide better pain control than meloxicam alone.

Unfortunately, Gabapentin and amantadine for chronic pain: is your dose right? (2018) Grubb T Today’s Veterinary Practice Nov/Dec 2018 states “Tramadol effectively treats osteoarthritis pain in cats, but those who have tried administering this drug to cats know that it can be difficult because its taste seems to be specially noxious to cats.”

There is more information about tramadol here, including information about commonly used dosages and possible side effects.

Amantadine

Amantadine was originally developed to treat influenza in humans. It is also used to treat Parkinson’s disease in humans.

Owner evaluation of quality of life and mobility in osteoarthritic cats treated with amantadine or placebo (2021) Shipley H, Flynn K, Tucker L, Wendt-Hornickle E, Baldo C, Almeida D, Allweiler S & Guedes A Journal of Feline Medicine and Surgery 23(6) pp568-574 found that amantadine significantly improved mobility and quality of life in arthritic cats, but also led to decreased activity. Like gabapentin, this is presumably because of the medication’s sedating effects. The dose used was 5mg per kilogram of body weight, given once daily. The study states “Overall, it appears that amantadine was associated with fewer adverse effects than tramadol and gabapentin for the symptomatic management of osteoarthritis in older cats.”

However, Gabapentin and amantadine for chronic pain: is your dose right? (2018) Grubb T Today’s Veterinary Practice Nov/Dec 2018 states “Because amantadine’s contribution to pain relief is not really analgesia (it is technically called antihyperalgesia), the drug must be used as part of a multimodal protocol with true analgesic drugs like NSAIDs, opioids, and gabapentin.”

Stem Cell Transplants

Adult stem cells can help the body to repair itself. One type, mesenchymal stem cells (MSCs), help to produce bone, cartilage and cells that assist with the creation of fibrous connective tissue, so they can be useful for treating joint problems. They have been widely used to treat arthritis in dogs and tendonitis in horses, but only used to a limited extent in cats.

The main problem with stem cell transplants for many people is the cost.

There is more information about stem cell transplants here.

This page last updated: 07 June 2022

Links on this page last checked: 05 June 2022