Crohn's disease and joint pain
Crohn's disease is a type of inflammatory bowel disease, or IBD, that can affect any part of the digestive tract. However, the inflammation most commonly affects the last section of the small intestine and the start of the colon.
Symptoms can vary between people but typically include:
- abdominal pain and cramping
- unintended weight loss
- bloody stools
Crohn's disease can also cause a range of other symptoms, including joint pain and soreness. This pain often occurs alongside a flare-up of intestinal symptoms.
In this article, we look at the link between Crohn's disease and joint pain. We also cover the different types of joint pain that people with Crohn's can get, when to see a doctor, diagnosis, and treatment.
Crohn's disease and joint pain
Joint pain from arthritis can occur with or without swelling.
Doctors refer to painful swelling of the joints as arthritis. According to the Crohn's & Colitis Foundation, arthritis is the most common complication of IBD that occurs outside of the intestines. They state it may affect up to 30 percent of people with IBD.
Although arthritis typically occurs with advancing age, it can also affect younger people with Crohn's disease.
Joint pain can occur with or without swelling. The medical community refer to joint pain without swelling as arthralgia.
According to Dr. Timothy R. Orchard, a consultant gastroenterologist at St. Mary's Hospital in London, United Kingdom, arthralgia affects between 40 to 50 percent of people with IBD.
Arthritis is when a person's joints become painful and inflamed. Over time, arthritis may cause lasting damage to these joints.
There are several different types of arthritis, but people with Crohn's disease are more likely to develop:
- peripheral arthritis
- axial arthritis
- ankylosing spondylitis
We discuss each of these below.
Peripheral arthritis typically affects the large joints, including:
The pain and swelling can move between different joints and, without treatment, may last from anywhere between a few days and several weeks. Peripheral arthritis tends to occur alongside intestinal flare-ups.
Peripheral arthritis usually causes no permanent damage to the joints.
Axial arthritis is also known as spondylitis or spondyloarthropathy. This type of arthritis causes pain and stiffness in the lower spine.
It can also affect the sacroiliac joints, which sit in the lower back between the spine and the hip bones.
Axial arthritis can develop before the onset of Crohn's disease, particularly in younger people.
This type of arthritis can lead to permanent joint damage. If the bones of the vertebral column fuse together, it can affect a person's range of motion.
Ankylosing spondylitis is a less common, but more severe form of spinal arthritis.
According to the Crohn's & Colitis Foundation, this type of arthritis develops in around 2 to 3 percent of people with IBD. However, it occurs more frequently in people with Crohn's disease than in those with other IBDs.
Ankylosing spondylitis sometimes spreads from the spine to cause inflammation in other parts of the body, such as the eyes, lungs, and heart valves.
This type of arthritis is more common in people under 30 years of age, particularly males. Similarly to axial arthritis, it sometimes occurs before the onset of Crohn's disease.
Initial symptoms include a significant reduction in spine flexibility, and the condition can cause permanent damage to the joints.
In people with Crohn's disease, symptoms of ankylosing spondylitis can persist and worsen following surgical removal of the colon.
While arthralgia causes joint stiffness, it does not cause the surrounding area to swell.
Arthralgia is joint pain without inflammation and can affect most joints within the body. However, it mainly occurs in the ankles, knees, and hands. When arthralgia affects two or more joints, doctors refer to it as polyarthralgia.
Symptoms of arthralgia include:
- joint pain
- redness around the joint
- heat at the joint
Unlike arthritis, arthralgia does not cause lasting damage to the joint, as the surrounding area does not swell.
Many people find that arthralgia is worse in the morning. Symptoms can also worsen after a period of inactivity.
When to see a doctor
Anyone with severe, persistent, or reoccurring joint pain should consult a doctor. This is especially important for people with Crohn's disease or any other form of IBD.
Some medications for Crohn's disease may also cause joint pain, as a side effect.
There are a number of tests that a doctor can use to help determine if there is a connection between joint pain and a person's Crohn's disease. These tests can also help rule out other possible causes.
Following diagnosis, a doctor will be able to make recommendations for referral and treatment.
Diagnosis for joint pain
It is not always easy for a doctor to determine if a person's joint pain is the result of also having Crohn's disease. There is a range of possible causes for joint pain, including it being a side effect of medication.
A doctor will often begin an assessment by asking the person about their symptoms and medical history. Possible questions include:
- When did the pain start?
- Where is the pain located?
- Does the pain move from joint to joint?
- Is the pain symmetric?
- Has the pain remained constant, or has it worsened over time?
- Have over-the-counter painkillers had an effect? If so, which ones?
- Is there any swelling, heat, or stiffness?
- Does the pain coincide with flare-ups of Crohn's disease?
- Do you have any other medical conditions?
Typically, the doctor will then do a physical examination to identify swelling, warmth, and stiffness in the joints.
To help with their diagnosis, a doctor may also order one or more tests, including:
- Blood tests. These can check for signs of inflammation in the blood and help rule out other conditions.
- Joint fluid analysis. A healthcare professional will take a sample of synovial fluid from an affected joint, using a needle. The sample can help rule out other conditions, such as gout or an infection.
- Imaging tests. X-rays, ultrasounds, and MRI scans allow the doctor to check for signs of inflammation and joint damage.
Treatment for joint pain
A doctor can prescribe a variety of drugs for joint pain.
Some over-the-counter medications can help relieve joint pain and reduce inflammation. However, it is best to speak to a doctor before trying these. This is because some nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen, and ibuprofen, can make symptoms of Crohn's disease worse.
A number of prescription drugs can help with joint pain. These include:
- opioid medications, including tramadol and hydrocodone
- biologic drugs, such as adalimumab, certolizumab, and infliximab
A doctor will sometimes recommend referral to a physical therapist who may suggest light exercises. These can:
- strengthen supporting muscles
- gently stretch affected areas to improve movement
- improve blood flow around affected areas
Other therapies that may also help with joint pain include:
- Aqua therapy. Light exercise in water can help relax and support the body.
- Acupuncture. Specially trained acupuncturists insert sterile needles into specific parts of the body. Some people find that this helps to relieve pain and other symptoms.
- Soft tissue techniques. This includes massage and acupressure on, or around, the joints. This helps to relax them and increases blood flow.
Lifestyle changes may also help to relieve some discomfort. These can include:
- Losing weight or maintaining a healthful weight to lessen the impact of joint pain in the legs and back.
- Learning safe techniques for lifting and carrying heavy objects.
- Adjusting chairs to support the back and maintaining a good posture when seated or walking.
- Wearing good-fitting, supportive, and comfortable footwear.
- Keeping warm as cold temperatures can worsen or trigger symptoms of joint pain.
- Resting joints when painful or swollen.
Natural remedies are also gaining in popularity. Some people find that glucosamine and turmeric supplements help with joint pain and inflammation. However, it is important to speak to a doctor before trying these, particularly as some supplements and natural remedies can interact with certain medications.
Crohn's disease is a long-term condition that can cause a range of gastrointestinal symptoms. Many people with this condition also have non-intestinal symptoms, including joint pain.
This joint pain is often a short-term condition that usually responds well to treatments for Crohn's disease.
Less commonly, joint pain that affects the spine can cause lasting damage and is more difficult for doctors to treat. However, early diagnosis and treatment can improve the outlook for people with this type of joint pain.
Several prescription medications can relieve joint pain and reduce inflammation. Physical therapy and lifestyle changes may also help.