If you have Cohn’s disease, you have a higher risk of arthritis. Experts believe this has to do with your genetics. Arthritis is usually more common when you’re older, but with Crohn’s or other types of inflammatory bowel disease (IBD), it can happen in your younger years too.
What Types of Arthritis Does Crohn’s Disease Cause?
Crohn’s puts you at risk for three kinds of arthritis:
Peripheral arthritis. This is the most common type of arthritis in people with Crohn’s and other types of IBD. It can affect bigger joints, like your elbows, wrists, ankles, and knees. Your pain may move from one joint to another. Peripheral arthritis is more common in people whose Crohn’s disease affects their colon. But Crohn’s-related peripheral arthritis doesn't usually cause major damage.
There’s no specific test for this kind of arthritis. Your doctor will do multiple tests to rule out other conditions. Those might include blood tests, joint fluid tests, and X-rays.
Axial arthritis. Doctors also call this spondylitis or spondyloarthropathy. It causes stiffness and pain in your lower spine. It can also cause you discomfort in the joints in your lower back. Symptoms might begin months or years before you notice any signs of Crohn’s disease. This is especially common in young people.
This kind of arthritis could lead to permanent damage in your body. This might happen if your spine begins to fuse together, which makes it hard to move your back like you used to. If these issues keep your ribs from moving easily, you may have a hard time taking deep breaths.
The progression of axial arthritis usually slows down a bit when you’re around 40.
Ankylosing spondylitis. This also affects your spine, and it’s more severe than axial arthritis. It tends to show up in people under 30. Teens and young adult males are most affected. The condition is rare and doesn’t happen too often in people with Crohn’s disease. But out of all forms of IBD, it happens in Crohn’s disease the most.
It’ll cause arthritis in your spine and lower back joints. It can also lead to inflammation in your eyes, heart valves, and lungs.
Experts aren’t sure what causes ankylosing spondylitis, but they believe it’s mainly genetic. Sometimes, this form of arthritis can predict if you’ll develop Crohn’s disease or another type of IBD.
How Can Crohn’s Disease Lead to Arthritis?
Your genes play a big role whether or not you’ll get arthritis along with your Crohn’s disease. That’s because Crohn’s might raise your body’s risk for luminal microbiota. These are organisms that can trigger arthritis.
Experts refer to the types of Crohn’s-related arthritis as “seronegative spondyloarthropathies.” This is a family of joint conditions. It includes:
- Ankylosing spondylitis
- Psoriatic arthritis
- Inflammatory bowel disease-associated arthritis
- Reactive arthritis
- Undifferentiated spondyloarthritis
Ankylosing spondylitis has a strong tie to a certain type of gene called HLA-B27. It controls your body’s immune response and it’s involved with Crohn’s disease.
Peripheral arthritis in people with Crohn’s disease also has a tie to HLA-B27, but it’s less strong. In this type of arthritis, there’s a very strong link to a rare HLA gene called HLA-DR103. About 35% of people with large joint arthritis have this gene. In the overall population, only 1% to 3% of people have HLA-DR103.
Doctors don’t know the exact reason these genetic ties lead to arthritis in people with Crohn’s disease. One theory is that regular arthritis flares result from a leaky, inflamed gut. This, plus your genetic risk for certain bacteria, could explain the link.
These things lead to uncontrolled inflammation in your system that targets your joints. Your arthritis risk likely depends on a combination of your genes and exposure to certain bacteria.
How Often Does Crohn’s Disease Lead to Arthritis?
About 20% of people with Crohn’s get arthritis from it. In fact, it’s the most common IBD complication outside of those related to your digestive tract. Experts found there’s a slightly higher chance you’ll get arthritis if Crohn’s disease affects your large intestine, or bowel.
What Are the Symptoms of Crohn’s-Related Arthritis?
Crohn’s-related arthritis is very different from rheumatoid arthritis (RA). If you have RA, you’ll develop a disease that deforms and breaks down your joints over time. People with this condition may need joint replacement surgery eventually.
But Crohn’s-related arthritis doesn’t cause your joints to change form or break down. Usually, it doesn’t lead to long-term joint damage. Instead, you may notice symptoms like:
- Severe and sudden swollen joints
- Joints that are hot to touch
- Pain and swelling in larger joints
- Pain and swelling that moves from joint to joint
With peripheral arthritis, you may notice pain for 1 to 2 years.
What Is the Treatment for Crohn’s-Related Arthritis?
If you have peripheral arthritis, treating your Crohn’s disease usually helps with your joint pain. Your doctor may prescribe steroids and medicines that affect your immune system (you might hear them called immunomodulators).
But you need to be careful if you use steroids. While they have anti-inflammatory benefits, too much of these drugs can cause harmful long-term side effects. Because of this, your doctor will keep steroid use to a minimum.
You also shouldn’t use nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen for your arthritis. They’ve been shown to trigger Crohn’s flare-ups.
Certain studies have shown that sulfasalazine may be a good anti-inflammatory medication for Crohn’s-related peripheral arthritis. But experts still need to look into this more.
For peripheral or axial arthritis, your doctor might suggest biologic therapies. These include treatments like, adalimumab (Humira), certolizumab pegol (Cimzia), and infliximab (Remicade). These drugs treat both ankylosing spondylitis and Crohn’s disease. Your doctor may also have you look into non-medical treatments to help improve the range of motion in your back. Your doctor may recommend stretching routines or the use of moist heat on your back.
Treating your Crohn’s disease may help with axial arthritis, but it helps more with peripheral arthritis.
With ankylosing spondylitis, rehabilitation therapy will help keep your joints flexible. But you may still develop a stiff spine, even with the best treatment. Your ankylosing spondylitis symptoms might get worse even after bowel resection or colectomy surgery for Crohn’s. Not everyone gets these surgeries, but your doctor may suggest them if Crohn’s has damaged your colon.
For these reasons, it’s important to see a rheumatologist, a doctor who specializes in joints and muscles, if you think you have this kind of arthritis. They can put you on biologic treatments to try and lessen joint pain and other complications.
In addition to medical treatment, you can also use exercise and rest to feel better with Crohn’s-related arthritis. Regular physical activity can help improve your range of motion. To keep your joints active, try things like swimming, biking, water aerobics, yoga, or tai chi. If your joints hurt, take a break and rest. Ice and elevate your joints to lessen discomfort or any swelling.
Always ask your doctor for advice when you begin a new exercise routine. They can help you find a routine that’s best suited for you.