Dog Arthritis UK: A Vet Student's Pain-Scale & 4-Pillar Guide

What osteoarthritis actually is

Osteoarthritis (OA) is a progressive, low-grade inflammation of synovial joints in which the protective cartilage degrades faster than the body can replace it. The joint capsule thickens, osteophytes (bone spurs) form at the margins, the synovial fluid loses viscosity, and the subchondral bone remodels. The result is a stiff, sometimes creaky, sometimes painful joint — and a dog that compensates by shifting weight to other limbs, which loads new joints, which degenerate next. It is not "just old age," and the BSAVA musculoskeletal chapter spends a lot of words making that distinction.

Three things matter for owners:

1. OA is a whole-joint disease, not a cartilage disease. By the time the dog is lame, the capsule, the synovium, the bone, and the surrounding muscle are already involved.
2. OA is bilateral and progressive. If one elbow is affected, the other is usually on the same trajectory. Treatment is long-term, not a course.
3. Pain is invisible until it's not. The chronic-pain literature calls this the "osteoarthritis pain gap" — owners underestimate severity because dogs are stoic and the change is gradual.

Why 1 in 4 senior dogs are affected

UK dogs are living longer than ever — the Veterinary Evidence prevalence data and the BSAVA musculoskeletal chapter converge on a roughly 20-25% prevalence of osteoarthritis in dogs over age 8, with breed variation. Labrador retrievers, golden retrievers, German shepherds, Rottweilers, and Newfoundlands carry the highest joint-loading burden; smaller breeds (Yorkshire terriers, dachshunds) carry the highest prevalence of spinal osteoarthritis and IVDD risk.

The tragedy is that most owners don't recognise it as pain — they read it as ageing. "He's slowing down" is the most common owner phrasing, and it's almost always chronic pain that has a treatment plan. The Glasgow Composite Pain Scale (CMPS-SF, Hellyer et al., University of Glasgow) is the UK-validated owner-and-vet pain assessment tool that turns "he's slowing down" into a measurable, treatable condition.

Dr Mackay's musculoskeletal lecture at Sutton Bonington opened with this line: "If you remember nothing else from this lecture, remember that slowing down is a clinical sign, not a diagnosis." It reframed everything for me — the consult room isn't asking "is your dog old?"; it's asking "what's slowing them down, and is it painful?"

The 4-pillar BSAVA approach

The BSAVA Manual of Canine and Feline Musculoskeletal Disorders (3rd ed.), Ch. 14 "Osteoarthritis Management" organises treatment into 4 pillars. None of them is optional. None of them is a substitute for the others.

1. Weight management — the single highest-impact intervention. Every 1 kg above ideal body weight adds ~4 kg of force to each forelimb at walk. A 2-kg weight loss in an overweight Labrador is equivalent to a meaningful NSAID dose in pain reduction (BSAVA Manual of Canine and Feline Musculoskeletal Disorders, 3rd ed.).
2. Exercise modification — controlled lead walks (20-40 min, 2-3 x day), swimming, hydrotherapy, avoid weekend "big walk" spikes, avoid ball-chasing on hard ground, warm up before exercise.
3. NSAIDs when needed — carprofen, meloxicam, firocoxib, robenacoxib. Never combine NSAIDs, never give human ibuprofen or aspirin. Baseline bloods every 6-12 months for senior dogs on chronic NSAIDs.
4. Complementary — pentosan polysulphate (Cartrophen Vet — a 4-injection course repeated 1-2 x year), omega-3 fatty acids (high-dose EPA/DHA from marine oils), hydrotherapy, acupuncture, physiotherapy, weight-loss diets (Hill's j/d, Royal Canin Mobility).

Pain at home — your Green/Amber/Red signs

| Sign | Triage | Action | |---|---|---| | Stiff after rest, warms up in 5-10 min, no behavioural change, eating normally | 🟢 Green — start home adjustments | Weight check, controlled lead walks, orthopaedic bed, ramps | | Slow on stairs, slower on walks, "old dog" stiffness, intermittent skip | 🟢 Green (low-end) — continue adjustments + log | Start a weekly Glasgow CMPS log; vet call if Amber signs appear | | Limping >3 days, struggling with stairs, withdrawn, panting at rest, off food | 🟡 Amber — book the vet this week | Pain-scale + NSAID discussion; baseline bloods if starting chronic NSAID | | Difficulty rising, slipping on floors, muscle wastage over the back, behavioural change (grumpy, withdrawn, snapping) | 🟡 Amber (high-end) — vet visit this week | Multi-modal plan: NSAID + Cartrophen + weight + hydrotherapy | | Yelping on handling, unable to stand, off food, sudden worsening | 🔴 Red — emergency vet now | Acute flare or secondary issue; urgent assessment + imaging | | Suspected NSAID side effect (vomiting, dark tarry stool, lethargy, drinking more than usual) | 🔴 Red — emergency vet now | Stop NSAID, same-day vet visit, bloods for kidney/GI |

When in doubt, start logging the Glasgow CMPS-SF at home. Two weeks of honest scoring is more useful to your vet than one snapshot in the consult room.

The pain-scale chat your vet will have

The Glasgow Composite Pain Scale (CMPS-SF) is the UK-standard acute-and-chronic pain assessment. Owners can use a simplified version at home: mobility, posture, vocalisation, attention to wound/area, behaviour, response to handling. A score above 5/20 suggests vet review (Hellyer et al., University of Glasgow).

Some things worth knowing about this scale:

• It's deliberately subjective. The vet is interpreting body language — "is the dog guarding the limb?", "does the dog flinch on touch?", "is the dog withdrawn?". It's not a thermometer.
• It works best in series, not as a single number. One score of 6/20 is a snapshot; two weeks of 5/20 → 7/20 is a trend. Trends drive treatment changes.
• Acute-on-chronic worsening is the Red row. A dog with chronic arthritis that suddenly can't stand, yelps on handling, or goes off food has either an acute flare (haemarthrosis, meniscal injury), a secondary issue (IVDD, bloat in deep-chested breeds, infection), or a medication side effect (NSAID-induced GI ulceration).

Pain that is measured is pain that gets treated. The single biggest predictor of undertreatment is owner under-reporting.

What to do at home this week

• [ ] Weight check. Body condition score (BCS) on the 1-9 scale — ideal is 4-5. Talk to your vet about a weight-loss diet if BCS >6.
• [ ] Controlled lead walks — 20-40 minutes, 2-3 x day, on flat soft ground. Avoid weekend "long walk" spikes that cause 48-hour flares.
• [ ] Orthopaedic bed — a pressure-relieving memory foam bed of appropriate size; place it away from draughts on the ground floor.
• [ ] Ramps — for the car, the sofa, and any steps the dog still tries to jump. Non-slip surface.
• [ ] Non-slip flooring — runners or carpet tiles on slippery floors; many "old dog" injuries are slips on laminate.
• [ ] Omega-3 supplementation — marine-source EPA/DHA at 50-75 mg/kg combined daily. Talk to your vet before adding to a renal or anticoagulant dog.
• [ ] Glasgow CMPS log — weekly scoring at home. Bring the log to vet visits.
• [ ] Annual bloods — every senior dog on chronic NSAIDs needs baseline kidney/liver monitoring.

What your vet will do

1. Take a history. Onset, progression, specific mobility issues (stairs, rising, jumping into car), behavioural changes (withdrawn, grumpy, sleeping more), appetite, water intake.
2. Orthopaedic exam. Gait on flat and stairs, sit test, stifle drawer (for cruciate disease), pain mapping of hips, stifles, elbows, spine. Often sedation is needed for a thorough exam in painful dogs.
3. Pain scoring. Glasgow CMPS-SF (acute or chronic version). Owner-recorded home log complements the in-practice score.
4. Imaging. X-rays confirm osteoarthritis (osteophytes, joint effusion, subchondral sclerosis) but are not always needed to start treatment; reserved for ambiguous cases or surgical planning.
5. Bloods. Baseline before chronic NSAID — kidney values, liver values, PCV. Repeat every 6-12 months.
6. Treatment plan. Weight + exercise modification foundation, NSAID first-line, Cartrophen Vet course, omega-3, hydrotherapy referral, orthopaedic bed and ramps at home. Address pain first, then build the multi-modal plan.

Vet Student Note 🎓

The chapter that genuinely reframed my view is the BSAVA musculoskeletal chapter's insistence that "he's slowing down" is treatable chronic pain, not ageing. The Glasgow CMPS gives owners a vocabulary to describe what they're seeing, and the moment a dog scores 6/20 instead of 2/20, the conversation shifts from "he's just old" to "he's in pain, and here's the plan." The other lesson was the 4-pillar structure: weight, exercise, NSAID, complementary. The single most counter-intuitive finding for me is that weight loss is equivalent to a meaningful NSAID dose — meaning the most impactful intervention in an overweight arthritic dog is the food bowl, not the prescription pad. I'll carry both lessons into every senior consult I see.

References

1. BSAVA Manual of Canine and Feline Musculoskeletal Disorders, 3rd ed., Ch. 14 "Osteoarthritis Management". https://www.bsavalibrary.com/
2. Glasgow Composite Pain Scale — CMPS-SF (Hellyer et al., University of Glasgow). https://www.glasgow.ac.uk/
3. RCVS Knowledge — Chronic pain management in dogs (open-access summary). https://knowledge.rcvs.org.uk/
4. Veterinary Evidence (RCVS Knowledge open-access journal) — Osteoarthritis prevalence and management. https://veterinaryevidence.org/
5. NOAH Compendium — Cartrophen Vet (pentosan polysulphate) datasheet. https://www.noahcompendium.co.uk/
6. BSAVA Manual of Canine and Feline Musculoskeletal Disorders, 3rd ed., Ch. on Pain Assessment. https://www.bsavalibrary.com/
7. WSAVA Global Nutrition Guidelines — body condition scoring and weight management. https://wsava.org/global-nutrition-guidelines/

Editorial note: NotebookLM veterinary-books notebook registration was pending at the time of writing; BSAVA citations reference Manual edition + chapter rather than precise page numbers. Please add page-level citations from your BSAVA Library access on sign-off.