Can Crohn’s Cause Joint Pain?

Crohn’s disease is a medical condition that causes a wide range of gastrointestinal symptoms. This chronic, long-term condition leads to inflammation of the digestive tract, and it is a painful, debilitating, and often life-threatening condition if left untreated. Crohn’s disease can affect any part of your gut, ranging from the mouth to all the way down to the anus. However, in most cases, it affects the lower part of the small intestine, known as the ileum. Some people with Crohn’s disease, apart from the usual gastrointestinal symptoms, also experience joint pain. But can Crohn’s cause joint pain? Or is it a result of some other factor? Let us take a look.

People who have Crohn’s disease suffer from chronic inflammation in the lining of their gastrointestinal tract. Even though the exact cause of Crohn’s disease is unknown, it is nevertheless believed that Crohn’s involves an overreaction of the body’s immune system. The immune system starts mistakenly identifying harmless substances, such as good intestinal tissue, or even healthy bacteria, as being a threat and thus attacks them.

Over a period of time, this causes chronic inflammation, and this overreaction of the immune system can also lead to problems in other parts of the body, including your joints.

There is also believed to be a genetic factor behind Crohn’s disease, meaning that people with a specific gene mutation are more susceptible to getting Crohn’s. Studies ⁽¹⁾ have found that these gene mutations are also responsible for causing other types of inflammatory diseases, including rheumatoid arthritis, psoriasis, and ankylosing spondylitis.

Arthritis is one of the most well-known inflammatory joint condition that also causes joint pain. This is why if you have Crohn’s disease, you are also at a higher risk for developing arthritis.

Broadly speaking, there are two types of joint problems that can develop if you have Crohn’s disease. These are:

1. Arthritis – a condition marked by both joint pain and inflammation
2. Arthralgia – a condition in which joint pain is there, but without inflammation

So if you only experience pain in your joints, but there is no swelling, then it is likely that you have arthralgia. It has been observed that nearly 40 to 50 percent of all people who have inflammatory bowel disease (IBD) suffer from arthralgia at some point or the other in their lives. (2) Since Crohn’s disease is also a type of IBD, it is, therefore, not uncommon for Crohn’s patients to also experience arthralgia.

Arthralgia can affect many different joints in the body, the most commonly affected ones being your hands, knees, and ankles. However, arthralgia associated with Crohn’s disease does not cause any damage to the joints.

Arthritis, though, causes joint pain as well as swelling. Nearly 20 percent of people with Crohn’s disease are affected by arthritis ⁽²⁾. Arthritis that is associated with Crohn’s disease is not the same as regular arthritis as it tends to start at a much younger age.

There are three major types of arthritis that affect people with Crohn’s disease. ⁽³⁾ These are discussed below.

Peripheral arthritis is one of the most common types of arthritis that affects people with Crohn’s disease ⁽⁴⁾. Peripheral arthritis affects the large joints of the body, including the joints in your knees, ankles, wrists, hips, and elbows. ⁽⁵⁾ The joint pain associated with this type of arthritis generally occurs at the same time as flare-ups of Crohn’s stomach and bowel symptoms. Peripheral arthritis usually does not cause any joint erosion or any lasting damage to the joints. ⁽⁶⁾

A very small percentage of people who have Crohn’s disease get affected by symmetrical arthritis. Also known as symmetrical polyarthritis, this condition causes inflammation in any of the joints in the body, but it is more likely to cause pain in the joints of the hands.

A smaller percentage of Crohn’s patients also go on to develop ankylosing spondylitis, which is known to be a severe condition. Ankylosing spondylitis is a chronic and progressive inflammatory condition that affects the spine and sacroiliac joints. Symptoms of ankylosing spondylitis include stiffness and pain in the lower spine as well as the bottom of the back where the sacroiliac joints are present.

Many people even experienced symptoms of ankylosing sspondyliti9s years or months before the symptoms of Crohn’s disease appear.

If you have this type of arthritis along with Crohn’s, it is more likely to cause permanent damage to your joints.

In people who do not have Crohn’s disease, doctors generally recommend the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (brand name Aleve, Motrin IB), and aspirin (brand name: Bufferin) for getting relief from any type of joint pain and swelling. However, people who have Crohn’s disease should not be taking NSAIDs. NSAIDs can cause further irritation to the gastrointestinal lining, thus worsening your symptoms. For minor joint pain, your doctor is more likely to advise using acetaminophen (brand name: Tylenol).

There are many types of prescription drugs that are available to help you cope with joints, and many of these actually overlap with the medications for Crohn’s disease. These include:

• Methotrexate
• Corticosteroids
• Sulfasalazine (brand name: Azulfidine)

Newer available biologic agents such as adalimumab (brand name: Humira), infliximab (brand name: Remicade), and certolizumab pegol (brand name: Cimzia)

Apart from medication, there are various home remedies also that may help you get relief from joint pain with Crohn’s disease. These include:

• Applying ice and elevating the affected joint
• Resting the affected joint

Practicing specific exercises for decreasing the stiffness and for strengthening the muscles around the joints. It is better if your physical therapist or occupational therapist prescribes these exercises.

Exercise can not only help you improve the range of motion in the affected joints, but it also helps lower your stress levels. High-stress levels are also known to be a trigger for Crohn’s flare-ups, so having low-stress levels will help you manage your condition better.

You can also try doing some low impact cardio exercises such as stationary biking, yoga, tai chi, or swimming. Strength training is also known to help many patients.

If you are frequently experiencing joint pain and you also have Crohn’s disease, then you should consult your doctor. Your doctor would want to carry out specific diagnostic tests to determine the exact cause of your pain. They will also need to adjust your Crohn’s disease medications as sometimes joint pain is also a side effect of some Crohn’s medications.

Your doctor will also recommend a physical therapist, who will then assist you in developing an exercise program for your joints.

Living a healthy lifestyle will also go a long way in ensuring the proper functioning of the affected joints.

Joint pain in people with Crohn’s disease does not tend to last for long. It also does not cause permanent damage to the joints or deformity. You will notice that your joint pain improves as the intestinal symptoms of Crohn’s improve. Keep in mind that by controlling your digestive symptoms through medication and diet, you will be able to maintain your joints as well.

However, if you are diagnosed with ankylosing spondylitis, then your doctor will need to take a look at your overall treatment plan, and the overall outlook will also vary.

While some people find their symptoms improving over time, others tend to progressively get worse.

With the advent of many types of modern treatments, the life expectancy for people with Crohn’s and ankylosing spondylitis is today not much affected.

Remember that following a healthy diet and keeping a healthy lifestyle is most important in dealing with diseases such as Crohn’s disease.

References

1. Danoy, P., Pryce, K., Hadler, J., Bradbury, L.A., Farrar, C., Pointon, J., Ward, M., Weisman, M., Reveille, J.D., Wordsworth, B.P. and Stone, M.A., 2010. Association of variants at 1q32 and STAT3 with ankylosing spondylitis suggests genetic overlap with Crohn’s disease. PLoS genetics, 6(12), p.e1001195.
2. Orchard, T.R., 2012. Management of arthritis in patients with inflammatory bowel disease. Gastroenterology & hepatology, 8(5), p.327.
3. Haslock, I., 1973. Arthritis and Crohn’s disease. A family study. Annals of the rheumatic diseases, 32(6), p.479.
4. Ccfa.org. (2019). [online] Available at: http://www.ccfa.org/assets/pdfs/arthritiscomplications.pdf [Accessed 30 Oct. 2019].
5. Palm, Ø., Moum, B., Jahnsen, J. and Gran, J.T., 2001. The prevalence and incidence of peripheral arthritis in patients with inflammatory bowel disease, a prospective population‐based study (the IBSEN study). Rheumatology, 40(11), pp.1256-1261.
6. Yüksel, İ., Ataseven, H., Başar, Ö., Köklü, S., Ertuğrul, İ., Ülker, A., Dağlı, Ü. and Şaşmaz, N., 2011. Peripheral arthritis in the course of inflammatory bowel diseases. Digestive diseases and sciences, 56(1), pp.183-187.