What Is The LOAD Questionnaire
LOAD (Liverpool Osteoarthritis in Dogs) is the validated owner-completed questionnaire for tracking canine osteoarthritis severity and treatment response.
Developed by Hercock et al. 2009 (Veterinary Record) and shown sensitive to clinical change by Walton et al. 2013 (PLoS One).
Key features:
- 13 items scored 0-4 (none / mild / moderate / marked / severe)
- Total range 0-52
- Severity tiers: mild (0-10), moderate (11-20), marked (21-30), severe (31-52)
- MCID (Minimum Clinically Important Difference) = 4 POINTS — change ≥4 represents real clinical improvement detectable by owners
When To Use LOAD
| Timing | Purpose |
|---|---|
| At OA diagnosis | Establish baseline |
| 4-6 weeks after any treatment change | Assess response — has it dropped ≥4 points? |
| Every 3-6 months once stable | Track for progression |
| Any time signs change | Quantify the change |
Use the SAME observer (one consistent person in household) for valid longitudinal comparison.
Interpreting LOAD Scores
Severity Tiers
| LOAD Score | Tier | Typical management |
|---|---|---|
| 0-10 | Mild / subclinical | Weight management + lifestyle |
| 11-20 | Moderate | + NSAID + adjuncts |
| 21-30 | Marked | Multimodal pharmacology + physio + injections |
| 31-52 | Severe | All above + QoL conversation |
Treatment Response (MCID = 4 Points)
| Change | Interpretation |
|---|---|
| ≥4 point reduction | Significant improvement — treatment working |
| 2-3 point reduction | Mild improvement — below MCID but real |
| ±2 points | Stable |
| 2-4 point increase | Mild deterioration — reassess |
| >4 point increase | Significant deterioration — escalate / re-examine |
Weight Management – The #1 Intervention
The Kealy et al. 2002 Purina Lifespan Study showed lean BCS dogs lived ~1.8 years longer and developed OA 2-3 years later than overweight littermates.
Marshall et al. 2010 demonstrated significant LOAD improvement with weight loss alone in OA dogs — independent of medication.
Realistic target: BCS 4-5/9; weight loss 1-2% body weight per week using a prescription weight-loss diet calibrated to RER of TARGET weight (see PuppaDogs Ideal Weight Calculator).
The Multimodal Pharmacology Toolkit
NSAIDs (First-Line)
Evidence-based core treatment:
- Carprofen (Rimadyl, Carprieve) — see PuppaDogs Carprofen Calculator
- Meloxicam (Loxicom, Metacam) — see PuppaDogs Loxicom Calculator
- Robenacoxib (Onsior)
- Firocoxib (Previcox) — see PuppaDogs Previcox Calculator
- Mavacoxib (Trocoxil) — monthly dose, EU primarily
- Grapiprant (Galliprant) — EP4 antagonist, gentler GI/renal profile — see PuppaDogs Galliprant Calculator
Monitoring: CBC + biochemistry baseline and at 30 days, 90 days, then every 6 months. Watch for GI signs, renal function, hepatic enzymes.
Anti-NGF (Librela / Bedinvetmab)
Recent dramatic addition to canine OA toolkit:
- Monthly subcutaneous injection
- Anti-nerve growth factor monoclonal antibody
- Excellent for NSAID-contraindicated dogs (CKD, hepatic disease, GI history)
- See PuppaDogs Librela Calculator
Adjunctive Analgesia
Gabapentin (Neuropathic Pain)
5-15 mg/kg PO q8-12h — addresses neuropathic / central component of chronic pain.
Amantadine (Central Sensitisation)
3-5 mg/kg PO q24h — NMDA antagonist, helpful in chronic OA where central sensitisation contributes.
Tramadol
Limited evidence in dogs — Budsberg 2018 RCT found no significant analgesic effect superior to placebo in canine OA. Many specialists now prefer gabapentin + amantadine.
Joint Injections
- PSGAG (Adequan) — IM injections — see PuppaDogs Adequan Calculator
- Hyaluronic acid intra-articular
- PRP (platelet-rich plasma) — emerging evidence
- Stem cells — variable evidence quality
Physical Therapy
- Hydrotherapy / underwater treadmill — excellent for OA
- Therapeutic exercises — strengthen supporting muscles
- Laser therapy — some evidence
- Acupuncture — variable evidence; some response in some dogs
Joint Supplements
- Omega-3 fish oil — best evidence among supplements
- Green-lipped mussel (Perna canaliculus) — some evidence
- Glucosamine / chondroitin — variable evidence, generally safe
See PuppaDogs Omega-3 Calculator and Glucosamine Calculator.
Home Environment Modifications
| Modification | Benefit |
|---|---|
| Non-slip surfaces (rugs, yoga mats, gripper socks) | Reduces slip injuries |
| Ramps vs stairs | Vehicle entry/exit, raised furniture |
| Orthopaedic memory-foam bed | Better joint support |
| Raised food/water bowls | Reduce neck/back strain |
| Easy-access bedroom | Avoid stairs where possible |
| Controlled exercise | Regular short walks > infrequent long |
| Avoid high-impact | No frisbee, fast direction changes |
| Swimming | Zero impact, full range of motion |
| Warmth | Jackets in cold, no draughts |
Exercise For OA Dogs
Principles:
- Regular and consistent > weekend warriors
- Low impact > high impact
- Multiple short sessions > long single session
- Avoid abrupt direction changes
- Swimming excellent if available
- Hydrotherapy professional supervision ideal
Breed Considerations
High Hip/Elbow Dysplasia Breeds
Labrador, Golden, German Shepherd, Rottweiler, Bernese, Newfoundland, Saint Bernard — OA often hip + elbow + sometimes shoulder. Specialist orthopaedic exam + radiographs identify primary joint disease. Some have surgical options (TPLO, hip replacement, fusion).
Chondrodystrophic Breeds
Dachshund, Basset, Corgi — predisposed to back problems (IVDD) alongside limb OA. Differentiate carefully — back pain may present as “reluctance to jump” or “stiffness” attributed to limb OA. See PuppaDogs IVDD Calculator.
Cavalier King Charles
Screen for syringomyelia / Chiari-like malformation — phantom scratching, neck pain, neurological signs can mimic or coexist with OA. MRI for atypical cases.
When To Escalate / Re-Examine
- Rapid worsening (>4 LOAD points in <3 months)
- Failure to respond to first-line treatment after 4-6 weeks at optimal dose
- New lameness pattern (new joint, worse on one side)
- Concurrent illness (especially when on NSAIDs — check kidney/liver)
- Concerning signs — lameness with fever (septic arthritis, immune-mediated polyarthritis)
- Declining quality of life despite multimodal treatment — see PuppaDogs Quality of Life Calculator
Severe OA – End-Of-Life Considerations
When LOAD scores remain >30 despite multimodal treatment, quality of life conversation is appropriate.
Use PuppaDogs Villalobos QoL Calculator for objective ongoing assessment.
Better to make decision before final crisis where possible — when a dog has more good days than bad, family can prepare and dog can have peaceful end at home or planned vet visit.
Honest Caveats
- LOAD is owner-reported — observer bias inevitable; same observer matters
- MCID of 4 is for owner-detectable improvement — smaller improvements may still be clinically meaningful
- Disease can progress despite stable LOAD scores — radiographic progression and LOAD do not always correlate
- Comorbidities affect mobility and LOAD scores — concurrent neurological disease, cardiac disease, fatigue can confound
- Some dogs are stoic — under-report pain; objective measures (force plate, accelerometry) may capture more
- This is a monitoring tool, not a diagnostic — diagnosis of OA requires veterinary examination + imaging
Conclusion
The LOAD questionnaire is the validated tool for tracking canine osteoarthritis severity and treatment response. Total 0-52 scored across 13 owner-rated items. Tier categorisation (mild/moderate/marked/severe) and the 4-point MCID for response provide objective framework for treatment decisions. Weight management is the single most effective intervention — even 10% weight loss substantially improves LOAD scores. Multimodal pharmacology — NSAIDs + Librela + gabapentin + amantadine + joint injections + physiotherapy + supplements — combined with environment modifications and appropriate exercise maximises function. Repeat LOAD every 4-6 weeks during treatment adjustment, every 3-6 months when stable, with the same observer for valid longitudinal comparison.
Frequently Asked Questions
What is the LOAD questionnaire for dog arthritis?
LOAD (Liverpool Osteoarthritis in Dogs) is the validated owner-completed questionnaire for tracking canine osteoarthritis severity and treatment response. Developed by Hercock et al. 2009 Veterinary Record, validated for sensitivity to change by Walton et al. 2013 PLoS One. 13 items scored 0-4 (none/mild/moderate/marked/severe) for total 0-52. Severity tiers: 0-10 mild; 11-20 moderate; 21-30 marked; 31-52 severe. Minimum clinically important difference (MCID) = 4 POINTS – change of 4 or more represents real clinical improvement detectable by owners. Use baseline at OA diagnosis, then every 4-6 weeks during treatment adjustment, every 3-6 months when stable.
Is my dog’s arthritis getting worse or better?
Use LOAD score change. MCID (Minimum Clinically Important Difference) = 4 POINTS per Walton 2013. Reduction of 4 or more points = SIGNIFICANT IMPROVEMENT (treatment working). 2-3 point reduction = mild improvement below MCID. Plus or minus 2 points = STABLE. 2-4 point increase = mild deterioration, reassess. More than 4 point increase = SIGNIFICANT DETERIORATION, escalate treatment or re-examine. Use the SAME observer (one consistent person in household) for valid longitudinal comparison. Single LOAD score gives severity tier; SERIAL LOAD scores give response.
What is the best treatment for dog osteoarthritis?
MULTIMODAL approach evidence-based. (1) WEIGHT MANAGEMENT is the SINGLE MOST EFFECTIVE intervention – Marshall 2010 showed significant LOAD improvement with weight loss alone; Kealy 2002 showed lean dogs lived about 1.8 years longer and OA onset 2-3 years later. (2) NSAIDs first-line – carprofen, meloxicam, robenacoxib, firocoxib, mavacoxib, Galliprant – all evidence-based. (3) LIBRELA (bedinvetmab) anti-NGF monthly injection – dramatic recent addition. (4) ADJUNCTIVE – gabapentin 5-15 mg/kg for neuropathic; amantadine 3-5 mg/kg for central sensitisation. (5) JOINT INJECTIONS Adequan/HA/PRP. (6) PHYSIOTHERAPY/hydrotherapy. (7) ENVIRONMENT modifications – non-slip, ramps, orthopaedic bed, raised bowls. Combination amplifies effect.
Does my dog need NSAID for arthritis?
Depends on severity. MILD OA (LOAD 0-10) often managed with WEIGHT MANAGEMENT + LIFESTYLE + supplements alone. MODERATE OA (LOAD 11-20) typically benefits from NSAID. MARKED-SEVERE (LOAD 21+) usually multimodal with NSAID as foundation. NSAID monitoring critical – baseline CBC + biochemistry; recheck 30 days, 90 days, then every 6 months. Watch for GI signs (vomiting, diarrhoea, melaena), renal function (creatinine, BUN, USG), hepatic enzymes (ALT). NSAID contraindicated in CKD, severe hepatic disease, dehydration, concurrent corticosteroids. ALTERNATIVE if NSAID contraindicated – LIBRELA (bedinvetmab) anti-NGF monthly injection works well; gabapentin/amantadine adjunct.
Should I give my arthritic dog joint supplements?
VARIABLE EVIDENCE BASE for joint supplements. BEST EVIDENCE – OMEGA-3 fish oil (multiple RCTs show LOAD improvement; PuppaDogs Omega-3 calculator). MODERATE EVIDENCE – GREEN-LIPPED MUSSEL (Perna canaliculus); some RCTs show benefit. WEAKER EVIDENCE – GLUCOSAMINE/CHONDROITIN – some studies show benefit, others negative; generally SAFE so often used. LIMITED EVIDENCE for many proprietary blends. Supplements are ADJUNCTS – not replacement for weight management + appropriate pharmacology in moderate-severe disease. Discuss specific products with vet; quality control of supplements is variable. Reputable brands with veterinary involvement (Antinol, Synovan, YuMove etc.) generally have better quality control.
When should I consider euthanasia for arthritic dog?
Discuss with vet when QUALITY OF LIFE substantially declines DESPITE optimal multimodal treatment. Useful objective tools: VILLALOBOS QoL CALCULATOR (PuppaDogs) – 7 domains scored 0-10; total over 35 of 70 = acceptable QoL; under 35 = concerning. LOAD over 30 (severe tier) despite multimodal therapy is also informative. Specific QoL flags: cannot rise without significant pain or assistance; cannot toilet without help; cannot enjoy any of previous activities; more bad days than good days; signs of suffering or distress that medications cannot adequately control. BETTER TO DECIDE BEFORE FINAL CRISIS where possible – allows planned peaceful end at home or vet visit with family present, rather than emergency decision. Discuss with vet, family, sometimes pet bereavement counsellor.
Related PuppaDogs Calculators
Continue building your dog’s personalised care plan with these related PuppaDogs calculators:
- Dog Pregnancy / Whelping Due-Date Calculator
- Puppy Weight Predictor (Adult Weight Calculator)
- Heatstroke Risk Calculator for Dogs
- Bloat (GDV) Risk Calculator for Dogs
- Dog Life Expectancy Calculator (Breed, Body Condition, Lifestyle)
- Spay/Neuter Timing Calculator for Dogs (Breed-Specific)
References & Further Reading
The dosing ranges and safety information on this page are drawn from the following veterinary references. Always defer to your own veterinarian and the manufacturer’s label for your specific product.
- Hercock CA, Pinchbeck G, Giejda A, Clegg PD, Innes JF. Validation of a client-based clinical metrology instrument for the evaluation of canine elbow osteoarthritis. Veterinary Record, 2009.
- Walton MB, Cowderoy E, Lascelles D, Innes JF. Evaluation of construct and criterion validity for the Liverpool Osteoarthritis in Dogs (LOAD) clinical metrology instrument and comparison to two other instruments. PLoS One, 2013.
- Marshall WG, Hazewinkel HA, Mullen D, et al. The effect of weight loss on lameness in obese dogs with osteoarthritis. Veterinary Research Communications, 2010.
- Kealy RD, Lawler DF, Ballam JM, et al. Effects of diet restriction on life span and age-related changes in dogs. JAVMA, 2002.
- Budsberg SC, Torres BT, Kleine SA, et al. Lack of effectiveness of tramadol hydrochloride for the treatment of pain and joint dysfunction in dogs with chronic osteoarthritis. JAVMA, 2018.
- Lascelles BDX, Brown DC, Maixner W, Mogil JS. Spontaneous painful disease in companion animals can facilitate the development of chronic pain therapies for humans. Osteoarthritis and Cartilage, 2018.
- PuppaDogs. Carprofen, Loxicom, Galliprant, Previcox, Librela, Adequan, Glucosamine, Omega-3, Gabapentin Calculators. puppadogs.com.
