Understanding Arthritis and Raised Liver Enzymes in Dogs

Slowing down is not an inevitable part of getting older. For many dogs it is the first sign of arthritis, and arthritis can be treated.

This article starts at the early stage, with why it pays to act and why effective pain relief matters more than supplements. Then it looks at how to approach testing, and what to do if a blood test later shows changes in the liver, and why that is rarely a reason to panic.

As always, we focus on your dog's quality of life.

Stiffness and slowing down are signs of discomfort worth acting on, not a normal sign of old age.

The early signs are easy to miss because they build gradually. You might notice your dog:

• Slowing down on walks, or turning for home earlier
• Taking a moment to get going after resting
• Hesitating at stairs, the car or the sofa
• Playing less, or being less keen to greet you
• Becoming grumpy when touched or approached. Pain is an incredibly common cause of behavioural change, if in doubt discuss a pain relief trial with your vet.

Arthritis is painful, and pain is what I call a "welfare blocker". It needs to be treated, not put up with, and the earlier it is treated the more comfortable and active your dog can stay.

What makes the biggest difference is effective pain relief prescribed by your vet. Supplements and joint diets have a part to play, but they will not control arthritis pain on their own, and relying on them for too long can mean your dog stays in pain when they did not need to. 

Weight control, sensible exercise and a comfortable home help too, and they work best alongside proper pain relief rather than instead of it.

You do not always need an X-ray before treatment can start. Many dogs can be diagnosed from their history and a hands-on examination by their vet. An X-ray can be helpful, for example to rule out other causes of lameness, but it is not always necessary. Our Pet diagnostic test guide explains how to decide whether a test is worth doing.

Non-steroidal anti-inflammatory drugs (NSAIDs) are the mainstay of arthritis treatment in dogs, because they ease both the pain and the inflammation behind it.

They work by reducing the chemicals that drive inflammation in the joint, which helps dogs move more freely and comfortably. Several are available, including carprofen, meloxicam and firocoxib. The older ones remain highly effective and have a long record of safe use. Newer, more targeted options, such as grapiprant (Galliprant), are also available.

The side effects you are most likely to see affect the gut: vomiting, loose stools or a poorer appetite. These are usually self-limiting once the medicine is stopped, but contact your vet if you notice any of them. Dogs vary a great deal in what suits them, and swapping to a different type of NSAID often works well. My dog Tilly had diarrhoea on meloxicam, but did well on carprofen for many years for her arthritis secondary to elbow dysplasia. Your vet will advise on the timing when changing from one to another. 

Never give human anti-inflammatories such as ibuprofen, which are very dangerous for dogs.

A list of possible side effects is not the same as the likelihood of them happening.

Every medicine has a leaflet, and every leaflet lists what could go wrong. Most dogs do well on arthritis medicines that are prescribed and monitored properly. Your vet will check that your dog is a good candidate before starting, and will ask you to watch for changes in appetite, stools, thirst and energy.

The risk of leaving arthritis untreated is not theoretical. It is pain, every day, along with the loss of movement, muscle and confidence that comes with it. Weighing the benefits against the risks for your individual dog is the right approach, and you can read more about it in Is pet medication safe?

Blood tests can add useful information, but they are not a requirement of ongoing care, and you should never feel forced into them.

What they are good for:

• Giving a baseline before pain relief starts, so later results have something to be compared with
• Checking the kidneys and liver, and picking up other conditions that change which medicine is the safest choice
• Spotting a trend over time, which is often more informative than a single result

What they cannot do:

• Replace what you see at home. Appetite, vomiting, stools, thirst, energy and how easily your dog gets up are often the earliest clues.
• Make the decision on their own. A mildly raised number in a dog who is well and more comfortable on treatment is a reason to look closer, not automatically a reason to stop.
• Predict every reaction. Reactions to these medicines are generally uncommon and unpredictable, so a normal result is reassuring but not a guarantee.

If blood tests are hard to afford, please do not stop your dog's medication because of it. Pain relief that works is far more important than a test result, and it is entirely reasonable to talk to your vet about how to manage without regular testing. What matters is that you understand the risks, and know what to look for in your particular dog. Contact your vet promptly if you see:

• Vomiting, or going off food
• Loose, dark or black stools
• A change in how much your dog drinks or urinates
• Unusual tiredness or dullness
• Yellow tinges to the gums, eyes or skin

A simple and cheap urine test- the specific gravity, can provide useful information about organ function.

Stopping pain relief because of a number, or because tests are out of reach, can swap a small and uncertain risk for a certain one, which is ongoing pain.

A simple diary can help: a note each day of appetite, energy, toileting and how stiff your dog is. It makes it much easier to spot a change, and to show your vet what is happening between appointments.

Stay calm and look at your dog. Raised liver enzymes are common in older dogs, and on their own they are rarely an emergency.

• Do not panic. If your dog is bright, eating well and moving more comfortably, a mild rise is usually something to recheck and understand, not something to act on in a hurry.
• Do not assume it is the drug. Older dogs often develop changes in the liver that have nothing to do with their medicines. These age-related changes, sometimes called old dog hepatopathy, can raise liver enzymes in dogs who are otherwise well. Blaming the pain relief can lead to stopping the very thing that is helping.
• Do not chase the numbers. A blood result is a snapshot, and it moves up and down. Treating the lab report rather than the dog can mean repeated tests, changed medicines and a dog who is back in pain. Your vet will look at the trend, and at how your dog is in themselves.
• Look at the dog. Appetite, energy, mobility, thirst, stools and the colour of the gums tell you far more than a single enzyme level.

The next sections explain what the enzymes mean, and how your vet decides whether to look further.

Is it liver disease?

Often it is not. Raised liver enzymes are common in older dogs, and many turn out to have a cause other than liver disease.

The liver is a busy organ that reacts to what is happening elsewhere in the body. Common reasons for raised enzymes include:

• Age-related changes in the liver (old dog hepatopathy), which are often harmless
• Medicines, including steroids, some anti-seizure drugs and, occasionally, pain relief
• Hormonal conditions such as Cushing's disease, an underactive thyroid or diabetes
• Illness elsewhere in the body, such as dental disease, pancreatitis, bowel inflammation or heart disease
• Primary liver disease, which is less common but important to rule out

Your vet will weigh up how high the numbers are, whether they are rising, and which enzymes are involved. They will also look at how your dog is in themselves, and at other results such as bilirubin and albumin.

A mild rise in a dog who is bright, eating well and moving comfortably is often simply rechecked in a few weeks. If the numbers stay up or climb, the next steps might include a test for liver function, such as a bile acid stimulation test.

Tell your vet promptly if you notice a change in drinking or appetite, vomiting, or  unusual tiredness.

Pain relief should not be dropped without a plan, because untreated arthritis pain is a welfare blocker: it has to be treated, not balanced out by the good parts of your dog's day.

The aim is to protect the liver where there is a real reason to, without leaving your dog in pain. Depending on your dog and the results, your vet might talk to you about:

• Carrying on with closer monitoring. If the rise is mild and your dog is well and comfortable, this is often a reasonable choice, with a recheck in a few weeks.
• Changing the medicine. Dogs respond differently to different anti-inflammatories, and swapping to another type often works well. Newer, more targeted options such as grapiprant might be a better choice.
• A different kind of pain relief. If anti-inflammatories genuinely cannot be used, or are not enough on their own, there are other options. These include medicines that work in different ways and are processed differently by the body.
• Add-on pain relief. Combining treatments can sometimes control pain well while using less of any one medicine.
• Looking again at other medicines. If your dog takes other drugs that can raise liver enzymes, those may be part of the picture.
• Everyday measures that take pressure off the joints. Keeping your dog at a lean weight, gentle regular exercise, physiotherapy or hydrotherapy, non-slip floors, ramps and supportive bedding all help, and they do not depend on the liver at all.

Whichever route is chosen, a few principles keep things safe and clear. Make one change at a time so you can see what is working. Agree a monitoring plan with your vet that works for you and your dog. 

Yes, there can be. They work best as a support for the liver alongside effective pain relief, never as a replacement for it.

Your vet may suggest a liver support product if enzymes are raised. Ingredients such as SAMe and silybin (milk thistle) are commonly used for this. The evidence is more limited than for the medicines themselves, but this is one situation where I am happy to recommend a good quality supplement.

A few things are worth keeping in mind:

• Choose a veterinary product, and check it with your vet before starting. Some supplement products have been shown to have low levels of active ingredients, so quality matters.
• Tell your vet about everything your dog takes, so nothing is doubled up or clashes.
• Be wary of hard-sell marketing on social media, which often uses fear to steer people away from effective, prescribed treatment. Advice that pushes you away from effective pain relief is harmful, and the people giving it should not be trusted with your dog's health.

It can help to bring a few questions to your next appointment, or to write them down beforehand:

• How comfortable is my dog, and how well controlled is their pain?
• What do these results mean for my dog in particular, is there a trend we should watch for?
• If you are suggesting a scan or further tests, what do you expect them to show, and what might change in how we manage my dog?
• If a biopsy is being considered, what are the risks and benefits, and what are you expecting to find?
• Could any of my dog's medicines or supplements be contributing?
• What are the benefits and risks of continuing the current pain relief, compared with the alternatives?

Being told that your older dog has liver changes on a blood test can be frightening. It is natural to worry about what it means, to wonder whether the medicine is to blame, and to fear that you may have to choose between your dog's comfort and their health. Understanding what the result does and does not mean, and keeping your focus on how your dog is feeling day to day, can make it feel much less daunting.

If you would like help thinking it through, a second opinion can bring that clarity. We can look at the results, the pain relief options and the risks and benefits for your dog, and help you prepare for the conversation with your own vet.

Book a free introductory chat or find out about a Clarity Consult.