Arthritis and Inflammatory Bowel Disease

Category: Inflammatory Spondyarthropathy Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD

Daytona Beach News Journal

Tom, a 35-year-old man with a history of Crohn's disease, suffered with frequent abdominal cramping and bloody diarrhea. Additionally, during the past few months, he has experienced joint pain and swelling in his left knee and ankles, which he has observed to be linked to his bowel condition. The more active his diarrhea and abdominal pain, the more prominent his arm and leg arthritis-- when his diarrhea and abdominal pain are under control, so is his arthritis.

Two conditions where the bowel wall becomes inflamed, ulcerated and/or scarred:  ulcerative colitis and Crohn's disease. Both conditions tend to be chronic and to wax and wane over many years.  Ulcerative colitis, which affects about in 1 in 2000, is a disease of the large bowel (colon) that most commonly leads to abdominal cramps with bloody diarrhea.  While Crohn's disease affects slightly more people, 1 in 1500, it can involve both the small and large bowel, but still its symptoms are similar to those of ulcerative colitis.

Like Tom, it is common for patients to suffer from arthritis and inflammatory bowel disease.  There are two distinct forms of inflammatory bowel associated arthritis: one involving the arm and leg joints called peripheral arthritis, and the other involving the spine called spondylitis. 

Peripheral arthritis, the more common of the two, tends to be a sign of bowel inflammation, often showing up just before bowel symptoms or flare ups occur, and subsiding when bowel inflammation improves (either spontaneously or as a result of treatment). Normally involving large joints, such as the knee or ankle, few joints are affected at the same time and they eventually improve without causing joint damage. While peripheral arthritis is best treated by controlling bowel inflammation, its prognosis is good.

In contrast, spondylitis, which is more difficult to treat,  tends to be present for even years before bowel symptoms appear.  Patients experience back pain and stiffness, particularly in the morning.  And unlike peripheral arthritis, spondylitis seems to be associated, in more than half the cases, with the gene called HLA-B27, but not the activity of  bowel inflammation. 

Both forms of arthritis have been associated with episodic eye inflammation, and/or inflammation where ligaments and tendons attack to the bone.

Some patients have found non-steroidal anti-inflammatory drugs (NSAIDs) such as Naprosyn or Indomethacin quite helpful, especially in adequate doses.  Disease modifying anti-rheumatic drugs (DMARDs), such as Methotrexate and Sulfasalazine also have helped some patients with a poor response to NSAIDs. 

Due to new biologic agents such as Remicade, proven very effective in controlling spondylitis, the future of arthritis of inflammatory bowel disease is bright.

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