Inflammatory Bowel Disease (IBD) is associated with several other conditions including liver disorder primary sclerosing cholangitis, fissures, fistulas, and arthritis. Arthritis is the most common extraintestinal complication, affecting an estimated 25% of all IBD patients. The two most common forms of arthritis experienced by IBD patients are peripheral and spinal arthritis.
Peripheral arthritis
Peripheral arthritis is most common in people with ulcerative colitis or Crohn's disease of the colon. Typically, the course of the arthritis follows that of the IBD, with flare-ups and remissions coinciding. There is no one test that can diagnose peripheral arthritis, but instead several tests including blood tests, joint fluid analysis, and x-rays are used to exclude other conditions.
Symptoms of peripheral arthritis are pain, swelling, and stiffness in one or more joints of the arms and legs (wrists, knees, and ankles) that may migrate between joints. When pain in peripheral arthritis is untreated it can last from several days to weeks. Fortunately, this type of arthritis does not generally cause any permanent damage.
Treating peripheral arthritis often involves resting painful joints along with splints and occasional moist heat. Exercises prescribed by a physical therapist are used to improve range of motion. Nonsteroidal anti-inflammatory drugs (NSAIDs) are sometimes used to decrease the redness, swelling, and pain of inflamed joints. However NSAIDs can aggravate the symptoms of IBD and should only be used with the supervision of a physician familiar with IBD.
Another method of treating this form of arthritis is to gain control over the inflammation in the colon due to IBD. The arthritis symptoms will usually lessen when the IBD is quiescent. IBD patients being treated with prednisone often get a bonus side effect of relief from joint pain.
Spinal arthritis (Spondylitis)
In spinal arthritis, symptoms could appear months or even years before the onset of IBD. Symptoms include pain and stiffness in the joints of the spinal column that is at its worst in the morning, but will improve with physical activity. Active spondylitis rarely continues beyond the age of 40.
Spinal arthritis can lead to fusion of the bones of the vertebral column. This permanent complication can lead to a decrease in range of motion in the back and a limitation of rib motion that impairs the ability to take deep breaths.
The goal of treatment for spinal arthritis is to maximize range of motion of the spine. Physical therapy using postural and stretching exercises and the application of moist heat to the back are two common forms of treatment. Many patients benefit from NSAIDs, but this may be a risky option for IBD patients. Treating the IBD usually has no effect on this type of arthritis.
