Joint pain is the most common external manifestation of Crohn’s and Colitis. In fact, the two types of joint inflammation, arthritis and arthralgia, affect 40% of all IBD patients. In comparison, 30% of those with UC, and 20% with CD will be diagnosed with arthritis. Arthritis is joint pain from excess inflammation, whereas arthralgia is joint pain without inflammation. For those with IBD, an estimated 50% will experience arthralgia at some point during their lives, myself included.
The exact link between IBD and joint pain is not fully known. Part of it is probably related to genetics. It’s also speculated that it may be your body’s reaction to the spreading of chronic inflammation of the intestines. Either way more research will need to be done in this area to get more definite answers. We do know that arthralgia is less harmful long term than arthritis, as arthralgia does not cause damage to the joints. This type of joint pain is most commonly found in knees, ankles, and hands. Since the joins are not inflamed themselves, inflammation cannot damage them. This is the type of joint pain that I have, and it often mirrors my UC symptoms. However, I still struggle with knee and hip pain even when in remission, but it is much more extreme in times of flaring.
As for arthritis, there are several different forms. Here we will cover the three main types, what joints they affect, and how your IBD can impact them.
- Peripheral Spondyloarthritis: This is a type of spondyloarthritis (SpA). Although it’s quite a long name, spondyloarthritis simply refers to a group of inflammatory conditions that affect the skeletal system. SpA affects the large joints in the arms and legs. These include, knees, ankles, shoulders, and elbows. This type of arthritis will generally mirror your IBD symptoms, being worse when flaring.
- Axial spondyloarthritis: This type is also categorized as a SpA, more specifically axSpA. Instead of affecting the arms and leg joints, axSpA affects the sacroiliac joints in the pelvis and the lower spine. This arthritis has the tendency to fuse joints together over time which may require surgery or limit mobility. It does not reflect the state of your IBD, as it can be diagnosed years before.
Ankylosing spondylitis (AS): This is a more severe type of axSpA. AS can affect movement, flexibility, and mobility. Many times, it will make your back stiff which forces you to be in a bent over posture which can become more limiting as time goes on. AS seems to act on its own as well, not responding to flare or remission.
So, what do you do to get diagnosed if you suspect you may have any type of arthritis? Firstly, speak to your gastroenterologist and let them know you’re experiencing joint pain. They can then refer you to a rheumatologist, a specialist in treating arthritis. Your rheumatologist may do a series of tests ranging from standard blood work, to MRI’s, x-rays, and joint fluid analysis. After these tests are performed, they will be able to determine if and which type of arthritis you have. Keeping a journal of symptoms, what makes your pain better or worse, and what it feels like can also give your rheumatologist a huge head start in your diagnosis.
While you are waiting to be diagnosed and even after, there are a few ‘home remedies’ you can try to help manage pain and inflammation. A warm compress or heating pad can help relieve pain, as well as ice and elevation. It can also be helpful to stretch. Ask your rheumatologist to refer you to a physical therapist. They can be really beneficial in showing you which stretches will help and the use of correct technique to prevent further injury. You can also follow an anti-inflammatory diet, avoid any known trigger foods, and practice deep breathing and meditation.
There are also several medications that can be prescribed to help control inflammation and therefore symptoms. As tempting as it may sound, remember to avoid NSAIDS as they have been shown to cause IBD flares. Instead, your doctor may prescribe steroids like prednisone, tofacitinib (Xeljanz) an oral treatment used to reduce inflammation in those with UC as well as treating psoriatic and rheumatoid arthritis, Biologics like adalimumab (Humira), golimumab (Simponi), infliximab (Remicade), and vedolizumab (Entyvio), or disease-modifying antirheumatic drugs (DMARDs), like sulfasalazine (Azulfidine) and methotrexate.
While I know joint pain of any kind can feel debilitating, especially on top of IBD symptoms, remember to take it a day at a time and do what you can to mitigate your symptoms. Be gentle with yourself and give yourself more time to rest. Whether your joint pain is reflective of your IBD symptoms or not, taking any prescribed medication for it as directed and consistently will help you to see results as soon as possible. I have found personally that rotating heating pads and ice in about 20-minute increments on my sore joints, meditation and deep breathing, as well as CBD lotion help me to stay relatively pain free. Work with your doctors and specialists to find a care routine that works for you. Keep fighting fellow IBD warriors, and remember you are not alone.
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