Crohns Disease and Joint Pain: Whats The Connection?

Curated by Claudia Shannon / Research Scientist / ishonest

People with Crohn’s disease have chronic inflammation in the lining of their digestive tract.

The exact cause of Crohn’s disease isn’t known, but this inflammation involves the immune system mistaking harmless substances, like food, beneficial bacteria, or the intestinal tissue itself, as threats. It then overreacts and attacks them.

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Over time, this results in chronic inflammation. Sometimes this overreaction can cause problems in other areas of the body outside the gastrointestinal tract. The most common is in the joints.

Crohn’s disease also has a genetic component. In other words, people with particular gene mutations are more susceptible to Crohn’s disease.

Research has found that these same gene mutations are also related to other types of inflammatory conditions, such as psoriasis, rheumatoid arthritis, and ankylosing spondylitis.

Crohn’s disease and joint pain

If you have Crohn’s disease, you may also be at an increased risk of two types of joint condition:

  • arthritis: pain with inflammation
  • arthralgia: pain without inflammation
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These two conditions may affect up to 40 percent of people with inflammatory bowel diseases (IBDs) like Crohn’s disease.

Arthritis

Inflammation from arthritis causes joints to be painful and also swollen. Arthritis may affect up to 20 percent of those with Crohn’s disease.

Arthritis that occurs with Crohn’s disease is a bit different from regular arthritis because it starts at a younger age.

Following are the types of arthritis that can occur in people with Crohn’s disease:

Peripheral arthritis
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A majority of the arthritis that occurs in people with Crohn’s disease is called peripheral arthritis. This type of arthritis affects the large joints, such as those in your knees, ankles, elbows, wrists, and hips.

The joint pain typically occurs at the same time as stomach and bowel flare-ups. This type of arthritis typically doesn’t result in any joint erosion or lasting damage to the joints.

Symmetrical arthritis

A smaller percentage of those with Crohn’s disease have a type of arthritis known as symmetrical polyarthritis. Symmetrical polyarthritis can lead to inflammation in any of your joints, but it typically causes pain in the joints of your hands.

Axial arthritis

This leads to stiffness and pain around the lower spine, and can lead to limited and motion and potentially permanent damage.

Ankylosing spondylitis
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Finally, a small percentage of people with Crohn’s disease will develop a severe condition known as ankylosing spondylitis (AS). This progressive inflammatory condition affects your sacroiliac joints and spine.

Symptoms include pain and stiffness in your lower spine and near the bottom of your back at the sacroiliac joints.

Some people may even have symptoms of AS months or years before their Crohn’s disease symptoms appear. This type of arthritis can lead to permanent damage.

Arthralgia

If you have aching in your joints without swelling, then you have arthralgia. Roughly 40 to 50 percent of people with IBD have arthralgia at some point in their lives.

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Arthralgia can occur in many different joints throughout your body. The most common places are your knees, ankles, and hands. When arthralgia is caused by Crohn’s, it doesn’t cause damage to your joints.

Diagnosing joint pain

It can be difficult to tell if your joint pain is the result of an intestinal condition like Crohn’s disease. No single test can say with certainty, but there are some signs.

One difference from regular arthritis is that the inflammation tends to mainly affect large joints, and may not affect both sides of your body evenly. This means, for example, that your left knee or shoulder may feel worse than the right one.

Rheumatoid arthritis, by contrast, tends to also affect smaller joints, like those in the hand and wrist.

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The stomach problems that come with Crohn’s disease may become an issue long before the disease leads to joint pain.

Treatment

Normally, doctors would recommend using nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin (Bufferin) or ibuprofen (Motrin IB, Aleve), to relieve joint pain and swelling.

However, NSAIDs aren’t recommended for people with Crohn’s disease. They can irritate your intestinal lining and worsen your symptoms. For minor pain, your doctor may recommend using acetaminophen (Tylenol).

Several prescription drugs are available to help with joint pain. Many of these treatments overlap with Crohn’s disease medications:

  • sulfasalazine (Azulfidine)
  • corticosteroids
  • methotrexate
  • newer biologic agents such as infliximab (Remicade), adalimumab (Humira), and certolizumab pegol (Cimzia)
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In addition to medication, the following at-home techniques might help:

  • resting the affected joint
  • icing and elevating the joint
  • doing certain exercises to reduce stiffness and strengthen muscles around joints that can be prescribed by a physical or occupational therapist
Lifestyle changes

Exercise helps improve the range of motion in your joints and also helps relieve stress. Low-impact cardio exercises like swimming, stationary biking, yoga, and tai chi as well as strength training may help.

Adjusting your diet may also ease the symptoms of Crohn’s disease, particularly with help from foods that can change the makeup of bacteria in your gut.

These include prebiotics like honey, bananas, onions, and garlic, as well as probiotics like kimchi, kefir, and kombucha.

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Yogurt is also a probiotic, but many people with Crohn’s disease are sensitive to dairy foods and may want to avoid it.

Natural remedies

Besides probiotics and prebiotics, you may benefit from taking fish oil supplements. These are high in omega-3 fatty acids, which may reduce inflammation and joint stiffness.

Acupuncture may also help with the symptoms of both Crohn’s disease and arthritis.

When to see a doctor

If you’re experiencing joint pain, see your doctor. They may want to perform diagnostic tests to rule out other causes of your pain.

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Your doctor may also want to adjust your Crohn’s disease medications. Occasionally, joint pain could be related to side effects of your medication.

Your doctor can recommend a physical therapist to help you develop an exercise program for your joints.

Outlook for joint pain

Joint pain for people with Crohn’s disease typically lasts only a short time and usually doesn’t result in permanent damage. Your joint pain will likely improve as your intestinal symptoms improve.

With gastrointestinal symptoms tamed through medication and diet, the outlook for your joints is generally good.

However, if you’ve also received an AS diagnosis, the outlook is more variable. Some people improve over time, while others get progressively worse. With modern treatments, life expectancy for people with AS typically isn’t affected.

Read this article in Spanish.

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