Inflammatory Bowel Disease & Arthritis

Ulcerative Colitis and Crohn's Disease make up a group of chronic diseases known as Inflammatory Bowel Disease (IBD). IBD can affect the digestive system starting anywhere in the mouth all the way down to the rectum and anus. Ulcerative Colitis generally affects the colon (large intestine), but can happen anywhere in the digestive tract, and Crohn's Disease affects the small bowel. The most common symptoms of these diseases include, but are not limited to, abdominal pain, diarrhea, rectal bleeding, loss of appetite, weight loss, dehydration, malnutrition, fatigue, blood in the stool, an urgency to have several bowel movements a day, joint inflammation, and joint pain. Both diseases are autoimmune in nature meaning that the immune response of the body acts against itself. IBD usually begins during adolescence and early adulthood but can affect any age group. There are peaks between the ages of 15 - 30 and then again later in life between the ages of 50 -70.

The most frequent extra-intestinal complication of IBD is arthritis, affecting about 25% of all patients. The two most common forms of arthritis experienced by these patients are Peripheral Arthritis and Enteropathic Arthritis. Symptoms of these include inflammation and pain in the joints, limitation in range of motion, and stiffness of the joints.

Peripheral Arthritis involves the extremities and affects up to 30% of those who have IBD. Symptoms include inflammation and pain in the joints, swelling, and stiffness in the joints of the arms and legs (wrists, knees, and ankles). If peripheral arthritis pain goes untreated it can last from several days to several weeks but does not cause any permanent damage. Treatment for this sort of pain generally consists of resting the joints, applying moist heat to the affected areas, and using splints to help support the joints. Often a physical therapist will be able to provide you with exercises to help reduce the pain and improve range of motion. Other treatments comprise of non-steroidal anti-inflammatory drugs (NSAID's). These include medications such as ibuprofen and naproxen. They can help to reduce pain and decrease swelling in the joints but can also aggravate other symptoms of Inflammatory Bowel Disease and so should be used with caution.

Enteropathic Arthritis involves the spine and the sacroiliac joints and affects about 10% - 20% of patients with Ulcerative Colitis and Crohn's Disease. Sacroiliitis is an inflammation of the sacroiliatic joints, which are located in the lowest part of the back. It is thought that this type of arthritis is a result of an immune response to the intestinal bacteria that are released into the body from portions of the bowel that are inflamed. Symptoms include stiffness and pain in the joints of the spinal column. Fusion of the bones of the spine can occur leading to permanent complications and a decrease in range of motion in the back. It can also impair the ability to take deep breaths as it could limit the range of motion in the ribs. Treatment for Enteropathic Arthritis is generally the same as that used for Rheumatoid Arthritis. The main goal of treatment is to maximize range of motion. Medications include NSAID's, methotrexate, and sulfasalazine. Physical therapy and stretching exercises have been shown to reduce the pain associated with this type of arthritis.

Although there is no known way to prevent the onset of IBD arthritis, one way to manage the symptoms of both types of arthritis is being able to control the inflammation in the digestive tract. Arthritis symptoms associated with flare-ups of Ulcerative Colitis and Crohn's Disease have been shown to improve dramatically once the IBD becomes quiescent.

Sources

Penn State - Milton S. Hershey Medical Center (College of Medicine)

Saibil, Fred. Crohn's Disease and Ulcerative Colitis: Everything You Need to Know. Tonawanda, NY: Firefly Books; Revised Edition, 2009.

Tubesing, Andrew. Colitiscope: Living with Crohn's Disease and Ulcerative Colitis. Duluth, MN: Pfeifer-Hamilton, Inc., 2009.

Radbruch, Andreas, and Peter E. Lipsky. Current Concepts in Autoimmunity and Chronic Inflammation. New York, NY: Springer Publishers, 2006.