The Small Animal Clinician’s Guide to Early Detection of Osteoarthritis: Tools, Tips, and Treatment Options
By: Dr. Juli D. Goldstein, DVM, CHPV
Osteoarthritis (OA) is one of the most common causes of chronic pain and mobility impairment in dogs. In everyday small animal practice, experienced clinicians know that by the time osteophytes, sclerosis, and significant joint remodeling appear on radiographs, the disease process has often been active for months or even years. Early osteoarthritis diagnosis requires a shift in mindset from identifying radiographic evidence of mid and end-stage structural damage to recognizing subtle biologic and functional changes that occur much earlier in the disease process.
What is early or subclinical osteoarthritis?
Subclinical osteoarthritis and early detection are becoming an increasingly important concept in veterinary medicine. Patients with subclinical OA do not yet have dramatic radiographic changes but may already demonstrate intermittent discomfort, subtle lameness, altered movement patterns, or mild declines in performance that may be attributed to aging rather than joint disease. In these patients, low-grade synovitis is a likely contributor to the earliest clinical manifestations of OA, as synovial inflammation is now recognized as an important driver of OA initiation and progression before substantial cartilage loss becomes apparent. Many clinicians have encountered the middle-aged Labrador that hesitates before jumping into the car, the agility dog with decreased performance, or the German shepherd that becomes stiff after exercise despite “normal” radiographs. These cases are common examples of preclinical osteoarthritis that veterinary clinicians are learning to recognize earlier.
One of the greatest challenges in canine joint degeneration early detection is that radiographs are relatively insensitive to early disease. Radiographs primarily identify bone remodeling and joint space changes, but they do not adequately assess synovitis, early cartilage degradation, inflammatory mediator activity, or subtle joint instability. Early OA is often a biological and inflammatory change within the joint that may precede detectable radiographic abnormalities by months or years. When possible, taking advantage of advanced imaging, like CT and MRI scans, can provide more detailed and sensitive evaluations in at-risk OA patients.
Synovitis in subclinical OA is increasingly recognized as a major driver of disease progression. Cytokines such as IL-1β and TNF-α contribute to matrix degradation and perpetuate inflammation within the joint environment. Matrix metalloproteinases further degrade cartilage and extracellular matrix components. In many dogs, these inflammatory changes are present well before overt radiographic OA develops.
Tips to recognize early OA signs
For the practicing clinician, early joint disease dogs present in ways that can be easy to overlook for pet owners and veterinary professionals, especially during busy appointment days. Owners may report that their dog is “slowing down,” “acting older,” or “not wanting to play as much.” However, these owner comments should not automatically be dismissed as normal aging. In many cases, these are early indicators of discomfort or altered biomechanics.Additionally, and perhaps more commonly, pet owners may accept these changes as a normal part of aging and therefore never mention them during routine wellness visits. However, this presents an opportunity for veterinarians to involve pet caretakers by requesting videos of the pet during daily walks and playtime.
Whether a patient presents for a routine wellness examination or evaluation of a specific complaint, subtle lameness assessment is critically important in these patients and should be part of the orthopedic screening process. Mild gait asymmetry, shortened stride length, altered weight shifting, intermittent toe-touching, or difficulty transitioning from sitting to standing can all represent early OA. Canine intermittent lameness diagnosis can be particularly frustrating because many dogs appear normal during the actual examination. Home video footage frequently becomes one of the most valuable diagnostic tools available to clinicians, particularly when lameness is intermittent or absent during the examination.
Working and sporting dogs deserve particularly close attention. Decreased performance working dog lameness cases may manifest as slower weave pole times, reluctance to jump, shortened endurance, altered turning behavior, or changes in drive and attitude before obvious orthopedic abnormalities are present. Trainers and owners often notice these subtle changes before veterinarians do. Listening carefully to these observations can provide valuable clues regarding early disease.
A thorough orthopedic examination remains one of the most important tools for early OA diagnosis. Additionally, mild joint effusion is often one of the earliest objective abnormalities detected during an orthopedic examination and may be present before radiographic evidence of OA.4,9 Other orthopedic exam findings for patients with early OA may include the following:
Subtle decreased range of motion
Low-grade periarticular thickening
Discomfort on hyperextension or flexion
Early muscle asymmetry
Clinicians should also pay close attention to compensatory loading orthopedic disease patterns. Dogs are exceptionally adept at redistributing weight away from painful joints. For example, a patient with early elbow OA may present primarily with contralateral shoulder strain or cervical discomfort. Dogs with partial cruciate disease may overload the opposite pelvic limb, accelerating degeneration elsewhere. Recognizing these compensatory patterns can help identify pathology earlier.
Additionally, early cruciate disease partial tear signs are commonly missed in practice. Many dogs with partial cranial cruciate ligament injuries do not demonstrate a classic drawer sign initially, instead, clinicians may appreciate subtle stifle effusion. Other signs may include:
Mild pain on hyperextension
Sitting with a limb abducted
Intermittent hindlimb lameness
Progressive muscle atrophy
These dogs are often categorized as “soft tissue injuries” until more advanced instability develops. Early intervention during this stage may significantly alter disease progression.
Risk profiling is another valuable strategy for detecting preclinical OA. Certain populations should automatically trigger a higher index of suspicion. These include:
Overweight dogs
Large breed dogs
Patients with elbow dysplasia or hip dysplasia
Working dogs
Athletic dogs
Dogs recovering from TPLO or orthopedic surgery
Obesity alone significantly increases OA risk and contributes to inflammatory cytokine production throughout the body.
One of the reasons early OA remains underdiagnosed is that many patients do not present with overt lameness. Instead, they present with lifestyle changes, activity avoidance, altered play behaviors, or decreased willingness to perform previously routine activities. These changes are often subtle enough that neither the owner nor the clinician immediately associates them with chronic joint pain. Clinical metrology instruments (CMIs) and other owner-directed questionnaires and checklists, can aide in early OA recognition detection of subtle disease signs. Tools such as the Liverpool Osteoarthritis in Dogs score (LOAD), Canine Brief Pain Inventory (CBPI), and the Canine Osteoarthritis in Dogs Staging Tool (COAST), help quantify changes that owners may otherwise struggle to describe. Repeating these assessments over time can reveal progression even when physical findings remain subtle. The COAST tool also allows clinicians to assign an OA stage to drive standardized treatment recommendations. These can be repeated to determine response to treatment and OA progression.
Advanced diagnostic modalities are also improving canine joint degeneration early detection. Force plate gait analysis and pressure-sensitive walkways can detect asymmetrical loading patterns before lameness becomes clinically obvious9. Diagnostic ultrasound can help identify synovitis, mild effusion, tendon abnormalities, and soft tissue pathology. While most OA changes can be identified on radiographic evaluations, early risk assessments and subtle changes may not be identified until later stage disease. Utilization of the Orthopedic Foundation for Animals (OFA)survey films can identify hip dysplasia risk on dogs as young as 2 years old. Additionally, the Pennsylvania Hip Improvement Program, or PennHip, has demonstrated superior predictive value for future hip OA risk because it quantitatively measures passive hip laxity in canine patients as young as 16 weeks of age. Films can be submitted for evaluation after completing a free online training and certification course. In referral settings, CT with contrast and MRI may identify changes not detected on standard radiographic surveys, including cartilage defects, subchondral bone changes, or meniscal injury before radiographic OA develops.
Emerging biomarker research may eventually transform early OA diagnosis in veterinary medicine. Synovial fluid biomarkers, inflammatory mediators, metabolomics, and proteomic profiling are currently being investigated for their ability to detect disease earlier than conventional imaging. Although these tools are not yet routinely used in general practice, they reinforce the growing understanding that OA is fundamentally a biologic disease before it becomes a structural one.
Intervention and treatment options for early osteoarthritis
One of the most important clinical decisions is determining when subtle findings justify intervention. Many veterinarians hesitate to initiate treatment when radiographs are normal or only reveal mild abnormalities. However, waiting for advanced imaging changes may represent a missed opportunity to preserve joint health.
The goal of intervention during subclinical OA in dogs is not simply pain management. Instead, the focus should shift toward preserving cartilage integrity, reducing inflammation, supporting joint homeostasis, and minimizing progression. Weight management remains one of the most impactful interventions available. Even modest weight reduction can significantly decrease joint loading and inflammatory burden.
Rehabilitation and controlled exercise programs are also extremely valuable for early joint disease dogs. Maintaining muscle mass, improving proprioception, and supporting joint stability can help reduce progression of disease. Individualized exercise recommendations are often more beneficial than generalized activity restriction. Board certification can be obtained through the American College of Veterinary Sports Medicine and Rehabilitation, in addition to various certification programs.
Pharmacologic therapy may also play a role in selected cases. NSAIDs remain first line treatment, and are important tools for managing inflammation and discomfort, although clinicians increasingly use them strategically and multimodally rather than reflexively.
OA treatments continue to evolve within veterinary medicine, and targeted joint therapies to directly address altered joint mechanics and damaged tissue are improving standard of care for OA patient management. Intra-articular regenerative therapeutics are increasingly being incorporated into earlier stages of disease because they may help modulate the joint environment and inflammatory cascade associated with OA progression. Mechanisms of action include therapies that focus on cell signaling, immunomodulation, paracrine and trophic effects, and providing a bioscaffold to help accomplish healing. The rationale for these therapies is particularly compelling in preclinical disease where supporting the synovial environment and joint mechanics before irreversible degeneration develops may offer the greatest long-term benefit. Available intraarticular regenerative therapeutics include:
Orthobiologics (e.g., autologous and allogenic platelet-rich plasma, autologous condition serum (ACS), and interlukein-1 receptor protein antagonist (IRAP)
Stem cells (adipose and bone marrow derived)
Natural bioscaffold hydrogels (i.e., collagen elastin hydrogel microparticles (CEHM)
Synthetic bioscaffold hydrogels (i.e., 2.5 % polyacrylamide hydrogels)
The new standard of osteoarthritis care
Communication with owners is equally important during early OA discussions. Many owners still believe arthritis is simply an inevitable part of aging. It’s critical to help them understand that joint pain without radiographic evidence can still represent meaningful disease. Educating owners about subtle clinical signs and encouraging earlier evaluation can significantly improve outcomes.
The future of osteoarthritis management in veterinary medicine is clearly moving toward earlier recognition and intervention. Wearable gait monitors, AI-assisted gait analysis, biomarker development, improved imaging technologies, and utilizing multimodal treatments to include targeted regenerative therapeutics will likely continue shifting OA management toward a preventative and proactive model.
Ultimately, OA should no longer be viewed as a disease that begins once radiographs become abnormal. Instead, clinicians should recognize OA as a continuum that starts with biologic dysfunction, low-grade inflammation, and subtle changes in movement long before severe structural damage develops. Experienced clinicians are often already identifying these cases intuitively through careful observation, thorough orthopedic examination, and pattern recognition developed over years of practice.
As our understanding of osteoarthritis evolves, the profession is increasingly recognizing that earlier intervention may provide the best opportunity to preserve lifelong joint function and mobility. By the time we see advanced osteoarthritis on radiographs, we are often already behind. Evolving small animal practice requires that we learn to recognize and address OA much earlier in the disease process.
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About the Author:
Dr. Juli D. Goldstein earned her Bachelor of Science in Zoology and Doctor of Veterinary Medicine from Auburn University, where she received Young Alumni Achievement Awards from both the College of Science and Mathematics and the College of Veterinary Medicine. She is also certified in animal hospice and palliative care.
Her veterinary background includes small animal emergency and general practice, marine wildlife medicine, clinical research, and laboratory animal care across North America and internationally. As a research professor and chief clinician at Florida Atlantic University, she contributed to over 50 peer-reviewed publications and led health assessments of more than 400 wild dolphins.
Dr. Juli is known for her work with “Winter” and “Hope,” the dolphins featured in Dolphin Tale, where she appeared as herself. She currently consults for NOAA Fisheries and marine facilities, and serves on the Auburn University College of Veterinary Medicine Alumni Advisory Council.