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Is Your Cat Hiding Her Arthritis Pain?

Analysis by Dr. Karen Shaw Becker

Story at-a-glance

  • About 45% of all cats — and 90% of cats 10 years and older — have some degree of arthritis; cats are notorious for masking pain, so it’s important to watch for behavioral changes that indicate your kitty is uncomfortable
  • There’s also a new 6-question checklist you can use to quickly determine if your cat needs to visit your veterinarian for a checkup
  • Cats with arthritis require a multimodal treatment approach that includes lifestyle modifications, non-toxic pain control, and a customized oral protocol that includes chondroprotective agents
  • It’s important for both you and your veterinarian to continuously monitor your arthritic cat and make adjustments as necessary to treatment protocols

Veterinary researchers estimate that 45% of all cats and 90% of kitties over the age of 10 have some degree of arthritis (also referred to as degenerative joint disease).1

The condition is clearly pervasive, but like so many things about our mysterious feline friends, you’d never know it, which is why there’s been so much research in recent years aimed at helping both pet parents and veterinarians better understand what’s going on with them.

The reason more arthritic cats aren’t diagnosed and treated is because it can be remarkably difficult to pick up signs of pain in kitties, who as a species are very skilled at masking discomfort and illness. In the wild, predators are much more likely to target weak or injured animals, so cats are programmed by nature to avoid looking like easy prey.

“It really comes down to understanding what pain looks like in cats,” veterinarian Margaret Gruen, assistant professor of behavioral medicine at North Carolina State University College of Veterinary Medicine told online publication Futurity.

“People tend to assume that their cat will vocalize or show their pain in the same way a dog might, but chronic pain in cats doesn’t show itself that way. Instead, behaviors that owners might attribute to ‘getting old’ or ‘slowing down’ can often be signs of joint pain or disease.”2

Behavioral Changes to Watch For

Since cats are masterful at hiding pain, what you want to look for instead of obvious limping, for example, or difficulty standing up from a lying position, are behavioral changes. Some of these might include:

Reluctance to jump up on things, or difficulty gaining the height needed

Decreased interest in other family members, both people and pets

Eliminating outside the litterbox, especially if the box has high sides, or is upstairs, or is located in a hard-to-reach spot

Becoming less active; sleeping more

No longer covering urine or feces with litter

Lack of appetite

If you notice one or more of these signs in your cat, it’s time to make an appointment with your veterinarian. The sooner you find out the underlying cause of your cat’s behavior change, the sooner you can get her on the road to feeling better.

New 6-Question Checklist Helps Identify Cats With Arthritis

To make things even easier for pet parents, Gruen and two colleagues at NC State have proposed a simple six-question yes-or-no checklist to detect degenerative joint disease in cats:3

  1. Does your cat jump up normally?
  2. Does your cat jump down normally?
  3. Does your cat climb up stairs or steps normally?
  4. Does your cat climb downstairs or steps normally?
  5. Does your cat run normally?
  6. Does your cat chase moving objects (toys, prey, etc.)?

According to Gruen, the questionnaire is “… a way to start the diagnostic conversation with a veterinarian — the checklist was designed to be reasonable in both specificity and sensitivity, but also user-friendly for owners without overgeneralizing.”

The research that led to the questionnaire looked at 249 cats with, and 53 cats without arthritis from five different studies. The initial checklist contained nine questions; the final checklist was pared down to six questions. The sensitivity and specificity of the proposed checklist were approximately 99% and 100%, and 55% and 97%, respectively.

Cats With Arthritis Require a Multimodal Treatment Protocol

Thankfully, at least some of my colleagues in the conventional veterinary community, such as veterinary surgeon and canine rehabilitation specialist Dr. David Dycus are suggesting a paradigm shift is needed in treating pets with arthritis. They want veterinarians to move beyond the traditional approach of "… here's your pain reliever and your anti-inflammatory, see you later.”4

Dycus recommends determining a baseline with these patients through the use of joint supplements, diet and exercise. He also makes the point that when arthritic pets visit the veterinarian, it’s usually during a flare-up of their condition. He suggests taking a step back with these patients to consider what can be done to get the flare-up under control quickly and aggressively.

In these situations, pharmaceuticals may be required, but especially in the case of non-steroidal anti-inflammatories (NSAIDs), Dycus suggests starting at the lowest dose possible, as infrequently as possible. He also recommends veterinarians use a range of treatment modalities, which might include cartilage-building joint injections, rehabilitation therapy, and acupuncture.

The goal should be to keep arthritic pets active to help them maintain range of motion and lean body weight.

I applaud Dr. Dycus’s less-is-more approach to NSAIDs and other drugs for pets — especially cats — with arthritis. As a general rule, in non-emergency situations, I always try safer, non-toxic approaches first. Drugs have their place, but in my opinion, they’re overused to the point of abuse in conventional human and veterinary medicine.

An entirely proactive approach to osteoarthritis, which I would love the veterinary community to embrace, involves preventing the condition from occurring in the first place.

By charting range of motion of joints during annual exams and changes in muscle girth from year to year, vets are in a position to make musculoskeletal recommendations before significant joint degeneration occurs. By offering dynamic supportive protocols as age-related changes occur, we can slow the entire degenerative process; proactive medicine at its best!

Pain Control Options

Pain can sometimes be managed by offering a variety of rehabilitative therapies, including cold laser therapy, pulsed electromagnetic field therapy (PEMF), cold and heat therapy, and acupuncture (or aquapuncture). As arthritic kitties age, anti-inflammatory and pain medications are often prescribed to manage day-to-day discomfort; however there are many wonderful natural treatments and remedies for arthritis that can reduce the need for painkillers long term.

In many cases, cats may need a short course of drugs to relieve pain quickly, but most owners are concerned about the long-term side effects of these medications, especially with older cats.

The good news is that if natural non-steroidal anti-inflammatories (NSAIDs) are started at the same time as the drugs, often times the drugs can be tapered down, or given intermittently, and the patient can be supported with an improved quality of life on a blended protocol of supplements including:

A high-quality omega-3 supplement (krill oil)

CBD oil


Supergreen foods (spirulina, astaxanthin)

Turmeric or curcumin

Homeopathic remedies (Rhus tox, Arnica)

Natural anti-inflammatory formulas (devil’s claw, boswellia, proteolytic enzymes, TCM formulas)

Esterified Fatty Acid Complex (EFAC) complex

Lifestyle Recommendations

In my experience, physical therapy is an absolute must for arthritic cats and should be designed to maintain and increase joint strength, muscle tone, and range of motion. This can be accomplished with therapeutic exercises and massage. These protocols should be designed by an animal physiotherapist or a rehab veterinarian and can dramatically improve a cat’s quality of life.

Keeping your cat at a lean, healthy weight is absolutely crucial in preventing or alleviating arthritis symptoms. An overweight kitty with arthritis can have noticeable improvement in symptoms after losing just a small amount of body weight.

Pets need to move their bodies more, not less, as they age. This can be a challenge for cats but can be done with diligence and creativity. Although the intensity, duration and type of exercise will change, daily activity is still crucial to prevent profound musculoskeletal weakness with age. Muscles maintain your cat’s frame, so preserving muscle tone will also slow the amount of joint laxity (which causes arthritis) as well.

Other crucial factors in maintaining the health of an arthritic cat include feeding a nutritionally optimal, species-specific diet, and avoiding unnecessary re-vaccinations (titer test instead). Learn how to get your cat off of ultra-processed junk food (kibble) here.

In addition to therapies such as laser treatments and the Assisi loop, I’ve found that incorporating maintenance chiropractic, acupuncture, daily stretching, and mild exercise along with an oral protocol to manage pain and inflammation will yield the best results possible for my kitty patients with arthritis. The sooner you begin these steps, the better results your cat will have.

Oral Joint Support Recommendations

Chondroprotective agents (CPAs) that protect your cat’s remaining cartilage, including glucosamine sulfate, MSM, eggshell membrane, perna mussel (green-lipped clam), Adequan, and cetyl myristoleate are essential for cats with arthritis. CPAs slow the rate of cartilage degeneration, which is critical.

The form, dose and type of CPA your veterinarian prescribes should be based on a careful assessment of your cat’s individual needs. CPAs should be blended with pain control options (listed above) as necessary.

There are also ayurvedic and Chinese herbs and nutraceuticals that can be very beneficial for kitties with arthritis, depending on their individual symptoms. It's important to monitor your pet's symptoms on an ongoing basis, because arthritis progresses over time. Your cat’s body is constantly changing, and her treatment protocol will need to evolve as well.

In the vast majority of mild to moderate joint pain cases, if CPAs and natural pain control options are initiated early, the need for intermittent NSAID therapy can be minimized to those occasional “bad days” when the weather or the day’s activities temporarily exacerbate your pet’s discomfort.

Moderate to severe joint pain cases (requiring consistent NSAID drug administration to maintain quality of life) can rely on lower drug doses by using an integrative protocol. It’s also important to note that many painkillers can become toxic to kitties over time.

I recommend finding a proactive integrative or holistic veterinarian to work with you to customize a comprehensive protocol for your pet.

Practitioners who’ve gone beyond their traditional veterinary school training to learn and incorporate complimentary therapies into their practice will have many more options to offer your arthritic cat. If your proactive vet doesn’t offer rehabilitation services, they should be able to connect you to animal physical therapists in your area.

I also recommend bringing your cat for a wellness checkup with your veterinarian at least twice a year to review the status of her health, and to check the range of motion in her joints, the muscle mass she’s either gaining or losing, and to make adjustments to her protocol as necessary to ensure her quality of life is optimal.

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