Joint diseases

Joint Diseases in Rabbits

What types of joint diseases exist?

Arthritis, Osteoarthritis
This is an inflammation of the joints, often resulting in the affected joints becoming swollen, warm, and the skin around them appearing reddened and painful. Arthritis can have bacterial origins but may also be caused by other factors. In acute cases, some rabbits may develop a fever. German Giant rabbits are predisposed to arthritis.

Arthrosis, Osteoarthrosis
This refers to excessive, painful wear of the cartilage layer in the joints, particularly in the spine (spondylosis) and joints. Initially, rabbits experience pain when standing up, but the pain subsides after they „warm up“ and only returns after excessive movement. In later stages, they may experience pain even at rest. To compensate for the loss of cartilage, the body attempts to counteract arthrosis by forming bony growths, but these often worsen the pain by compressing nerves. This process also causes the joint to stiffen. However, not all cases of arthrosis are painful! This condition is typical in older rabbits. Even if arthrosis is detected on an X-ray, it does not necessarily mean the rabbit is suffering. The clinical presentation (e.g., whether the rabbit shows symptoms) is key.

Spondylosis
This is a degenerative condition of the spine (spinal arthrosis) involving changes to the vertebral bodies. Due to the wear and tear of intervertebral discs and ligaments, the spine becomes less mobile, leading to stiffness in the rabbit. The body compensates by forming bony growths, which in some cases may be painful. This condition is typical in older rabbits. Like arthrosis, detecting spondylosis on an X-ray does not necessarily mean the rabbit is in pain. Again, the clinical presentation is critical.

Hip Dysplasia
This painful condition involves deformities and misalignments in the hip joint caused by improper ossification. The joint socket is too shallow, leading to a malformed joint head. Over time, arthrosis develops as a consequence. The body produces bony growths, which can be painful. Large rabbit breeds are particularly prone to this condition.

There are many other joint diseases that can affect rabbits.

How can I tell if my rabbit is affected?

Joint diseases in rabbits are sometimes only noticeable when the condition is already advanced. At that point, you may observe a few of the following signs:

• Pain-relief posture: Rabbits may occasionally sit in a position where they push their hind legs far forward, so they are positioned further ahead than the front legs. This posture helps to alleviate pain.
• Reduced movement: The rabbit moves around less than it used to.
• Difficulty with jumping: Occasionally, you might notice the hind legs getting caught on the edge of the litter box during a jump.
• Avoiding elevated surfaces: Jumps onto elevated objects become less frequent or are avoided altogether. The rabbit may appear clumsy, miss its target, struggle to jump, or land poorly.
• Inadequate grooming: The rabbit may inadequately groom its hindquarters and hind legs, leading to unconsumed cecotropes (special droppings). Often, rabbits may sit in their own waste, resulting in a dirty or matted rear end.
• Difficulty standing upright: The rabbit may stop „standing up“ on its hind legs altogether or topple over when attempting to do so.
• Unusual grooming positions: Rabbits may clean themselves in unusual postures, often by sitting on their hindquarters or lying down.

Typical sitting positions in joint diseases. For example, the animal may lean over another animal or a piece of furniture to relieve the painful joints.

Arthritis posture and sitting position while grooming due to joint pain.

• If the disease is very advanced, a wobbly spine may sometimes be observed, and the rabbit may occasionally bend or tilt sideways. Often, the gait is no longer stable and becomes slightly swaying. Paralysis is also possible.

• The rabbit may change its habits, lie differently, avoid elevated places, and move significantly less.

• Symptoms can become more pronounced with cold or heat, or weather fluctuations, and the overall condition may fluctuate greatly. Many rabbits are more affected by damp cold. Heat can alleviate pain.

• After resting for a long time, the rabbit’s gait may initially appear odd, but it „warms up“ as it moves for a longer period.

• Some rabbits develop sore feet (pododermatitis) because they sit differently, placing excessive pressure on the back part of their foot. For some affected rabbits, it may even be more comfortable to tolerate the pain of pododermatitis to relieve joint pain in that sitting position.

• Rabbits with arthritis often have thick, swollen, warm joints (e.g., front paws).

A definitive diagnosis, depending on the condition, can sometimes be made from the clinical picture, but in other cases, an X-ray, computed tomography (CT), or magnetic resonance imaging (MRI) may be necessary to confirm the diagnosis.

Cause: How do joint diseases develop?

Joint diseases are typically age-related conditions that appear later in life, but in some cases, they can occur earlier.

The following factors are responsible for arthritis, spondylosis, and hip dysplasia (HD) (often multiple factors contribute):

• Genetic predisposition: Certain rabbit breeds, especially the German Giants and other very large breeds, have a hereditary tendency to develop joint diseases (similar to large dog breeds). This includes HD, as well as arthritis, spondylosis, and arthrosis. The predisposition can vary significantly depending on the breeding line.

• Increased body weight: Overweight rabbits experience higher joint wear. Large breeds, which must carry a higher body weight due to their size, are also affected.

• Old age: As rabbits age, they are more likely to develop these diseases, with older rabbits being particularly affected. Wear and tear can occur throughout their lives, especially in very old rabbits or with long-term, unhealthy stress on the joints.

• Joint strain: Excessive joint stress can exacerbate these conditions. To prevent this, high jumps (e.g., jumping onto high platforms or stable roofs) should be avoided by installing ramps and railings at elevated places. A softer surface (such as straw, hay, thick bedding, mats, or carpets) is also beneficial, as it helps to absorb weight and reduce strain.

• Movement and exercise: Healthy, less stressful movement helps prevent joint diseases, while insufficient movement can trigger them (e.g., in cages or stalls with limited space).

• Malnutrition: A poor diet (e.g., inadequate food, low energy, or insufficient vitamins/nutrients, an unbalanced calcium-to-phosphorus ratio, store-bought pellets, or calcium-restricted diets) or inadequate vitamin D synthesis (lack of direct sunlight, no UVB lamps, no fortified food) often leads to calcium loss in bones (osteoporosis), which can eventually lead to arthritis.

• Misalignment of joints/limbs: Misalignments can contribute to joint diseases due to increased wear, such as when an animal has had a limb amputated.

• Infections: Arthritis can also be caused by infections (septic or infectious arthritis). In large breeds, infectious arthritis is believed to play a significant role. Respiratory, gastrointestinal, urinary tract, or heart valve infections are common causes, as are direct inflammations from injuries or pododermatitis. Bacteria, mycoplasma, viruses, protozoa, and fungi can all trigger these infections.

• Antibiotic use: The use of antibiotics (such as gyrase inhibitors like Enrofloxacin – Baytril or Marbofloxacin – Marbocyl) can damage connective tissue, leading to arthritis.

• Arthritis leading to arthrosis: After arthritis (joint inflammation), typically caused by injury or genetic factors (common in large breeds), joint degeneration (arthrosis) can follow.

• Polyarthritis: Arthritis and arthrosis can sometimes be linked to the immune system affecting multiple joints at once (polyarthritis). There is a genetic or breed-specific predisposition in large rabbit breeds. Polyarthritis is often associated with symmetrical joint swelling, diarrhea, weight loss, and sometimes fever. It can be triggered by factors like recent vaccinations, sulfonamide or other medications, ticks, infections (including digestive disorders, bladder sludge, heart problems, etc.).

Treatment: How are the diseases treated?

Goals of treatment:

• Pain relief

• Improvement of joint function

• Restoration and maintenance of quality of life

• Prevention or slowing of disease progression

• Preservation and rebuilding of muscle mass and strength

Unfortunately, joint diseases in rabbits cannot be cured, except in cases such as hip dysplasia (HD), where a prosthetic hip joint could theoretically be used (similar to procedures in dogs). However, there is little experience with this surgery in rabbits, and since rabbits put a lot of strain on their hind legs (due to hopping), experts do not recommend such surgeries.

Therefore, the primary focus of treatment is to achieve pain relief and slow or stop the progression of the disease.

Therapy: How are joint diseases treated?

Therapeutic Approaches: These can be combined for more effective treatment.

1. Pain Therapy:
   • Pain relief is essential in managing joint diseases.
   • Meloxicam (e.g., Metacam) is the preferred painkiller as it is anti-inflammatory and can be given twice a day. It starts with a higher dosage and is then gradually reduced. In severe cases, it may be combined with Metamizole (e.g., Novalgin). In some instances, stronger painkillers like Tramadol and Gabapentin are used. Different painkillers target different pain pathways, so a combination of medications may be needed.
   • The dose for rabbits is typically higher than for cats or dogs (e.g., a dose of 1mg/kg/day for Meloxicam has been shown to reduce pain in rabbits).
   • Pain relief breaks the cycle of discomfort, allowing the rabbit to move more, which in turn helps to build muscle and improve quality of life. With increased movement, the symptoms often diminish as the rabbit „warms up.“
   • Long-term use of Meloxicam is generally well-tolerated, but it can cause or worsen organ issues (e.g., gastrointestinal, liver, or kidney problems). Therefore, it is advised to start with Meloxicam and switch to other pain relief options once the rabbit is comfortable. In cases of chronic disease, it is recommended to use a gastric protector (e.g., Sucrabest) to avoid stomach problems.
   • If pain relief from these medications is not optimal for some rabbits, they can be combined with other treatments. To reduce stress during administration, it is helpful to mix the medication with crushed banana, oat flakes, or fruit juice, which encourages the rabbit to take it willingly.
2. Alternative and Complementary Treatments:
   • Some rabbits respond very well to CBD oil as a pain reliever. Calmin or Calmin forte are examples of suitable products, with Calmin forte often being used at a dose of 4 drops per kilogram of body weight per day.
   • Monoclonal Anti-NGF antibodies (Solensia, Librela) are not suitable for rabbits, as they are designed for dogs and cats and do not work in rabbits.
   • For infectious arthritis (swollen, hot joints), antibiotics should be administered for at least 4-6 weeks and a minimum of 2 weeks beyond symptom resolution. Suitable antibiotics include Doxycycline, Enrofloxacin (e.g., Baytril), and Metronidazole.
3. Homeopathic Treatments:
   • Traumeel and Zeel are often used during acute arthritis flare-ups or as a continuous treatment. Ost Heel can also be used long-term. In acute cases, Discus comp. can be applied. Ampoules are generally preferred as they are sugar-free, though tablets are easier to administer.
   • The effectiveness of these homeopathic treatments is not scientifically proven, but they are often used with good results in practice.
4. Natural Remedies:
   • Ginger is considered one of the most effective natural remedies for joint diseases. It can be grated and mixed into crushed banana, Cuni Complete, or other tasty food. Some rabbits may even eat it straight. Gradually increasing the amount will help them get accustomed to it. Ginger juice (diluted with some tasty liquid) can also be administered directly into the mouth (0.2-0.5 ml per kg body weight).
   • Other beneficial plants include willow twigs, poppy, ash bark, dandelion roots, nettle, devil’s claw, and rose hip powder, all of which may have anti-inflammatory and pain-relieving properties.
   • Omega-3 fatty acids (e.g., Rodicare Derma, flax seeds, sunflower seeds, or algae oil) can also support joint health.

1. Supplements:
   • Rodicare Artrin, which contains plant extracts, may help some rabbits.
   • If the rabbit is overweight, weight loss is crucial to reduce joint stress.
   • Soft bedding is important for comfort, such as hygiene and faux leather beds for rabbits, which are easy to clean.
   • Herbal supplements like Drynaria, Rejoint (for arthritis) or Backmotion (for issues with the hind limbs) may also be beneficial. Analgos is a gentle, well-tolerated pain medication.
2. Immunomodulation and Other Supplements:
   • Gladiator Plus for Small Animals is useful, particularly when the rabbit is weak or has other health issues. It helps regulate the immune system, encouraging more movement and significantly reducing arthritis pain.
   • Physiotherapy is highly effective and can improve joint function in most rabbits. A trained animal physiotherapist can guide you through suitable exercises.
   • Laser therapy can be very beneficial for some rabbits in reducing pain and improving mobility.
3. Environmental Adjustments:
   • Heat therapy can help alleviate pain, especially in colder weather. Rabbits with joint diseases should have access to a warm environment or a heat source during winter.
   • Regular veterinary check-ups are crucial, especially for rabbits with additional health issues, as these can exacerbate joint pain.

By combining various treatment options, you can effectively manage joint diseases in rabbits, improve their comfort, and slow the progression of the condition.

If the treatment is no longer effective and the condition has progressed significantly, euthanasia should eventually be considered, as severe pain or the inability of the rabbit to get up results in an insufficient quality of life. When reaching this point, corticosteroids can also be used for treatment (but not before).

Experience Report

Improvement in Quality of Life and Pain Relief through Physiotherapy. Grooming before and after Physiotherapy:

Important: Rabbits with joint diseases need assistance with ear care, as they can have difficulty or are no longer able to perform grooming movements (such as scratching their ears with their hind legs), leading to a buildup of secretions in the ears, which can cause infections. Regular check-ups with an otoscope at the veterinarian are recommended, and affected rabbits should be supported with ear care. The ear care should be performed similarly to that of lop-eared rabbits.

Nutrition for Rabbits with Joint Diseases

Many rabbits with joint diseases are underweight. It is crucial not to make the mistake of feeding them high-energy foods (such as oatmeal, fruit, or dried food). Based on experience, these can worsen joint pain and even lead to further weight loss. These rabbits benefit from being fed fresh grass, aromatic herbs, bitter greens, and cabbage (if tolerated), which can help them regain weight and break this vicious cycle.

Example: Sepperl’s Treatment

Experience Report:
Sepperl had jumped from a low height and landed on his hind legs, twisting them. He had already shown signs of arthritis, such as the „arthritis-sit“ and getting stuck at the edge of the toilet. After the incident, he barely moved, lay in the sun, and lost a lot of weight. X-rays revealed hip dysplasia, osteoarthritis, and spondylosis, and acute arthritis due to the fall could not be ruled out. Initially, he was treated with Metacam.

Before
This is how he walked when he was still able to move somewhat well, though he often twisted his legs and hardly moved.

Before
The Metacam only had a mild effect; often, I felt like it wasn’t working at all. So, we decided to try additional medications.

He was given:

• In the morning: Ginger, Rejoint, and Gladiator Plus in banana, Backmotion, and Analgos as treats.
• In the evening: Backmotion, Analgos, Zeel, and Ost Heel, all as treats.
• Sometimes he gets a second portion of ginger.
• I also offer a lot of meadow grass and oak, which he likes to eat.
• During acute flare-ups and in the beginning, he gets Traumeel and Discus comp continuously.

In the right photo, you can see how frail and underweight he was.

I gradually weaned him off the Metacam after a while when he started feeling significantly better. Even without it, he’s still doing well.

Two months later

His condition fluctuates slightly day by day, but it’s quite good now, a huge improvement compared to before. I wouldn’t have believed it… He’s gained a lot of weight and has reached a healthy normal weight. He moves much more, wobbles far less, no longer collapses, and is now playing in the garden. He still has a slight wobble at the back, but it’s nothing compared to before… I never thought his joints would stabilize again.

Four months later

In the meantime, Sepperl developed a skin fungus due to his weakened immune system, but we continued administering the medications mentioned above, along with additional joint supplements such as ArthroGreen (plus) and RodiCare Artrin. Since he was quite stable, there wasn’t much noticeable difference, and his condition remained very stable. We also gave him black cumin oil and other skin/fungal medications.

We’ve made it! He’s back to being absolutely fit, jumping onto fairly high objects, appears completely pain-free, and runs around a lot. We were even able to stop the medications. If his condition worsens again, we’ll start the treatment again right away. He’s gained weight again and even put on enough winter fat. The only thing he can’t do anymore is make „männchen“ (standing on hind legs), but it doesn’t seem to bother him at all.

Before – After
(From the emaciated, weakened little bundle of misery to a strong, healthy buck)

By now, the treatment had settled into a routine where he received ginger mash and Gladiator Plus for small animals 3-4 times a week. Additionally, we occasionally mixed in supplements that he had previously received continuously. If his gait worsened, we temporarily added more medication and tapered it off once he improved.

The flare-ups had become much weaker and less frequent.

Sepperl lived with arthritis for many years and recovered so well from the acute condition that, with the support of the treatments, he was able to live the rest of his life without issues. He passed away due to a heart condition.