Arthritis Associated With Inflammatory Bowel Disease
What Is It?
Inflammatory bowel disease (IBD) refers to two disorders — Crohn's disease and ulcerative colitis — marked by inflammation of the intestinal tract. They are thought to be autoimmune disorders in which the body's immune system mistakenly attacks the intestinal tract, and other parts of the body, although this is unproven.
Some people with inflammatory bowel disease have a type of arthritis that is similar to rheumatoid arthritis in some ways. However, there are some important differences. With the arthritis associated with IBD, inflammation tends to involve only a few, large joints and it tends not to involve both sides of the body equally. For example, it might affect the knee on one side and the ankle on the other. In rheumatoid arthritis, more joints, especially small ones in the hand and wrist are involved and joints on both sides of the body are affected equally. Antibodies commonly found in the blood of people with rheumatoid arthritis are not usually present in the blood of people with IBD arthritis. Unlike rheumatoid arthritis, arthritis associated with IBD may affect the lower spine, especially the sacroiliac joints, and is associated with a certain gene (called HLA-B27).
The bowel problems caused by inflammatory bowel disease usually appear long before the arthritis develops. Occasionally the arthritis appears first and the inflammatory bowel disease is diagnosed months or even years later.
Besides the symptoms of IBD on the intestinal tract (such as bloody diarrhea, crampy abdominal pain and fever), people with the arthritis of IBD have pain, swelling, stiffness (particularly in the morning) in those joints that are inflamed. Symptoms tend to vary over time, sometimes better, sometimes worse. Often, but not always, the joint symptoms correlate with the bowel symptoms; that is, the joints tend to be more painful and swollen when the gastrointestinal symptoms are worse. Common complaints include low back pain that is worse in the morning and better when you exercise, limited joint motion and gelling, which means becoming more stiffness after not moving around much.
There is no test that can confirm the diagnosis of arthritis associated with inflammatory bowel disease. Your doctor will ask about your medical history, especially whether you have inflammatory bowel disease. He or she will look for typical symptoms, and will examine you to look for inflamed joints.
Arthritis associated with IBD tends to be chronic (long-lasting), though it may get better and worse over time. Rarely, certain treatments can cause the arthritis to subside or even go away. For example, if a patient with ulcerative colitis has a colectomy (removal of the colon), the arthritis may disappear.
There is no known way to prevent IBD arthritis.
There is no single best treatment for arthritis associated with IBD. Joint pain may be relieved by a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen. IBD can cause bleeding in the intestinal tract, which can be made worse by a medication that thins the blood, including most NSAIDs. Any NSAID may worsen the intestinal inflammation caused by inflammatory bowel disease.
For more severe cases, injections of corticosteroids into the inflamed joint can provide prompt, though often temporary, relief. Other medications that may help include those that may be prescribed for the intestinal disease such as sulfasalazine (Azulfidine), azathioprine (Azasan, Imuran) or oral corticosteroids. Medications used in the treatment of rheumatoid arthritis, such as methotrexate (Folex, Methotrexate LPF, Rheumatrex) can also be effective. Finally, newer agents, such as injections of adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel) and infliximab (Remicade), may be quite effective for IBD arthritis. Infliximab, adalimumab and certolizumab are approved for severe Crohn's disease; their use may improve the arthritis as well as the bowel inflammation.
If joints become severely damaged, joint surgery, including joint replacement, may help.
It's important to strike a balance between rest and exercise. Your doctor may refer you to a physical therapist, occupational therapist or podiatrist. Splints, shoe inserts or braces can provide relief in ways that medications cannot.
When To Call a Professional
Call your doctor if you have symptoms of IBD (including chronic diarrhea, crampy abdominal pain, unintentional weight loss or recurring fever) or of arthritis (including joint pain, swelling, or limited motion).
With treatment, the outlook for IBD arthritis is generally good, although the condition is quite variable. Severe cases may be associated with significant joint damage and the need for surgery within a year or two, while other cases are much milder.
Crohn's & Colitis Foundation of America
386 Park Ave. South
New York, NY 10016
National Institute of Diabetes & Digestive & Kidney Disorders
Office of Communications and Public Liaison
Building 31, Room 9A04
31 Center Drive, MSC 2560
Bethesda, MD 20892-2560
American College of Rheumatology
1800 Century Place
Atlanta, GA 30345-4300
P.O. Box 7669
Atlanta, GA 30357-0669