Cats, arthritis and kidney disease

If your older cat has stopped jumping onto the sofa or the windowsill, or now takes a roundabout route via a chair to reach their favourite spots, they may well have arthritis, which is extremely common in older cats and shows up as a change in what they do rather than as limping. 

They might sleep more, hesitate before jumping up and especially down, groom less, or simply not bother with the places they used to love. 

Only a vet can confirm it, usually from an examination and sometimes X-rays, but you can start helping straight away with easy routes to their favourite places and warm, low beds, and by asking your vet about pain relief, which can make a real difference even when a cat also has kidney disease, as many older cats do. 

The rest of this blog is about how to weigh up that decision.

X-ray studies have found signs of arthritis in most older cats, with figures of around 80 to 90 percent in cats over 12 often quoted, but very few are diagnosed or treated. 

Cats rarely limp, so the signs are changes in what they do. They may sleep more or hide away, not jump up, and especially not jump down, find other routes to their favourite places, or stop going to them at all. 

Some cats groom less and get a scruffy or matted coat over the back and hips, some miss the litter tray because the edge is hard to step over, and some become grumpy about being stroked or picked up. 

Most owners put these changes down to old age, which is understandable.

Typically not. Many cats are diagnosed from the vet examination, which usually finds a restricted range of movement and discomfort when a joint is moved, along with what you have seen at home. 

How a cat responds to treatment helps too, because if they become more active and go back to their favourite places once their pain is treated, that tells us the pain was there. 

X-rays can help in some cats, but they usually require sedation or a short anaesthetic and what they show doesn't always match how much pain a cat is in.

I would be confident to treat without x-ray on the basis of a "presumptive" diagnosis i.e. all the evidence points that way. This is because my first priority is to treat pain that is likely to be affecting your cat's quality of life.

I think of quality of life as a balance between the good and bad things in a cat's day. A warm bed, a favourite person and a sunny spot all add to the good side, but some things can't be made up for in this way, and pain is one of them. 

I call these welfare blockers, because while a cat is in pain the good things can't do their job properly, so pain needs to be treated in its own right rather than accepted as part of getting old.

Many older cats with arthritis also have some kidney disease, often early and not yet diagnosed, and the 2024 ISFM and AAFP guidelines on long-term NSAID use report that up to 69% of cats with degenerative joint disease also have chronic kidney disease. 

Traditionally the most effective drugs for arthritis pain were NSAIDs, usually meloxicam, and these carry warnings about the kidneys, so quite often the pain relief was never started. The worry is a real one but it is often overstated, and it is a shame when a cat is left in pain, because NSAIDs can still be used with care, since the kidney risk can be checked for, monitored and managed, whereas the pain is there every day and affects how a cat lives. 

There is now also a newer drug, frunevetmab, which works differently from an NSAID, so there really is no excuse for leaving a cat with arthritis in pain, and I go through both options below.

Pain relief comes first, and supplements are add-ons that sit alongside it and never replace it, because they are not enough on their own and a cat with arthritis who is only on supplements or a special diet is very likely still in pain. 

Supplements are classed as feed, so they are checked for safety and labelling but they don't have to prove they work, and they are not allowed to claim that they do, which means nobody has to show that a supplement relieves arthritis pain before it is sold, and the same rules apply whether the product is for a dog or a cat. 

I don't want to completely dismiss them, as they may be a useful part of the picture once the pain is being treated. The guidelines say a systematic review found evidence to support omega-3 supplements and omega-3-enriched diets in cats with arthritis, and that joint diets may help too, so these are the ones I'd look at first.

Note that if your cat has kidney disease, a prescription kidney diet has good evidence that it helps cats live longer, so it may well matter more than any joint supplement.

Arthritis is slowly progressive, and every month spent waiting for a supplement to start working is another month of pain for a cat who could have been more comfortable, and with NSAIDs still available and frunevetmab now an option there is no reason to rely on supplements. 

It's also genuinely hard to tell by eye whether something is working, because we all want it to, so a cat who seems brighter after starting a supplement isn't evidence, whoever is telling you. Keeping them lean helps their joints, although in a cat with kidney disease I'd take care over weight loss because losing muscle is a worry in its own right, so it is important to talk to your vet. 

And if you are giving a supplement, please do tell your vet, so they know the whole picture.

Frunevetmab (Solensia) is a monthly injection that blocks nerve growth factor, which is involved in arthritis pain, and because it works differently from an NSAID it is a very good place to start in many cats, particularly when there are worries about the kidneys. 

The 2024 ISFM and AAFP guidelines recommend anti-NGF antibodies, like NSAIDs, as first-line treatment for arthritis in cats. It is a newer drug but the guidelines and the published evidence  are encouraging. 

There are still gaps, though, and the guidelines point out that long-term studies beyond six months are needed, that there is limited published data in cats with arthritis and kidney disease together, and that adverse effects can include skin problems such as dermatitis, hair loss and itching. 

It also has to be given monthly, which adds to the cost, and for a cat who hates the carrier and the clinic a monthly visit can be a welfare cost in itself.

That is why meloxicam still has an important place. If a cat won't tolerate monthly visits, or if frunevetmab hasn't given enough relief, an NSAID given at home is a good alternative, and as set out below the guidelines support its use in cats with stable kidney disease. I'd want your vet to go through the pros and cons with you for your own cat.

The 2024 ISFM and AAFP consensus guidelines on the long-term use of NSAIDs in cats, written by an international panel, say that meloxicam and robenacoxib have strong evidence of safety and efficacy for arthritis pain, including in cats with stable, early kidney disease, and that cats with stable kidney disease may be treated with an NSAID depending on an individual assessment of the cat and good support for the person caring for them. The ideal cat has stable kidney disease at IRIS stage 1, 2 or 3, is well hydrated, is eating and drinking well and has normal blood pressure, while NSAIDs should be avoided if the kidney disease is advanced or progressing, or if they are dehydrated or have low blood pressure. The panel is also open about the limits of the evidence. Some of the encouraging findings come from retrospective studies, such as one in which cats with kidney disease on long-term meloxicam lived a median of 18.6 years, and the one prospective trial found no change in kidney excretory function over six months but more protein in the urine of the cats given meloxicam. Their conclusion is that the risks and benefits should be discussed with you, and that the aim is to relieve pain with the lowest risk of side effects.

Gabapentin is often prescribed for arthritis in cats with kidney disease, and I understand why, but the evidence that it relieves arthritis pain isn't strong and it wouldn't be my first choice. 

The guidelines describe one small placebo-controlled study of 20 older cats with arthritis, in which gabapentin reduced activity, with sedation the most common side effect, while improving some impaired activities, and some cats were wobbly, weak or had muscle tremors. It may also lower blood pressure, including in cats with kidney disease. 

It is good for anxiety, and a dose before a vet visit can make the trip much less frightening for a cat, although it can affect gait, which matters when the vet is checking their nervous system. 

Making it easy to reach the places they love can make a big difference, and the guidelines suggest steps, ramps or pieces of furniture so they can get to beds, sofas and perches, with non-slip surfaces where they walk. 

A litter tray with a low side, raised food and water bowls, and warm beds or safe, non-electrical self-warming heat pads all help cats with sore joints, and the way down matters as much as the way up. 

Gentle grooming helps with places they can no longer reach, and their nails may need checking more often. 

These changes work alongside pain relief and are not a replacement for it. 

If any of this sounds like your cat, write down things they used to do and no longer do, with a rough date for when you noticed, and take that to your vet, asking whether it could be pain and what could be done about it.

Every cat is an individual and it is imperative that you speak to your own vet about your cats care, this blog can only provide general guidance.

You're not a bad owner for missing things, because cats hide pain very well and you are the person who knows what has changed. 

If you would like a second opinion on a cat with complex conditions, or would like to take a deeper look at their quality of life where the choices feel difficult, that is what Pet Lighthouse is for.

You can book a free introductory chat below.