Arthritis is a common extraintestinal complication of IBD, affecting up to 30% of patients with ulcerative colitis or Crohn’s disease.
Arthritis manifests as joint pain, joint swelling, and a loss of flexibility. Although the condition generally affects people as they age, young patients with IBD often experience symptoms – sometimes even before symptoms of IBD arise.
Arthritis conditions associated with IBD
1. Peripheral Arthritis
Peripheral arthritis is the most common type of arthritis associated with IBD. The condition affects the large joints in the hips, arms, and legs (including elbows, wrists, knees, and ankles). The discomfort can be migratory, moving from one joint to another. While there are no specific methods for diagnosis, a doctor can observe joint fluid, take blood tests or use X-rays to rule out other conditions.
In patients with IBD, the level of joint inflammation reflects the level of inflammation in the colon, with the condition generally improving alongside treatment for the underlying IBD. There is not usually permanent damage.
2. Axial Arthritis
Axial Arthritis (also known as Spondylitis or spondyloarthropathy) affects the lower spine and sacroiliac joint in the lower back and results in pain, stiffness, and restricted rib motion that may make it difficult to draw a deep breath. In some cases, the vertebral column fuses together and restricts back motion. It’s crucial to alert a rheumatologist immediately if you suspect you may have Axial arthritis.
In younger populations, the symptoms of Axial arthritis may show months (or sometimes years) before IBD symptoms appear. Treatment will likely require biologic therapy, as well as stretching exercises, moist heat application, and physiotherapy.
3. Ankylosing Spondylitis
Ankylosing Spondylitis (AS) is a rare and severe form of spinal arthritis that affects 2-3% of IBD patients, though it is seen more in Crohn’s disease than ulcerative colitis. This condition impacts the spine and sacroiliitis joints and can affect the eyes, lungs, and heart valves. AS is characterized by a drastic loss of flexibility in the lower spine. It usually manifests in people under 30, generally adolescents and young men.
AS can sometimes manifest before the development of IBD, and symptoms have been known to worsen even after removal of the colon. Rehabilitation therapy is usually needed to maintain flexibility, and biologic therapy can also help reduce damage to the joints and other complications.
How to Manage Arthritis with IBD
The best way to manage IBD-related arthritis is to adhere strictly to your UC treatment regime, whether this is conventional, CAM, or a combination. In most cases, managing UC will soothe joint pain, stiffness, and discomfort, especially in axial arthritis.
Keep your gastroenterologist updated with any joint pain or swelling. They’ve seen it before and should be the first one to consult about any extra-intestinal manifestations of IBD.
If you have IBD, common nonsteroidal anti-inflammatory drugs like aspirin or ibuprofen can irritate your intestinal lining and further increase inflammation. Some patients are able to take these medications, but it’s important to consult your doctor first.
Herbal Support for Arthritis
The Arthritis Foundation recommends Boswellic acid for rheumatoid arthritis and osteoarthritis. Boswellia contains two active compounds that inhibit NF-κB activity and IκBα degradation. Both play a role in immune and inflammatory responses.
Boswellia has been shown to:
- Suppress interleukin-1 β, TNF-α & interferon-γ
- Enhance the production of IL-10
- Inhibit pro-inflammatory cytokines
- Reduce tissue damage from rheumatoid arthritis
Curcumin, the bioactive compound in turmeric, may also help as it is a potent anti-inflammatory. Curcumin reduces NF-κB activity, which can cause chronic inflammation, and targets numerous inflammatory cytokines. If you’re seeking curcumin for arthritis, make sure to purchase a product with high bioavailability.
A recent trial found the combination of Boswellia and curcumin to be an effective RA therapy due to the synergistic effects of the two remedies.
Lifestyle Habits to Help Manage Arthritis
When managing inflammation, it’s always beneficial to implement certain lifestyle changes. Regular movement, stress relief tools, and a clean, healthy diet will support your body’s healing process and help guard against future inflammation.
- Movement, especially yoga or tai chi (avoid high-impact exercise and wear proper footwear).
- Anti-inflammatory foods like omega-3 fatty acids, fatty fish, olive oil, antioxidant-rich fruits, veggies, and green tea.
- Relaxation techniques can help manage inflammation, as stress is a common trigger for flare-ups.