COAST Development Group’s international consensus guidelines for the treatment of canine osteoarthritis
Cachon, T. et al. (2023) COAST Development Group’s international consensus guidelines for the treatment of canine osteoarthritis. Frontiers in Veterinary Science, 10, no. 1137888.
The aim of the Canine OsteoArthritis Staging Tool (COAST) Development Group’s consensus guidelines for the treatment of canine osteoarthritis (OA) is to provide an evidence-based reference resource to support veterinary practitioners with the development of tailored OA management and treatment plans based on the OA stage of individual patients.
A literature search was carried out on three search engines using relevant terms for the various treatment options. For each recommendation the nine members of the COAST Development Group individually assessed the level of evidence and based on their interpretation of the data, and any personal clinical experience, voted on the recommendations. Therefore there were three levels of recommendation unanimous, majority or minority. Recommendations on surgical procedures were determined by the COAST Development Group’s orthopaedic surgeons only.
The Group proposed a practical ‘base and build’ approach for individual canine OA management protocols, using the Canine OsteoArthritis Staging Tool excluding radiography (COASTeR) stage to guide treatment and management choice. The recommendations are presented by the COASTeR stage: Stage 0: no clinical signs of OA and no OA risk factors identified; Stage 1: no clinical signs of OA and one or more risk factors were identified; Stage 2: clinical signs of OA and mild osteoarthritis pain; Stage 3: clinical signs of OA , moderate osteoarthritis; and Stage 4: clinical signs of OA, severe osteoarthritis.
The foundational elements, which include lifestyle evaluation and educational opportunities such as annual health check and education programmes form the ‘base’ of the recommendations and are applicable to all patients (COASTeR Stage 0-4). The ‘build’ elements are the COASTeR stage-specific management and treatment recommendations which are intended to build or expand on the foundational elements.
Recommendations at COASTeR Stage 0 include elements such as disease education, nutrition/diet, bodyweight, exercise and physical therapy. Then recommendations build up to COASTeR Stage 1 which includes elements such as modified exercise or focused/more frequent patient evaluations. COASTeR Stages 2-4 contain specific management and treatment recommendations which expand on the foundational elements step-by-step, with flexibility to meet the needs of the patient and requirements of the pet caregiver.
The study was funded by Elanco who also collated meeting notes and reviewed drafts of the manuscript. An infographic showing recommendations at the different stages would have been a useful addition.
These consensus guidelines provide clear evidence-based recommendations for the treatment of canine osteoarthritis. They provide a practical reference source which will help practitioners develop patient-specific OA management protocols for different stages of the disease.
The following may also be of interest:
inFOCUS: Quality of Life assessment tools – Arthritis / DJD pain assessment [RCVS Knowledge] [online] Available from: https://infocus.rcvsknowledge.org/qol-quality-of-life-assessment-tools-disease-specific-assessment-tools-arthritis-DJD-dogs/ [Accessed 22 October 2023]
Corral, M.J. et al (2021) A prospective, randomized, blinded, placebo-controlled multisite clinical study of bedinvetmab, a canine monoclonal antibody targeting nerve growth factor, in dogs with osteoarthritis. Veterinary Anaesthesia and Analgesia, 48 (6), pp. 943-955. https://doi.org/10.1016/j.vaa.2021.08.001
An inFOCUS summary of this paper is available.
Kronenberger, K. (2023) In dogs diagnosed with osteoarthritis, how safe and effective is long-term treatment with bedinvetmab in providing analgesia? Veterinary Evidence, 8 (1). https://doi.org/10.18849/ve.v8i1.598
Wong, L. Y. S., & Govendir, M. (2022) Comparison of the effect of marine-derived omega-3 fatty acids (n-3 FAs) as an adjunct to a non-steroidal inflammatory drug (NSAID) therapy vs NSAID therapy alone, for dogs with osteoarthritis. Veterinary Evidence, 7 (1). https://doi.org/10.18849/ve.v7i1.527
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