Thank you very much for coming to listen today to this webinar. We're going to be talking about the diagnosis and treatment of osteoarthritis in rabbits and guinea pigs. My name is Emma Keeble.
I'm one of the senior lecturers at Edinburgh Vet School. I teach, finally vet students there on rotation. We see a lot of first opinion.
And also referral cases. So, we'll be having a chat through this topic today and hopefully, you will learn a little bit about this condition in these species. So what do we know about osteoarthritis?
The problem with a lot of exotic animals is we really don't have the references or or research available, in pet animals to know why, these conditions occur and how to treat them. We do have quite a few references in a laboratory animal research, because rabbits and guinea pigs have been used to develop animal models for the study of arthritis in humans. So we have a lot of papers, that are quite sort of scientific.
We do have some radiographic scoring systems, that have been evaluated and then perhaps extrapolated to pet species, but again, not specific to rabbits and guinea pigs. And we do know, certainly in guinea pigs, there are some specific genetic lines where osteoarthritis can occur really from a very early age. The other thing that's a bit difficult with these species is that they are prey animals, and so they typically do tend to hide signs of pain, because obviously, if you think about it, you know, if in the wild they were to show pain, they'd probably be eaten.
So it's very difficult for us as vets and certainly for owners as well, to pick up sometimes on these, these painful conditions. And these can therefore go undiagnosed until they're really quite advanced, and that obviously is a cause for concern. But we are now a lot more aware of some of the conditions in these small species, in particular arthritis, and hopefully this will improve our welfare and care of these small pet species.
So, in this webinar, we're going to have a bit of a chat really about how to look at the clinical signs that might be associated with osteoarthritis, what you might be able to find on your clinical examination. And then moving on from that, we'll be looking at how you diagnose osteoarthritis, and looking at sort of pre prevention, treatment options, lifestyle changes. So we, there are a lot of things that we can do to help our pet rabbits and guinea pig cases with these conditions.
So I put about 6 learning objectives up. So hopefully, you will feel that, that these have been well covered and that you have learned a bit about this condition. And the main thing I think is, really being able to detect the subtle signs of early onset osteoarthritis.
And once we're concerned about the possibility of that, we need to know how we're going to actually, evaluate that animal and diagnose the condition. And following on from that, then we need to be able to give owners good advice about what the treatment options are available, what sort of lifestyle changes might be needed, and whether there are any preventative dietary supplements that we could recommend as well. So I thought it'd be helpful to sort of recap about what osteoarthritis is.
And I'm calling it osteoarthritis, that implies an inflammatory condition. So, sometimes this is more referred to as osteoarthrosis, if this is not actually inflammatory, but perhaps, you know, secondary to other factors. Either way, it is a progressive disorder of the joints and it affects the cartilage, within the joint.
What then happens is the Cartilage deteriorates, and so new bones starts to form at the the surface of the joint, and these are called osteophytes. And these basically a response to, you know, the changes within the joint. They're trying to stabilise that joint by producing more sort of calcification around it.
We do know, certainly in other, other animals and, and humans, it's often a multifactorial process. So it can be primary due to sort of spontaneous wear and tear, as you get older and older, or there could be a secondary specific cause. And, and often it's not sort of black and white.
We do know that genetics can play an important role. It might be that there's been a traumatic, event that's precipitated this arthritis. We know that with ageing, obviously, the joints can become, more arthritic as well.
So there are other, other possible, underlying causes for this condition developing. We're also now aware that there can be secondary factors like the diet of the animal, and we'll come on to talk about that a little bit later, and, and other husbandry factors. So, for example, if you have a very overweight animal, that's gonna put a lot more stress on those joints, and they're more likely that we would get arthritis developing.
If the animal is overweight, it might be sitting around more, more sort of sedentary, or it might be in pain with the arthritis is not able to move, so we get this, poo dermatitis developing. And certainly in guinea pigs, we're, we're, you know, very concerned about vitamin C deficiency because they can't produce their own. So they have to rely on dietary vitamin C.
So that could affect the joints as well. It affects the, the, collagen and the, and the cartilage of the joints, and you can get bleeding into the joints with that condition. We might also have problems with our substrate, we might have traumatic events, and we might also have an animal that's in a too small a cage.
Hopefully that's the thing of the past, but it's certainly inadequate exercise could also contribute. We see a lot of stifled joint arthritis in pet guinea pigs. It really is very, very common.
And what worries me is it's often not picked up, by the owner or by us as vets. So 11 sort of take home tip for today is start feeling your guinea pig knees, know what's normal, and know what's very grossly thickened, and know what the normal range of movements of those, those knees is as well in, in healthy young animals. And you will start picking this up on your clinical exam.
How common is it? You know, I'm talking about this as if it's something that we should be looking at every day on a day to day basis as vets in practise. Well, I, I think it actually is very, very common.
Certainly in rabbits, we're seeing it an awful lot, early, on in giant rabbit breeds, so things like continental giants. And In other animals and certainly in humans as well, we know that there is quite, quite a high incident as the animals get older. And in people, there's one study that looked at, you know, from the age of 65 years old, about 80% of the population have radiographic changes in at least one joint.
And I put pop the reference there for you if you're interested in looking that up. So we know that that it occurs. We do know that there are studies in particularly guinea pigs, looking at osteoarthritis in conjunction with vitamin C deficiency.
We also know that, osteoarthritis can really be a problem, particularly in the form of spondylosis of the spine in rabbits, even from as early as 24 months old. So this is something that, that we know is there. We have looked at a very small pilot study that we published.
Just an international conference recently, looking at the incidence of all our rabbits that were coming into the vet school, and about 61% of those radiographs were affected, and 100% of the guinea pig, radiographs we looked at had signs of osteoarthritis. So that's quite a concern. What are we going to see as vets?
And, and often, you know, may, maybe we're going to be talking to our owners, which is really important to get that good rapport, and they are telling us they're a bit worried. Or we might be able to say to the owners, can you keep an eye out for this? So, it is something that, that we as vets often don't pick up on.
And I've had sort of animals that we've been treating for chronic pain, that we then realised, yes, they've got really severe osteoarthritis. I think the problem for us is with guinea pigs, certainly in the UK, they're not routinely presented for clinical examination by vets, because we don't vaccinate them. Whereas in rabbits, we, we do, we have a yearly, vaccination.
So they do tend to come back in and we can pick up on these sorts of issues. But guinea pigs don't. So this is a real real worry.
And they often only come in once they've got issues, that are perhaps chronic and, and painful. So, basically, encourage your owners to know their pet, what's normal, what isn't. And I thought I'd show you this picture of, of my, pet rabbit, foreign.
Basically, you know, he quite regularly lies on his side, looking as if he's perhaps broken his spine. And this tends to give, you know, people. Who are walking past a bit of a shock and a worry.
But it's totally normal, relaxed behaviour. So you have to know what's normal and what isn't. And I think having that rapport with your clients and, and that really good relationship is very, very important, particularly with our little prey species, because they, the, the owners are the people who know, know their animal best.
What we're also finding is that rabbits and guinea pigs are living a lot longer than, than before because, you know, we've got some wonderful improved sort of husbandry. We know what sort of diet to put them on. And so we are seeing these sort of old age problems much more commonly.
So arthritis, I think, It is something I see much more these days. And I mentioned about them hiding signs of, of illness. So, you know, make sure you know what's normal, what isn't.
It can just be a very subtle change. Don't dismiss it, you know, listen to your owners, and, and act on it. So, talking to our, our owners, particularly if these animals are aged, and I would say, you know, guinea pigs over the age of 3, rabbits, you know, 78 years onwards, we're starting to see problems with arthritis.
So get owners to have a think about what's normal behaviour for them, what's their normal. Appetite, thirst, what they normally do in terms of their urination or defecation. And owners can also regularly monitor the body weight at home.
And, and I would probably say do that weekly can be really useful, cause one of the signs of sort of pain or chronic pain or underlying systemic illness is weight loss, and loss of body condition. So that's something that, that practical that we can get our owners to do. Wants just to share this, we do have some really helpful, useful information online.
You've got a, a reference there, looking at body condition scoring in rabbits and guinea pigs. And I think this is really helpful to have these charts available and to educate your clients as to how we actually feel for body condition. We can probably as vets look at the picture there, of that little, brown lopi rabbit and think, goodness, that looks thin.
You can see it's very sort of tucked in around the flanks and it's coat's very poor. But this is something perhaps we can get our owners to start thinking about as well. So I mentioned perhaps weighing, I would probably say you can weigh daily, but there will obviously be quite, you know, different fluctuations on a day to day basis, perhaps weigh weekly.
Do ask owners to check regularly for any signs of urine or faecal staining around the back end. Show them where pody dermatitis can occur, particularly saw hawks and rabbits, and get them to check the nails. And we'll come to discuss why all these factors are particularly important with arthritis.
Another thing that you might notice is a lot of, loss of the muscle around the back end and in some cases an abnormal gait as well. So these are little signs that that we can get our owners to keep an eye on for us. What's difficult as vets is that the, these, animals often present as for secondary reasons.
So owners haven't picked up perhaps that there is arthritis. And so they present more for weight loss or, you know, probably sort of stery coats. They might have urine or faecal stain at the back end.
I mentioned the sore hocks as well, very common. It doesn't just have to be the hocks and guinea pigs, we quite often see, pressure sores of the sort of carpal pads as well. And this could be just that they're older, they're less, active, they're more sedate, they're perhaps putting on a bit of weight even.
And that's why we're getting these. But we want to make sure there isn't an underlying cause. So always check in all your, your, clinical exams, the, the points of the hock in, in rabbits and the, carpal pads as well in guinea pigs.
And just be aware that our weight loss or our loss of body condition can occur related to chronic pain. So, animals that have arthritis, often the stifles are affected, so they can find it very difficult to posture properly to defecate or urinate in the litter tray. So we can have an animal that usually uses the litter tray really well and suddenly stops or starts having puddles or accidents around the house because they can't easily climb.
Into it, or that they can't posture properly. And because of this, we can find that there's urine staining or faecal staining around the back end. If you see that on your clinical exam, that's not normal.
So that just, it just raises a little, sort of alarm bell that something else might be going on with this animal because they like to keep themselves clean. And if we're sitting in our own sort of urine and and faeces, then we can get an ascending bacterial cystitis. We might also not want to void the urine as quick as regularly, and you could get buildup of urinary crystals within the bladder.
And that actually in, in worst case scenario, perhaps urli formation as well. Animals might be reluctant to walk, and you might see that there are sort of changes in how they bear weight, and that can obviously affect both the hind and forelimbs. I also mentioned the nail overgrowth.
So again, if you think about it, the animal's not moving as it would normally, quite quickly, the nails can become very overgrown and abnormal. And that might also raise some alarm bells for you that this animal isn't behaving as normally at home. So we need to start thinking about getting a full clinical history before our clinic exam.
And this is something I often get owners to fill out forms in the waiting room, or we might have, we've got a wonderful final year students on rotation, so very lucky, they can go off and get a good clinical history from the owner. And obviously, we're gonna perform a full clinical exam, so head to toe, as you would normally. But I'm not sure how many of you may be doing gait analysis.
So this is something I would do regularly. I'd try and open the box with the the animals in and put a little towel in front of it and see if we can encourage them out onto the consulting room floor to have a little hop around and a little sniff. They won't always do that, but, you know, it's quite nice to do that while you're chatting to the owner at the start of the clinical exam.
What we need to do for osteoarthritis specifically is we're going to be looking at palpating all the limbs for muscle mass or asymmetry, manipulating all those joints for any stiffness, any crepitus, any pain, you know, that can be repeated, if you're getting the animal pulling its leg away from you repeatedly, then that obviously is a cause for concern. And particularly in rabbits, as I mentioned, that spondylosis of the spine, have a gentle feel along the spine. You know, obviously don't push too hard because you might have something going on there.
But, but just do feel along and you will find animals may tense if they're uncomfortable, or you might find that the spine just feels much less mobile than normal. And I've mentioned to you before about checking the nails, checking the perineum, checking for poder dermatitis, and always do a body condition score and weight recording. This is something I do regularly at every consult, so we've got that on record.
In advanced cases, we are going to get lameness issues or we might get reluctant to move. And, and unfortunately, a lot of these osteoarthritis cases are presenting as advanced, conditions. So do you have a chat with the owner about any changes in behaviour?
Because, you know, if an animal's in pain or, you know, uncomfortable, then it might be manifested more as a sort of lethargy or reduced activity. And they might be less, Active behaviours. So, in guinea pigs, we call it popcorning when they sort of jump in the air and binking in, in rabbits when they jump up and sort of, click their sort of hind feet together.
And these sorts of happy sort of behaviours may not be occurring in our animals with osteoarthritis. With pain, we might have less, appetite, we might sort of have changes to the appetite. We might have even teeth grinding.
So, do you have a quiz about that. Also have a quiz about how the animals behaving at home? Is it suddenly stopped using steps?
Is it more reluctant to jump up onto the sofa? Is it not liking to go perhaps into the kitchen where the floor's a bit slippy, or onto any laminate flooring and it's just staying in the carpeted area? And has it stopped using its litter tray recently?
And again, that, that could all be signs that there's pain in the joints, and problem with arthritis. And then of course, we specifically want to ask about any gait or posture changes. What with guinea pigs sometimes we find is that they're very reluctant to stand up on their hind limbs to reach out to a hay rack, for example.
And this can all this information is really important because we can then gather that and assess how effective we think the animal is by this osteoarthritis. So I just wanted to show you a couple of videos. These are Animals that presented, and as I mentioned to you, just get them to have a little hop around the, the consulting room.
I've deliberately there, not put a little towel down, cause I really want to see what these animals are doing. And you see there, with the grey lop, it's just done a pivot. It's not actually hopped.
We're still yet to have a hop, whereas its friend is hopping OK. We're still pivoting in there. Can you see, there's a real weakness of that hind hind quarter.
And it's quite nice having the two rabbits together cause you can actually see. Another thing that will happen is crawling, crawling behaviour if you've got an issue, with arthritis. So that's something else to look out for.
I've got a couple more videos to show you. So this is just in our ward. This little animals had a chance to, get out and about and you can see that it's actually crawling.
So this is a much more advanced case, of abnormal gait. And actually it's only crawling for a short period and then it's stopping, and a little bit reluctant to continue on there. So this is an obvious, really obvious gait abnormality that the owner had actually picked up, in this case.
Just to show you a 3rd video again in our consult room. Again, a large rabbit. You can see that crawling is very abnormal.
That's not, you know, and, and I know it's a slippery surface, but at home it was doing this as well. The owner wasn't aware that it had any issues. And that's a problem.
Very young giant breeds can, get arthritis even from sort of 34 years onwards. So, always be aware of, any gait abnormalities. So we're getting some good hops there, which is great.
I think we actually fall over, there we go, we fall over the. The the carrier there and get rescued. But at the start, we were doing that sort of crawling stance.
And as I mentioned with the first video, the pivoting is something that we worry about, you know, they shouldn't normally pivot to turn, they should be doing little hops. So how are we going to diagnose? We perhaps worried about it.
We've got some information from our clinical exam and our history that we're, we're concerned about. Certainly doing conventional X-rays, it's quite standard and, and it's fairly reliable. Most vets have access to radiography.
The only thing I would say is it can fail to detect sort of subtle early changes within the joint. It's very good for moderate to advanced lesions, but earlier changes perhaps CT or CT is actually much more superior, I would say. And subtle signs often can go unnoticed.
So I would do a full body radiography so that we're able to get the full spine as well as all those joints, you know, with, within the view. But often this would require sedation or general anaesthetic. So that's something that we might just want to think about in an older animal.
There's perhaps a slightly higher risk, of sedation or or anaesthesia in those cases. We tend to use CT at Edinburgh University just because, you know, a lot of our cases are referred, and what we find is we can, conduct this conscious in a vet mouse traps. You can see the, the little box that we use there.
We're piping in. At the end. We have an IV line attached, and we just gently form two little sausages either side of the animal and then place a little towel over the top.
And then they're in and out of the CT in about 1110, 11 seconds total. So it's a very simple, straightforward thing. Obviously, you might not have facilities like this, so you might need to anaesthetize your or sedate your animal, for CT imaging.
But what's good with CT is that that if you're using the contrast, you can actually highlight areas of inflammation, using that. So, you know, that's quite helpful to know whether perhaps this bone change we're seeing are actually actively inflammation as well. This is a CT at the level of a stifles in a rabbit, transactional, cross-sectional view.
And we have the, right side as you're viewing the image, you can see there's really gross changes to that stifle joint. And this animal had horrific, stifle arthritis. This is a transverse CT of the spine, the lower spine, and we can see little tiny bridges on the ventral aspect of the vertebrae, and these are bony, so they're reducing the mobility of that spine.
And this is what we call spondylosis. Now, what I think is important. If we see spondylosis in dogs and cats, we're not really that worried about it.
It doesn't seem to affect them too much. But if you think about how mobile the rabbit's spine is and how important it is to have that mobility to hop and push out the back legs in doing so. I think spondylosis is much more affecting in rabbits than it is in dogs and cats.
So when we see quite extensive spondylosis, I do think this is likely to be significant just because of the way these animals differ in terms of their gait. I wanted to pop a little CT report that we had up here. This was from a large breed rabbit.
It had come in, I think just for a general checkup and vaccination. And when we, we were watching it in the consulting room, he was doing a lot of Crawling rather than actually hopping. So we, we discussed this with the owner, and decided that that perhaps we would like to do a conscious CT and this is a report that we, we got from that.
I think pretty much everything else on clinical exam was normal. . And it was quite shocking really to find that both elbows and both stifles, there was moderate modelling, and osteophytosis.
So, you know, moderate degenerative joint disease of both, joints, elbows and stifles. So that, that was really quite important. But we also found there was quite a degree of spondylosis along the spine.
And then there's perhaps a sort of incidental finding you often get this, when you're doing whole body CTs, there was a small sort of renal infarct that wasn't really clinically significant. So this is an animal that really the owner had no, notion that it had any issues. We're finding these pretty severe changes.
So we, we do need to be thinking that in older animals, we tend to see osteoarthritis. So older animals are potentially more likely to get other underlying conditions as well. So you might not just be focusing on your osteoarthritis, you might also have, you know, concurrent kidney disease.
If you've got weakness at the back end, it could be, encephalito caniculi in rabbits. And then in guinea. Pigs, we're thinking about possible vitamin C deficiency and bleeding into those joints causing a lame.
So have a think about other possible differentials. And if we're going to be doing diagnostic, yes, radiography is wonderful. You need to do, you know, two views so that you've got a reasonably sort of 3D view of the joints.
But also think about other underlying problems. Should we perhaps be doing a whole blood profile on this animal if we Thinking about putting it onto nonsteroidal anti-inflammatory medications long term. This is probably a good idea just to check renal parameters, if we think about using paracetamol, check liver parameters.
So there are reasons why we can, we, we should probably be doing whole blood profiles as well. I've also put a canicular serology in there if we've got sort of a weakness at the back end, could there be underlying infection with that parasite? And then we might also consider, especially what urine staining as one of our other clinical signs, full urinalysis looking at, specific gravity, dipstick, sediment.
And I do like to also perform a urine protein creatinine ratio, and there have been sort of normal values, recorded in, in rabbits and guinea pigs for that. And we might consider also an ultrasound, I guess. It's very good for the urogenital tract if you've got urine staining, and we want to rule out some other possibilities, and check that everything's normal before we sort of say it's down to the osteoarthritis.
I wanted just to touch a little bit on the scoring systems for osteoarthritis. Obviously, we, we're all very aware, I think, of conventional radiography. It's readily available to most vets in practise.
There has been a human radiographic rating system. It's called the KL system, and it uses a scale of 0 to 3 for osteoarthritis in people. And it basically looks at the number and sizes of osteophytes, changes to the joint space and then sclerotic changes as well.
We have as vets taken some of these systems and tried to adapt them to animals. But what really is the sort of sticking factor is having the same person interpreting these findings so that we have an experienced and well qualified person repeatedly, looking at these so that we know where there isn't sort of any subjectivity to the interpretation of those findings. We did a sort of small study that, I've got the reference later.
I'll show you. It was published at, at a conference. Just looking at all the, the different radiographs we'd taken over a, a, a two-year period.
And we looked at rabbits and chillers and guinea pigs and wanted to see whether there was presence of any arthritis. And we looked at the main joints, basically the elbow, shoulder, verticalcom, hip, and stifle. And what we found is that 64% of the animals that were presenting were affected at least one joint.
But there were animals that have multiple joints affected. And the stifle was really one of the most commonly affected and most severely affected joints in all species. So knee joints are the ones that we need to be looking at and paying particular attention to in our clinical exam.
In the rabbits that we looked at, there was a prevalence of osteoarthritis in 61%. But in the guinea pigs, OK, very small numbers, so we need to do a bigger, bigger project really to be sure of this, but there were 100% of of the radiographs we looked at had signs of arthritis, which is quite shocking really. And these were some very young animals as well.
So we're thinking we have a case, we're thinking it's causing clinical signs, the animal may be in some pain. What are we going to do to try and help that animal and how are we going to treat this? Well, I think it's very important to have that discussion with owners and get them on board right at the start because we're not going to cure this condition.
We're going to have to live with it and treatment is going to be palliative and we're going to try and help alleviate any pain. And therefore, it's really a long term commitment that owners will need to have. And, and lots of our lovely, rabbit and guinea pig owners are very committed to their pets and they're very happy once you explain all this to, to go ahead and, and, you know, get these animals onto some analgesia.
The problem is, what do we recommend? Because there's so many different therapies out there. And we have very little pharmacological data in, rabbits and guinea pigs about how effective pain relief might be, what sort of doses we need to give, how regularly.
And a lot of these medications and doses are extrapolated from use in other species, mainly dogs and cats, and And we know that, these little guys have a much higher metabolic rate and metabolism. So, you know, are these actually being effective? And that's, that's a big worry of mine, really, whether we are providing good analgesia.
But what is wonderful is you'll often have owners saying, my goodness, you know, they're a new, new animal, and they're now running around like they weren't before. So that's always really helpful when you actually get a very positive response to pain relief. And then on top of that, we're going to talk to the owners perhaps about some physiotherapy, about other things like, you know, bedding and environmental changes and how if the animal's very overweight, we might want to consider a little bit of weight loss as well.
So I thought we'd have a bit of a chat about analgesia in rabbits and guinea pigs to sort of help, sort of clarify what types of analgesia there are available and what might be best to use for osteoarthritis. And I mentioned that we, one of the factors about what we decide with the owner to give will be how easy it is for that owner to give the medication. And that, that is a problem sometimes.
You know, some rabbits just decide they do not want an oral medication. And it becomes a real struggle for that owner. So we have got some other possibilities of, topical, we, you know, we could possibly think about transdermal or something new that people are looking into.
CRI's continuous rate infusions. Those are really only for hospitalised animals, or perhaps injectable. But most of the time, I guess if this is gonna be long term, we're gonna be going for an oral medication.
And we're going to try and tailor that protocol really for the individual's needs. And, and it's often, an ongoing, evaluation, really depending on how the animal is reacting to its medications. So we do regularly get these animals back in, or even have follow-ups, phone conversations, emails to find out how the individual's coping and whether we need to tweak, the medication, change it slightly.
So I just was sort of writing down what, what analgesics we have available and just trying to think through our options. And, I put at the top there non-steroidal anti-inflammatory drugs, cause really, certainly in, in dogs, they've shown that non-steroidals are the best really medication for alleviation of pain due to arthritis. So we're kind of assuming that it would be the same in, in our small furries.
I've crossed off opioids, local anaesthetics, ketamine, meropotent, really for the reasons that I've put in the slide here, that, that often they're not very practical, perhaps to give, but also, they may be more specific to sort of visceral pain or there may be medications that we're going to reserve really for a hospitalised patient, you know, which has pack IV access or that we can, monitor very closely for any side effects. So if we're ruling out some other things there, then the list is a little bit shorter, isn't it? We've got paracetamol, Tramadol, gabapentin, and possibly alternative therapies, but these are very poorly used in rabbits.
We're starting to get people doing more acupuncture, in pet rabbits and guinea pigs, which is wonderful. And we're getting more information as to whether this, this helps or not. You know, really, currently, I would say.
So thinking about the non-steroidal anti-inflammatory drugs, they are the most commonly used analgesics, and they are used for chronic pain. They are analgesic, anti-inflammatory. They seem to be very well tolerated and are rabbits and guinea pigs.
And I have had animals on for quite extended periods of time. I've popped in a dose right there. So a lot of these, again, extrapolated perhaps from from dogs and cats, but we do have some quite, helpful information now about the use of meloxicam orally in rabbits and guinea pigs.
And so these are those rates that are there for you. And often, certainly in, in, in the UK we have medications that are actually licenced in these species. So we, we feel a little bit safer and happier giving them, obviously, and that's appropriate that that we do.
But I would say a lot of these animals are older. We might have renal insufficiency. We might have an animal that's not been eating.
We shouldn't be giving this medication if we've got any concern over the hydration status of the animal or over any renal parameters. . I put in that oropathic disease or coagulopathies.
And, and certainly in other animals, non-steroids can affect the GI tract as well. So just, just bear that in mind. If you've got an older animal, I think ideally, performing biochemistry prior to starting this medication, as well as your analysis and, urine protein creatinine ratios would be a good idea.
So with meloxicam, I just want to put a little bit about it so that we can understand it perhaps better what effect it's likely to have in these, these animals. Rabbits are known to metabolise much faster than dogs, cats, and even rats, actually, after oral admin admin. And they don't get as high peak concentrations.
But it does seem to be safe and, and it has been reported as being used quite long term. It seems to be quite palatable, the medications that we have as well. I've mentioned about if it's long term, we do really want to be checking the animal having regular revisits, and checking that there's no anaemia, no kidney function issues.
Perhaps even doing a faecal screen for cult blood in case of a bleed into the GI tract as well. And certainly warning our owners if, if the droppings suddenly become very dark and melanic, then, get back in touch with us straight away. Or if there's diarrhoea, get back in touch with us straight away.
And in those cases where we, we have had some that, that we're worried about, a little bit of bleeding into the GI tract, if we haven't got the option to stop that medication on welfare grounds, the animals in a lot of pain, then we might consider a gut protectant as well concurrently, or some people are even using gut protectants, you know, in, in case they're on long-term meloxicam anyhow. So just worth bearing in mind and talking to the owners about this and and so they're fully informed and aware of the potential side effects. What else could we use?
Well, we have been using a lot more paracetamol. And this is something that perhaps you're thinking, well, that's quite, quite a, a, a drug we use in days gone by. But it seems to be actually very helpful.
And certainly we consider paracetamol in cases that, either don't respond to other types of pain relief, or that, you're worried about the kidney parameters or any GI tract issues, and you might consider Starting on paracetamol, once you're pending your sort of, you know, blood results back. And I popped a wee dose straight up there. Unfortunately, this is anecdotal and it is extrapolated from from dogs.
I have used this dose as well in guinea pigs with, with thankfully no real side effects. So be, be aware that it is anecdotal, but we are seeing owners coming back saying, yes, this has made a massive difference to this animal. It's eating more, it's happier, it's more active.
I hadn't realised how lethargic it was before. Do be aware that at high doses, it can cause liver issues and you could see, enzymatic changes on your biochemistry. So again, discussion with owner, check the liver function prior to use, ideally, perhaps ultrasound of the liver as well to check that you've got no obvious changes there of pathology.
It is off licence in the UK, and we are using a, a human paediatric suspension. So again, being aware of that and, and the, the sort of legal requirements for use of this drug as well. Another medication that, that we use a lot, for, osteoarthritis and often in conjunction with either paracetamol or, meloxicam is Tramadol.
And what I'll often do with these is, if they're being given twice daily, the meloxicam and the tramadol, I'll try and stagger the dosing. So you almost get 4 times a day dosing. So you would perhaps give your Tramadol 7 in the morning, 7 at night.
And then you give your meloxicam 11 in the morning, 11 at night, 1212, whatever suits the owner best. And that way you're hopefully getting a better coverage all round for analgesia. So it can be used on its own.
It can be used with other analgesics, and it does seem to work. Again, a lot of the work, that has been looked at has shown that actually in rabbits, orally, it's the doses we're recommending, it doesn't seem to reach the types of levels that would be therapeutic in humans. But it does seem to work quite well in rats.
So You know, again, it's something that you might have to discuss with your owner. We have had some owners saying that the animals seem a little bit sort of sedated or in a bit of a trance. They're not their normal selves on it, in which case we might reduce the dose or we might decide to use a different Analgesia, but those are rare, I'd say, and we do have a lot of animals using these medications.
So I've put a little bit of a dose rate at the bottom there for you for rabbits and guinea pigs. We tend to go a little bit lower at 5 mg per kg by mouth twice daily. But, there are published dose rates of 10 to 20 mg per gig by mouth every 8 to 12 hours in guinea pigs and 10 makes per gig per every 12 to 24, sorry, that should say 24 hours in rabbits.
So, you know, perhaps start at a lower dose, see if there are side effects, see if that works. If it really doesn't, you can perhaps increase it a little bit, within those parameters. Just got a couple of other sort of alternative analgesics that if you're really struggling and you've got contraindications perhaps for using the non-steroidals or paracetamol, you potentially could consider gabapentin.
Again, we do have quite a few animals on this medication. It's more, sorry, it's more targeted this drug to, pain-related to nerve injury or dysfunction, so neuropathic pain. So, It's difficult to say whether this is actually working because of the osteoarthritis or, or whether we've got nerve stimulation as well.
But I think it's something that you could consider if other medications aren't working. So it's kind of your, your next generation after the first few, you know, you try those first and if that doesn't work, then come on to gabapentin. And certainly, there are some reports, but they are anecdotal, of it working in rabbits, not so much in guinea pigs.
But they have trialled it in, in rats and mice, and I've popped again, a dose rate that we use, at the bottom there so that you could start your Your animals or your patients on to that sort of lower end of the dose rate first. I haven't usually gone beyond 5 mg per gig by mouth twice daily. But certainly, it's worth thinking about this medication and reading up a bit more about it if you're, worried about using the others.
I've also popped amantadine up there with a question mark. It is something that I have thought about using. I haven't used it a lot, but it's something again that might be worth considering in cases where you're, you're really struggling because you know, of other, other problems or contraindications or compliance of the animal.
But you do still have to be careful with this, with liver disease, kidney disease, congestive heart failure, or if the animal has seizures at all, so don't, don't use this medication. And I did pop on there that you have to take 7 days to gradually, have an effect. You can't stop it suddenly.
So it's a sort of more long-term medication. And the side effects that have been reported in people, you know, loose bowels, excess gas, and anxiety. So I usually just let owners know that that's a possibility, and they keep an eye out for those possible signs.
And we're thinking about giving this just as a once a day dose by mouth, Which is the do straight at the bottom there. So moving on from analgesia, what else can we do? Well, there are a lot of, documents talking about different supplements, either mainly for prevention of osteoarthritis, but also potentially in cases to slow down the progression of the arthritis.
And I've been through a lot of these, papers, and there's some really good review papers. And, and I think the most, Common ones that seem time and time again to have good evidence that they do help are glucosamine and chondroitin sulphate. Sorry, the 9 shouldn't be there.
So chondroitin sulphate and glucosamine. And in one study, both of these given at the 200 milligramme per kilogramme once a day dose did seem to be protective, but this was in a laboratory animal model. And they were given at a very young age, 3 weeks of age, up to 18 months old.
And they were found to prevent the development of osteoarthritis. But I do worry, maybe it's too late for the chronic cases. And this is often the stage at which we are these animals as vets.
But I think it's worth thinking about and owners may have read about, you know, all these different things like, green lip muscle and cumin and turmeric and things like that. So, certainly there's good evidence about, about the glucosamine and chondroitin sulphate. Another thing that I thought was really interesting when I was looking up information sources for this webinar is that there is a paper on ultrasound, pulse low intensity ultrasound for treatment of osteoarthritis and guinea pigs.
And it was found to reduce the severity, but it did have best results when it was early on in the disease stages. And so I just wondered, could this be useful? It's something that we might think about in the future.
In this study, though, the animals were anaesthetized for this, and I don't think that's really practical, because treatments were given for 20 minutes, 5 days each week. That would just be too much for a wee animal. But I think it's something to think about and it's something that, that we might get more information on if studies are conducted in the future.
Physiotherapy is, again, very, I think very useful in rabbits and, and guinea pigs. It's something we're starting to do more work with. I'm not a, a qualified physiotherapist, but, I have a wonderful team.
This is actually a picture at the University of Glasgow that was lent to me by a client. But we have a wonderful team at Edinburgh also, we can go and talk to about different, physiotherapy. But I think really, don't, don't rule this out.
And if you have good relationships with your local physiotherapy team or you have a hospital situation with a physiotherapist, then you go and talk to them about how we can do things perhaps to help osteoarthritis. Wanted to show you this video. This is a little rabbit that's had a, a limb amputation and we were worried about.
Muscle wastage, in the, in the good hind limb. And it's, tolerated very well, the, the exercise, physiotherapy that we're doing here within the bath. And it seemed to really quite, like it, which is amazing.
We always had to keep the water very warm for this animal. But we're trying to build up that muscle, and help that animal, moving those joints. So this, this is something that can be considered.
So just really to wrap up this webinar in the last sort of 10 minutes, I wanted just to think also about what sorts of things can we do, around the home. And I think that's really important. We probably don't really talk about this enough with our pet rabbits and guinea pigs.
We do have to have a good rapport with our clients. And as I said right at the start, we need to have realistic expectations. How this gonna progress.
We're managing it, we're not curing it. It is likely to get worse over time. But there are many positive things we can do to help.
We're all very much aware of non-slip padded flooring. Maybe if there are ramps and stairs and high jumps up onto sofas, owners need to think about managing that and avoiding those, those, . More difficult, situations.
We could also cut a hole in the litter tray, so on one side, so it was much easier for the animal to get into it. It doesn't have to hop over it. We can lower the hay racks so they don't have to stand up on their back legs, and that's painful.
We can raise the bowls like we've got in this picture here. So if the animals got spondylosis of the spine, it may find it more difficult bending down to eat, so we can think about changing the bowl and the feeding the situation. We also can talk to owners about all these secondary issues that can occur and how they can carefully monitor for them.
So, you know, perhaps once a week, check all the feet for any pressure sores, once a day, check the back end for any faecal or urine staining. Weigh the animal once a week to see if there's any weight loss. If the animal's very overweight, we need to be talking to our clients about, weight loss, regime to try and, help ease the pressure on those arthritic joints.
And actually, regular short periods of exercise are very important because it helps build up muscle mass and alleviate the stiffness associated with arthritis. So something like scatter feeding rather than presenting An animal, the food in a bowl, like the picture here, it's going to encourage much more foraging behaviour. I put the picture up there because that animal was very overweight.
You can probably tell that from a distance. And as you can see, it's got a muesli-based diet that the owner was feeding it in the bowl there. So that's a whole different webinar.
But, I thought it was quite a good picture to show this animal's been select to feeding and obviously putting on a lot of weight in the meantime. We need to think about the bedding area, maybe the use of these lovely soft vet beds, or padded, carpeted areas. The difficulty I think with rabbits is they can chew things.
So you're gonna have to introduce these things quite gradually and under strict supervision. So what we don't want is to put a carpet in or a vet bed, and then the, the rabbit eats it and we end up having to, do emergency surgery for a gastric, foreign body pylorics. So, you know, talk to the owners, do it gradually, always supervised.
In the winter time, you know, if the heating's off and it's cold, we do get quite chilly up in Scotland here. And so you can get these little microwavable heat pads that you could leave with your animal covered, of course, so that that it's not too warm, but you could leave it in with them overnight so they've got a bit of warmth as well. And time and time again, owners say flooring is key, and animals do not like to walk on laminous or tiled flooring, which can be really difficult if they've got arthritis.
So providing a, a matting or with a good grip, astroturf, for example, something that they can, they can actually walk carefully on, is very important. Other things that people use, you know, for, for helping with that sort of bath mats that you can buy, yoga mats, any carpet cutoffs, we mentioned the fleece vet bed, or perhaps foam matting. Again, just being very careful, and watching that your animal does not eat it.
So supervise initially, only, and once you're happy that it's being left and not eaten, then, then that's fine. Another thing is bringing these animals in for regular nail clipping, or we can show our owners how to do that as well. As well as handling, try not to overhandle an animal with severe arthritis.
Just be gentle and supportive when you do handle that animal. And then I already talked really about adjusting the environment to make it easier to move about, reducing the opportunity to jump onto things, which could cause pain or could actually make the situation worse. I think also we should be really advising regular health checks for rabbits and guinea pigs.
And this is something if you're getting animals in at an early age for neutering or general advice that you can, import to your owners and say, this is important, that we need to see your ra rabbit or guinea pig regularly. Particularly, I would say any rabbits over 6 years of age and, obviously younger and giant rabbits, but guinea pigs over 3 years of age. And ideally, I think 6 monthly health checks.
Again, it depends on owner compliance and, and investment, you know, whether they're, they're really wanting to do this or not. But I do think, you know, so many things are missed, in these prey species that it is important for us to have a, a regular checkup. And we pick up things regularly that owners haven't perhaps noticed.
And in these exams, we should be manipulating the joint. So I really, really would, recommend that you do this now, particularly in your guinea pigs. And you will find, particularly the hocks and the stifles, you will find animals with arthritis.
There'll be pain, there'll be, thickening bone, and also much reduced, flexion extension, particularly the hocks. They won't be able to fully flex them, and you'll probably have pressure sores as well. So I would urge you to start looking and I think you will find these cases coming into you.
Just as a sort of, a final thought, we do need to think about the animal's quality of life and, and at all stages, you know, animal welfare should be discussed and assessed with the owner. It is painful, it is progressive, it's not cur curable. And so in very extreme cases, and certainly in in close consultation with owners, euthanasia might be the kindest option.
I would usually, obviously trial, analgesia first, and see what the response is to that. But if an animal's continuing to lose weight, body condition score, show behavioural changes, and be reluctant to move, I think that conversation has to be had, unfortunately, with the owner. Even just to sort of Not say this is something we, we're going to do now, but something that, that might, we might have to make that hard decision in the future.
And I think that's really important. So to summarise what we've been through, We've looked at osteoarthritis, how it develops, it's a degenerative, often inflammatory disease. It can be very painful, and it can lead to reduced mobility.
It is easily diagnosed on radiographs and CT imaging. And treatment generally is palliative, really aimed at sort of alleviating the clinical signs and the, and obviously addressing pain. We do need to emphasise that it's going to be long term, and there may be some lifestyle changes that are helpful, particularly things like weight reduction, soft substrates, and possibly physiotherapy as well.
So these are the references that I've just talked to you a little bit about through this webinar. Just thought it might be interesting if you want to look up at any of these, and a lot of the dose rates for analgesia are available in the carpenter formulary. There is actually new formary, I think a 2018 out as well.
So, you know, do, if you're seeing regularly small ferries, then, you know, do think about having a copy of that in your practise. It's very helpful and useful for looking things up and it's reference as well, which is great. I always think that's, that's the best way to be.
So thank you so much for listening. I hope you found it helpful. And I hope that it will, enable you to go back out into practise and be more confident diagnosing osteoarthritis in your guinea pig and, and rabbit cases.
Thank you so much.
