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.
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 (Remicade®) -- 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.
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.
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
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