By Karen Appold
Feeling the joint pain, stiffness, swelling, or redness of arthritis? You may be surprised to learn that about 25 percent of people with Crohn’s disease will develop arthritis, an inflammation of the joints. This makes it the most common extra-intestinal (outside the digestive tract) complication of Crohn’s. Some older patients report that their arthritis gets worse in the winter — a phenomenon that may be related to changes in atmospheric pressure, says Neilanjan Nandi, MD, gastroenterologist and assistant professor at Drexel University College of Medicine in Philadelphia. Dressing warm and exercising to maintain flexibility is key to keeping symptoms under control during the colder months, he says.
Explaining the Link Between Crohn’s and Arthritis
Some recent research suggests an overlap between Crohn’s disease and other autoimmune arthritis conditions, such as psoriatic and rheumatoid arthritis. An analysis of 10 autoimmune diseases published in August 2015 in Nature Medicine discovered 22 gene sites shared by at least two conditions including Crohn’s, ulcerative colitis, and psoriasis.
“It is believed that the chronic inflammation in the intestines or colon can trigger the immune system to start an inflammatory process in the joints or tendons,” says Michael R. Cannon, MD, a rheumatologist with Arthritis Consultants of Tidewater in Virginia Beach, Virginia. Both Crohn’s and rheumatoid arthritis are categorized as immune-mediated inflammatory diseases.
According to the Crohn’s and Colitis Foundation of America, having Crohn’s means you’re more likely to develop one of three types of arthritis:
- Peripheral Arthritis This condition affects the hands, wrists, elbows, knees, ankles, and feet. It tends to mirror the activity of Crohn’s, but doesn’t damage the joint cartilage or bone.
- Axial Arthritis Also called spondylitis or spondyloarthropathy, this affects the spine, back, and hips. It may start before you have any signs of Crohn’s and can lead to bone damage and destruction.
- Ankylosing Spondylitis A severe form of spinal arthritis, ankylosing spondylitis also can cause inflammation in the heart valves, lungs, and eyes.
In some people with joint pain and Crohn’s, the joint problem could be related to medication side effects or intolerance rather than true arthritis, says Jeffry A. Katz, MD, professor of medicine at Case Western Reserve University School of Medicine and director of the Inflammatory Bowel Disease Center at University Hospital in Cleveland, Ohio. If used over a long period of time, steroids, such as Deltasone (prednisone), can cause bone loss, leading to premature osteoporosis, subsequent bone decay, fractures, and eventual joint pain. This usually occurs in the back or hips.
Getting Crohn’s-related Arthritis Under Control
Tell your doctor about all of your symptoms. “Many people with joint pain and Crohn’s don’t tell their gastroenterologist about their joint problems because they just attribute it to getting older, rather than being a part of the inflammatory disease process,” says Christopher R. Morris, MD, rheumatologist with Arthritis Associates of Kingsport in Tennessee. In fact, arthritis related to Crohn’s often affects younger patients. Seeing a rheumatologist might help, and your rheumatologist and gastroenterologist can coordinate your care to better treat both conditions.
Dr. Morris adds that when you treat Crohn’s, you’re often treating the arthritis as well. Among the milder drugs, Azulfidine (sulfasalazine) can help both the gastrointestinal (GI) tract and joints while Lialda (mesalamine) does a better job of treating the GI symptoms than the arthritic symptoms.
An industry-funded study published in November 2016 in The New England Journal of Medicine suggested that a drug called Stelara (ustekinumab), used primarily for a subtype of arthritis that occurs in people with psoriasis, might also work for treating Crohn’s disease.
Physical therapy or exercise therapy is often part of the plan for arthritis treatment, particularly to help with back pain and to prevent losing range of motion in the joints.
Another important part of your treatment plan is exercise, which might reduce pain and strengthen muscles, providing additional joint protection, Dr. Cannon says. Consider exercises like:
- Low-impact aerobic exercise such as the elliptical machine, pool exercises, stationary bike, yoga, or tai chi
- Strength training
Unsure of how to start? A physical therapist can help develop an exercise program for you.
Morris cautions against exercising a joint that’s inflamed, and notes that overdoing exercise can trigger joint flares. Split up tasks, balance activity with rest, and pace yourself to be able to accomplish more over time.
Be sure to discuss your exercise program with your doctor so that you can map out a comprehensive plan to address Crohn’s disease, your degree of arthritis, and any other health problems you’re managing.