Is There A Link Between Crohn’s Disease And Joint Pain?

Crohn’s disease is a chronic condition that affects the gastrointestinal tract. It is a type of inflammatory bowel disease that can affect any part of your digestive tract. People with Crohn’s disease have inflammation in the lining of the intestine. While the exact cause of the condition is not known, but it is believed that the inflammation is caused by the immune system mistakenly identifying harmless substances such as beneficial bacteria, food, or even the intestinal tissue itself, as threats to the body. Thus, the immune system attacks them. This results in chronic inflammation. This overreaction of the immune system sometimes also causes problems in other parts of the body, most commonly in the joints, thereby causing moderate to severe joint pain. So is there a connection between Crohn’s disease and joint pain? Read on to find out more.

Overview of Crohn’s Disease

Crohn’s disease is a chronic condition that affects the gastrointestinal system. (1,2,3) It is a type of inflammatory bowel disease that can impact any part of the gastrointestinal tract. However, the inflammation commonly affects the start of the colon and the last section of the small intestine. (4,5) Symptoms of Crohn’s varies from person to person and can include:

Joint pain and soreness of the muscles are some other symptoms caused by Crohn’s disease. The pain has been observed to occur alongside a flare-up or relapse of the symptoms.

The exact cause of Crohn’s disease remains unknown. Yet, it is believed to be caused by the immune system overreacting to even harmless substances like beneficial bacteria, food, and the intestinal tissue itself. This causes inflammation in Crohn’s as well. This overreaction of the immune system is also believed to be the cause of other symptoms in the body outside of the digestive tract. The most commonly affected area is in the joints.

Crohn’s disease has also been found to have a genetic link. People with a particular gene mutation have been found to be more susceptible to Crohn’s disease. Some studies have also found that this same gene mutation is also associated with other types of inflammatory medical conditions, including rheumatoid arthritis, psoriasis, and ankylosing spondylitis. (6,7,8)

Link Between Crohn’s Disease and Joint Pain

If you have Crohn’s disease, you are more likely to be at a higher risk of developing two types of joint condition, including:

  1. Arthritis: a condition of the joints characterized by pain with inflammation
  2. Arthralgia: a condition of the joints characterized by pain without inflammation

Both these conditions are known to affect up to nearly 40 percent of people who have inflammatory bowel disease, such as Crohn’s disease. (9)

Arthritis and Crohn’s Disease

Arthritis is a condition marked by pain and inflammation of the joints. Inflammation from arthritis causes the joints to become swollen and painful. It is believed that arthritis affects nearly 20 percent of people with Crohn’s disease. (10) Arthritis that affects people with Crohn’s disease is slightly different from the regular form of arthritis as in people with Crohn’s, it begins at a much younger age.

There are several types of arthritis that affects people with Crohn’s disease. These include:

Peripheral arthritis: A majority of people with Crohn’s disease go on to develop peripheral arthritis. (11) Peripheral arthritis affects the large joints of the body, such as the ones in your ankles, knees, hips, wrists, and elbows. The joint pain associated with peripheral arthritis tends to occur together with the flare-ups of Crohn’s disease. This type of arthritis does not go on to cause any lasting damage to your joints, such as joint erosion. (12)

Axial Arthritis: This type of arthritis affects only a few people with Crohn’s disease. Axial arthritis causes pain and stiffness around the lower spine. It can also lead to restricted motion and cause permanent damage to the joints.

Symmetrical Arthritis: A small percentage of people with Crohn’s disease develop symmetrical arthritis, which is also known as symmetrical polyarthritis. This type of arthritis causes inflammation in any of the joints, but usually affects the joints of the hands, causing pain. (13)

Ankylosing Spondylitis: A very small percentage of people who have Crohn’s disease go on to develop a severe condition known as ankylosing spondylitis. This is a chronic and progressive inflammation condition that affects the spine and sacroiliac joints. Symptoms of the condition include stiffness and pain at the sacroiliac joints located near the bottom of your back and the lower spine. In fact, some people even experience the symptoms of ankylosing spondylitis several years or months before the symptoms of Crohn’s disease appear. Ankylosing spondylitis can cause permanent damage to your joints. (14)

Arthralgia and Crohn’s Disease

If you are experiencing pain in your joints without inflammation, then you are likely to have arthralgia. Nearly 40 to 50 percent of people with inflammatory bowel diseases such as Crohn’s disease have arthralgia at some point in their lives. (15)

Arthralgia is known to affect various joints throughout the body, but the most common parts it affects are the ankles, hands, and knees. In arthralgia caused by Crohn’s disease, there is no damage caused to the joints.

Diagnosis and Treatment of Joint Pain Linked to Crohn’s Disease

It is difficult to understand if your joint pain is being caused by Crohn’s disease or by a separate joint condition. There is also no one diagnostic test that can determine with certainty whether it is being caused by Crohn’s disease. However, there are several signs that can be an indication of this.

One of the key differences from regular arthritis is that the swelling tends to affect the large joints, and does not affect the same joints on both sides of the body. The stomach-related symptoms of Crohn’s disease are likely to already be an issue much before the disease causes joint pain.

Under normal circumstances, doctors usually recommend using nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (brand name Aleve, Motrin IB) and aspirin for relieving swelling and joint pain. However, people with Crohn’s disease are not supposed to take NSAIDs as these medications can irritate the intestinal lining and also aggravate the symptoms further. Instead, if you are experiencing minor pain, the doctors will recommend taking acetaminophen (brand name Tylenol).

There are also many prescription drugs to help with joint pain in Crohn’s disease, and many of them overlap with the medications you are taking for Crohn’s disease.

Conclusion

Joint pain in people with Crohn’s disease tends to last only for a short time and generally does not lead to permanent joint damage. Your joint pain is likely to improve as you go into remission, or your symptoms improve. However, if you have been diagnosed with ankylosing spondylitis, then the outlook tends to be variable. While some people may experience improvement over time, others may get progressively worse.

Nevertheless, with various modern treatments, the life expectancy of people with joint pain, ankylosing spondylitis, and Crohn’s disease is not typically affected anymore.

References:

  1. Baumgart, D.C. and Sandborn, W.J., 2012. Crohn’s disease. The Lancet, 380(9853), pp.1590-1605.
  2. Shanahan, F., 2002. Crohn’s disease. The Lancet, 359(9300), pp.62-69.
  3. Torres, J., Mehandru, S., Colombel, J.F. and Peyrin-Biroulet, L., 2017. Crohn’s disease. The Lancet, 389(10080), pp.1741-1755.
  4. Marks, D.J., Harbord, M.W., MacAllister, R., Rahman, F.Z., Young, J., Al-Lazikani, B., Lees, W., Novelli, M., Bloom, S. and Segal, A.W., 2006. Defective acute inflammation in Crohn’s disease: a clinical investigation. The Lancet, 367(9511), pp.668-678.
  5. Information, H., Diseases, D., Disease, C., Facts, D., Disease, D., Center, T. and Health, N., 2020. Definition & Facts For Crohn’S Disease | NIDDK. [online] National Institute of Diabetes and Digestive and Kidney Diseases. Available at: <https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/definition-facts> [Accessed 25 August 2020]. disease-molecular-genetics-and-clinical-implications/7D54962741FAA76A4523AC0DF32F0856
  6. Parkes, M. and Jewell, D., 2001. Ulcerative colitis and Crohn’s disease: molecular genetics and clinical implications. Expert reviews in molecular medicine, 3(30), pp.1-18.
  7. Cleynen, I., Boucher, G., Jostins, L., Schumm, L.P., Zeissig, S., Ahmad, T., Andersen, V., Andrews, J.M., Annese, V., Brand, S. and Brant, S.R., 2016. Inherited determinants of Crohn’s disease and ulcerative colitis phenotypes: a genetic association study. The Lancet, 387(10014), pp.156-167.
  8. 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 Genet, 6(12), p.e1001195.
  9. Vavricka, S.R., Schoepfer, A., Scharl, M., Lakatos, P.L., Navarini, A. and Rogler, G., 2015. Extraintestinal manifestations of inflammatory bowel disease. Inflammatory bowel diseases, 21(8), pp.1982-1992.
  10. Orchard, T.R., 2012. Management of arthritis in patients with inflammatory bowel disease. Gastroenterology & hepatology, 8(5), p.327.
  11. Ccfa.org. 2020. [online] Available at: <http://www.ccfa.org/assets/pdfs/arthritiscomplications.pdf> [Accessed 25 August 2020].
  12. 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.
  13. Norton, K.I., Eichenfield, A.H., Rosh, J.R., Stern, M.T. and Hermann, G., 1993. Atypical arthropathy associated with Crohn’s disease. American Journal of Gastroenterology, 88(6).
  14. Rudwaleit, M. and Baeten, D., 2006. Ankylosing spondylitis and bowel disease. Best practice & research Clinical rheumatology, 20(3), pp.451-471.
  15. Orchard, T.R., 2012. Management of arthritis in patients with inflammatory bowel disease. Gastroenterology & hepatology, 8(5), p.327.

Also Read:

Was this article helpful?

Yes No
×

Suggestions to Improve the Article

This article contains incorrect information.

This article does not have the information I am looking for.


I Have a Medical Question.

Ask A Doctor Now

If you are facing a medical emergency, call your local emergency services immediately, or visit the nearest ER or urgent care facility
×

Suggestions to Improve the Article

×

How Did This Article Help?

This Article Did Change My Life!


I Have a Medical Question.

Ask A Doctor Now

If you are facing a medical emergency, call your local emergency services immediately, or visit the nearest ER or urgent care facility
×

Thank you for your feedback.