Introduction Human frailty has long been studied and dozens of "frailty scales" have been developed, but equivalent research is more limited in cats. This pilot study aimed to determine the feasibility of recruiting and retaining veterinary practices and owners, collecting study data, and analyzing results about frailty in older cats.Methods Participating feline-exclusive practice veterinarians recruited cats aged 11-20 years, of either sex and of any breed. Owners completed a questionnaire about their cat and estimated its frailty. Study veterinarians also estimated the cat's frailty after obtaining a history, conducting a physical examination, and completing a separate questionnaire. The derived variables were used to investigate the following domains of frailty: (1) cognitive function; (2) behavior; (3) activity; (4) body weight; (5) body condition score; (6) muscle condition score; (7) any unexplained changes in weight, cognitive function, or eating behavior; and (8) the number of chronic diseases identified in the cat. Some cats were followed prospectively for 6 months, and mortality during this period was compared with frailty status, as determined by the veterinarian.Results Half (6/12) of the veterinary practices invited to participate successfully recruited 273 owner-cat pairs, with baseline questionnaire results obtained from 189 owners (69%) and veterinarian questionnaires obtained for 210 cats (77%). Of 122 cats having both owner and veterinarian questionnaire results, 45 (37%) were classified as frail by the owner and 51 (42%) by the veterinarian, with 28 (23%) classified as frail on both questionnaires. Of the cats with follow-up data, 13 of the 64 cats (20%) reported by veterinarians to be frail died or were euthanased during the 6-month follow-up, compared with only 1 of 54 cats (2%) that were not reported to be frail (Fisher's exact test P = 0.003).Discussion Developing a brief feline frailty questionnaire (FFQ) was feasible, and the results of such assessments were associated with 6-month mortality. A larger definitive trial should be considered to explore further the (dis)agreement between owners and veterinarians and better understand which frailty signs owners might be missing.

The robust advances in pain management for companion animals underlie the decision of AAHA and AAFP to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines for Dogs and Cats. The 2015 guidelines summarize and offer a discriminating review of much of this new knowledge. Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian-clientpatient relationship. The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual-patient basis. The guidelines include both pharmacologic and nonpharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention, and treatment of pain in animals. Postsurgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Degenerative joint disease is one of the most significant and under-diagnosed diseases of cats and dogs. Degenerative joint disease is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidencebased strategies for management are established in dogs, and emerging in cats. These guidelines support veterinarians in incorporating pain management into practice, improving patient care. (J Am Anim Hosp Assoc 2015; 51:67–84. DOI 10.5326/JAAHA-MS-7331) From the Total Bond Veterinary Hospitals PC, Gastonia, NC (M.E.); Cat Care Clinic and Feline-Friendly Consultations, Madison, WI (I.R.); Veterinary Teaching Hospital, Colorado State University School of Veterinary Medicine, Fort Collins, CO (G.G.); Pet Crossing Animal Hospital & Dental Clinic, Bloomington, MN (J.K.); Arbor Pointe Veterinary Hospital/Animal Pain Center, Canton, M.I. (M.P.); Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI (S.R.); and Morrisville Cat Hospital, Morrisville, NC (W.S.). Correspondence: mark.epstein@totalbondvets.com (M.E.) AAHA, American Animal Hospital Association; AAFP, American Association of Feline Practitioners; AE, adverse event; CKD, chronic kidney disease; CMI, clinical measurement instrument; CRI, constant rate infusion; COX, cyclooxygenase; DJD, degenerative joint disease; GI, gastrointestinal; LA, local anesthetic; MPS, myofascial pain syndrome; NSAID, nonsteroidal anti-inflammatory drug; OA, osteoarthritis; PSGAG, polysulfated glycosaminoglycan; SS(N)RI, selective serotonin (norepinephrine) reuptake inhibitor; TCA, tricyclic antidepressant; QOL, quality of life *These guidelines were prepared by a task force of experts convened by the American Animal Hospital Association and the American Association of Feline Practitioners for the express purpose of producing this article. These guidelines are supported by a generous educational grant from Abbott Animal Health, Elanco Companion Animal Health, Merial, Novartis Animal Health, and Zoetis, and are endorsed by the International Veterinary Academy of Pain Management. They were subjected to the same external review process as all JAAHA articles. Q 2015 by American Animal Hospital Association JAAHA.ORG 67

Rationale: The robust advances in pain management for companion animals underlie the decision of the American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines. The 2015 Guidelines summarize and offer a discriminating review of much of this new knowledge.Relevance: Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian-client-patient relationship. These Guidelines support veterinarians in incorporating pain management into practice, improving patient care.Approaches: The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual patient basis. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention and treatment of pain in animals.Evidence base: The Guidelines include both pharmacologic and non-pharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. Post-surgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Chronic pain is dominated by degenerative joint disease (DJD), which is one of the most significant and under-diagnosed diseases of cats and dogs. DJD is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats.

IntroductionDegenerative joint disease and associated pain are common in cats, particularly in older cats. There is a need for treatment options, however evaluation of putative therapies is limited by a lack of suitable, validated outcome measures that can be used in the target population of client owned cats. The objectives of this study were to evaluate low-dose daily meloxicam for the treatment of pain associated with degenerative joint disease in cats, and further validate two clinical metrology instruments, the Feline Musculoskeletal Pain Index (FMPI) and the Client Specific Outcome Measures (CSOM).MethodsSixty-six client owned cats with degenerative joint disease and owner-reported impairments in mobility were screened and enrolled into a double-masked, placebo-controlled, randomized clinical trial. Following a run-in baseline period, cats were given either placebo or meloxicam for 21 days, then in a masked washout, cats were all given placebo for 21 days. Subsequently, cats were given the opposite treatment, placebo or meloxicam, for 21 days. Cats wore activity monitors throughout the study, owners completed clinical metrology instruments following each period.ResultsActivity counts were increased in cats during treatment with daily meloxicam (p<0.0001) compared to baseline. The FMPI results and activity count data offer concurrent validation for the FMPI, though the relationship between baseline activity counts and FMPI scores at baseline was poor (R-2=0.034). The CSOM did not show responsiveness for improvement in this study, and the relationship between baseline activity counts and CSOM scores at baseline was similarly poor (R-2=0.042).ConclusionsRefinements to the FMPI, including abbreviation of the instrument and scoring as percent of possible score are recommended. This study offered further validation of the FMPI as a clinical metrology instrument for use in detecting therapeutic efficacy in cats with degenerative joint disease.

The robust advances in pain management for companion animals underlie the decision of AAHA and AAFP to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines for Dogs and Cats . The 2015 guidelines summarize and offer a discriminating review of much of this new knowledge. Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian-client-patient relationship. The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual-patient basis. The guidelines include both pharmacologic and nonpharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention, and treatment of pain in animals. Postsurgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Degenerative joint disease is one of the most significant and under-diagnosed diseases of cats and dogs. Degenerative joint disease is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats. These guidelines support veterinarians in incorporating pain management into practice, improving patient care.

Medical records where tepoxalin (Zubrin) or meloxicam (Metacam) were prescribed in cats were reviewed and data extracted. Comparisons were performed for exploring changes between pre- and post-non-steroidal anti-inflammatory drug course laboratory tests. Seventy-nine medical records fit the inclusion criteria (n = 57 and n = 22, tepoxalin and meloxicam, respectively). The median dosages administered were 13 and 0.029 mg/kg / day (tepoxalin and meloxicam, respectively). Median prescription durations were 11 (2–919) and 93 (4–1814) days for tepoxalin and meloxicam, respectively. Suspected adverse events were reported for tepoxalin (9%, 5/57 cats) and meloxicam (18%, 4/22 cats) a median of 774 and 448 days, respectively, after the prescription started. For cats prescribed meloxicam, there were several statistically significant changes for serum biochemistry and hematology parameters, but median values were within normal limits. These valuable clinical data suggest that tepoxalin and meloxicam are well tolerated in the clinical setting at the doses prescribed in this study.

OBJECTIVEThe current prevalence of onychectomy (declawing) in cats is unknown, and education regarding the procedure appears to vary greatly among veterinary schools. The purpose of this project was to determine the prevalence of onychectomized cats near Raleigh, NC and to document the frequency and style (laboratory or lecture) with which the procedure is taught in USA veterinary schools.ANIMALSOne thousand seven hundred ninety four cats ranging in age from 8 days to 21 years, of which 938 (52.3%) were female and 1719 (95.8%) were sterilized.METHODSData were collected over a 10-week period regarding cats seen for appointments in five veterinary facilities (two cat-only, two general, and one tertiary). Data collection included signalment and onychectomy status. During this time, 28 veterinary schools were polled regarding education of veterinary students in onychectomy.RESULTSThree hundred and seventy four (20.8%) cats had undergone onychectomy. A significantly higher percentage of declawed cats were seen in the general practices compared with the other practice types (p < 0.030). Younger cats had a higher rate of onychectomy (p < 0.001). Twenty-six veterinary schools responded to the survey (93%). Fourteen (54%) of the responding schools did not include in their core curriculum a lecture or surgical laboratory providing instruction in the onychectomy procedure.CONCLUSIONS AND CLINICAL RELEVANCEAlmost 21% of cats seen in veterinary hospitals near Raleigh, NC were declawed. Less than 50% of veterinary schools in the USA include a mandatory lecture or laboratory to teach the procedure. There appears to be a discrepancy between the popularity of the onychectomy procedure and the emphasis placed on relevant instruction in veterinary schools in the USA.

This study evaluated the types of items owners consider important to their cats' quality of life (QoL). We hypothesized that items contributing to QoL in cats are predominantly items requiring mobility. The objectives of the study were to describe the types of items considered important by owners for their cats' QoL; to describe the proportion of these items that involve mobility; to evaluate what patient factors, including severity of degenerative joint disease (DJD), affect this distribution; and to evaluate whether the proportion of QoL items involving mobility chosen by owners is different in cats presenting for a DJD study compared with a randomly selected population. A total of 830 client-generated items were evaluated. Regardless of DJD status, 40% of items listed by owners involved mobility, while 60% were 'inactive' items, rejecting our hypothesis. This highlights the need to assess non-active items that owners consider to constitute QoL to fully assess the impact of diseases like DJD and, therefore, the success of therapeutic interventions.

OBJECTIVE:To determine the prevalence of radiographic signs of degenerative joint disease (DJD) in a randomly selected sample of domestic cats.STUDY DESIGN:Prospective observational study.ANIMALS:Client-owned cats.METHODS:Cats (n=100) from a single practice and equally distributed across 4 age groups (0-5; 5-10; 10-15, and 15-20 years old) were randomly selected (regardless of heath status) and sedated for orthogonal radiographic projections of all joints and the spine. Quasi-Poisson regression analysis was used to investigate the relationship between patient demographics, blood biochemistry, hematologic and urine analysis variables, and DJD severity.RESULTS:Most (92%) cats had radiographic evidence of DJD; 91% had at least 1 site of appendicular DJD and 55% had > or = 1 site of axial column DJD. Affected joints in descending order of frequency were hip, stifle, tarsus, and elbow. The thoracic segment of the spine was more frequently affected than the lumbosacral segment. Although many variables were significantly associated with DJD, when variables were combined, only the association between age and DJD was significant (P<.0001). For each 1-year increase in cat age, the expected total DJD score increases by an estimated 13.6% (95% confidence interval: 10.6%, 16.8%).CONCLUSION:Radiographically visible DJD is very common in domesticated cats, even in young animals and is strongly associated with age.CLINICAL RELEVANCE:DJD is a common disease of domesticated cats that requires further investigation of its associated clinical signs.

OBJECTIVETo determine the items (question topics) for a subjective instrument to assess degenerative joint disease (DJD)-associated chronic pain in cats and determine the instrument design most appropriate for use by cat owners.ANIMALS100 randomly selected client-owned cats from 6 months to 20 years old.PROCEDURESCats were evaluated to determine degree of radiographic DJD and signs of pain throughout the skeletal system. Two groups were identified: high DJD pain and low DJD pain. Owner-answered questions about activity and signs of pain were compared between the 2 groups to define items relating to chronic DJD pain. Interviews with 45 cat owners were performed to generate items. Fifty-three cat owners who had not been involved in any other part of the study, 19 veterinarians, and 2 statisticians assessed 6 preliminary instrument designs.RESULTS22 cats were selected for each group; 19 important items were identified, resulting in 12 potential items for the instrument; and 3 additional items were identified from owner interviews. Owners and veterinarians selected a 5-point descriptive instrument design over 11-point or visual analogue scale formats.CONCLUSIONS AND CLINICAL RELEVANCEBehaviors relating to activity were substantially different between healthy cats and cats with signs of DJD-associated pain. Fifteen items were identified as being potentially useful, and the preferred instrument design was identified. This information could be used to construct an owner-based questionnaire to assess feline DJD-associated pain. Once validated, such a questionnaire would assist in evaluating potential analgesic treatments for these patients.

ObjectiveTo (1) determine prevalence of radiographically detectable meniscal mineralization in domestic cats and (2) to evaluate the association between meniscal mineralization and degenerative joint disease (DJD).Study DesignProspective study.AnimalsClient-owned cats (n=100) and 30 feline cadavers.MethodsRandomly selected client-owned cats were used to determine the prevalence of meniscal mineralization. Stifles from feline cadavers were used to evaluate the relationship between meniscal mineralization (using high-resolution X-ray), radiographic DJD, and cartilage damage. Menisci were evaluated histologically.ResultsForty-six percent of the client-owned cats had meniscal mineralization detected in 1 or both stifles. Pain scores were not significantly different between stifles with meniscal mineralization and those with no radiographic pathology (P=.38). Thirty-four of 57 cadaver stifles had meniscal mineralization, which was always located in the cranial horn of the medial meniscus. Percentage mineralization of the menisci was significantly correlated with the cartilage damage score of the medial femoral (r2=0.6; P <.0001) and tibial (r2=0.5; P <.0001) condyles as well as with the total joint cartilage damage (r2=0.36; P <.0001) score and DJD score (r2=0.8; P <.0001).ConclusionMeniscal mineralization is a common condition in domestic cats and seems to indicate medial compartment DJD.Clinical RelevanceClinical significance of meniscal mineralization is uncertain. Further work is needed to determine if the meniscal mineralization is a cause, or a consequence of joint degeneration.

BACKGROUND:Serum fructosamine (SF) concentrations depend on plasma glucose concentrations and are used to evaluate glycemic control in animals with diabetes mellitus (DM). Despite the strong association between obesity and DM, the effects of body weight (BW) and body condition on SF concentrations in clinically healthy cats have not been reported.OBJECTIVE:The aim of the study was to evaluate the effects of BW, body condition score (BCS), sex, and age on SF concentrations in healthy cats.METHODS:BW, BCS, and SF concentrations were determined in 84 clinically healthy client-owned cats (50 neutered males, 33 spayed females, and 1 intact female) of known age. The cats were enrolled prospectively in the study.RESULTS:Mean BW, median BCS, and mean SF concentrations for the 84 cats were 5.4 kg, 5/9, and 268.7 ± 45.5 μmol/L (range 197-399), respectively. BW was weakly but significantly correlated with SF (r=.26; P=.02), whereas BCS was not. Cats weighing >5.4 kg and cats with BCS>5/9 had higher mean SF concentrations compared with cats weighing <5.4 kg and cats with BCS <5/9, respectively. Cats categorized as normal weight to obese by BW (BW ≥ 4.0 kg) had higher mean SF concentrations compared with cats categorized as lean (BW< 4.0 kg). For domestic shorthair cats, the same was true for BCS: cats with BCS ≥ 4/9 had higher mean fructosamine concentrations than those with BCS<4/9. Male cats had significantly higher mean SF concentrations compared with female cats (285.1 ± 45.3 vs 244.5 ± 33.9 μmol/L, P<.001). Age did not affect mean SF concentrations.CONCLUSIONS:BW is positively correlated with SF concentration, and lean cats have lower SF concentrations than normal and obese cats. In contrast to previous reports, mean SF concentrations were higher in male cats than in female cats, even when males and females were matched based on BW, BCS, and age.