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 Crohns Disease:  Extraintestinal Manifestations : Arthritis
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ARTHRITIS ASSOCIATED WITH CROHN'S DISEASE

Extraintestinal Complications of IBD: Arthritis Arthritis is the most common extraintestinal complication of IBD -- occurring in about 25 percent of people who have Crohn's disease or ulcerative colitis. The type of arthritis can be either peripheral or spinal.

Peripheral Arthritis

In peripheral arthritis, the large joints of the arms and legs are most commonly involved. These are the elbows, wrists, knees, and ankles. The discomfort may be "migratory," moving from one joint to another. If left untreated, this pain may last from a few days to several weeks. Peripheral arthritis tends to be more commonly encountered with people who have ulcerative colitis or Crohn's disease of the colon, and the level of inflammation in the joints generally mirrors the extent of inflammation in the colon. Although no specific test can make the definitive diagnosis, various methods -- including analysis of joint fluid, blood tests, and X-rays -- may rule out other causes of joint pain. Fortunately, this type of peripheral arthritis does not cause any lasting damage.

In the general population, treatment of arthritis usually involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs), which work to reduce pain and swelling of the joints. However, as a rule, these medications -- which include aspirin and ibuprofen -- are not an option for some people with IBD because they can irritate the intestinal lining and intensify the inflammation in a certain portion of the IBD population.

Instead, physicians manage the arthritis symptoms by controlling the inflammation within the colon. Once that has subsided after a course of a medication such as prednisone or sulfasalazine, the joint pains generally disappear. Similarly, treatment with the newer biologic agents -- such as infliximab (RemicadeŽ) -- have also been shown to be effective in reducing joint inflammation and swelling. In addition to medication, doctors may recommend resting the affected joint as well as the occasional use of moist heat. Range of motion exercises, as demonstrated by a physical therapist, may also be helpful.

Spinal Arthritis

Also known as spondylitis or spondyloarthropathy, spinal arthritis produces pain and stiffness in the lower spine and sacroiliac joints. Interestingly, these symptoms may come on months or even years before the symptoms of IBD appear. Unlike peripheral arthritis, spinal arthritis may cause permanent damage if the bones of the vertebral column fuse together -- thereby creating a decreased range of motion in the back. In some cases, a restriction in rib motion may make it difficult for people to take deep breaths. Active spondylitis generally subsides by age 40. Therapy for people with spinal arthritis is geared toward improving range of motion in the back. Stretching exercises are recommended, as is the application of moist heat to the back. Unlike peripheral arthritis, there is no correlation between treatment of the underlying IBD and improvement in arthritis symptoms.

Ankylosing Spondylitis

A more severe form of spinal arthritis, ankylosing spondylitis (AS) is a rare complication. In addition to causing arthritis of the spine and sacroiliac joints, ankylosing spondylitis can cause inflammation of the eyes, lungs, and heart valves. The cause of AS is not known, but most affected individuals share a common genetic marker. In some cases, the disease occurs in these predisposed people after exposure to bowel or urinary tract infections. Occasionally, AS may foretell the development of inflammatory bowel disease. AS typically strikes adolescents and young adult males, usually appearing first as a dramatic loss of flexibility in the lower spine. Rehabilitation therapy is essential to help maintain joint flexibility. But even with optimal treatment, some people will develop a stiff or "ankylosed" spine. It is not always easy to determine whether the arthritis is connected with the intestinal condition. In general, the arthritis that complicates IBD is not usually as severe as in rheumatoid arthritis. The joints do not ordinarily undergo destructive changes, and joint involvement is not symmetric. Except for ankylosing spondylitis, arthritis associated with IBD usually improves as intestinal symptoms improve.

On behalf of learning, and use as teaching tools for those of us who need to know about our disease, I have tried to supply you with as much information as I could find on all of the drugs, treatments and disorders associated with Inflammatory Bowel Diseases. I have tried to blend all facts supported by research and also from personal experiences of other IBD sufferers into one readable webpage, and any and all information presented here is not entirely from one source. Most information contained within these pages is found in the public domain. At times you may find information used from another site, and as with all copyrighted materials you may find on these pages, I claim fair use under sections 107 through 118 of the Copyright Act (title 17, U.S. Code). Click here for more info

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