What is Inflammatory Bowel Disease-Related Arthritis?
The term inflammatory bowel disease (IBD) refers to a group of intestinal disorders that cause chronic inflammation of the gastrointestinal (GI) tract or digestive tract. Prolonged inflammation can result in the destruction or damage to the walls of the intestines, leading to the formation of sores and narrowing of the intestines. The two most common inflammatory bowel diseases include Crohn’s disease and ulcerative colitis.
Inflammatory bowel disease-related arthritis is used to describe types of inflammatory arthritis connected with IBD and includes ankylosing spondylitis, reactive arthritis, and psoriatic arthritis. Arthritis is the most common extraintestinal manifestation of IBD and can have a significant impact on morbidity and quality of life. About 30 percent of individuals with IBD may develop arthritis, which usually affects the large joints of the lower extremities. Treatment for IBD-related arthritis focuses on addressing the underlying condition, the inflammatory bowel disease itself. Most individuals’ arthritis symptoms improve substantially once their inflammatory bowel disease is controlled.
Causes of Inflammatory Bowel Disease-Related Arthritis
The exact cause of inflammatory bowel disease-related arthritis is unclear; however, the condition is believed to be genetically inherited as a majority of patients suffering from this condition are found to be born with a gene known as the HLA-B27 gene. Other risk factors for developing the condition may include:
- Immune system abnormalities: It may be an autoimmune condition in which the immune system functions abnormally by considering the gut bacteria and the cells in the lining of the colon as foreign particles and attacks and destroys them, causing IBD symptoms.
- Family history and genetics often play a role.
- Environmental factors: These include cold climates, sedentary jobs or lifestyles, poor hygiene, and high consumption of processed and fatty food.
- Smoking: It has been associated with aggravating symptoms of IBD.
- Ethnicity: Certain ethnic groups such as Ashkenazi Jews and white people are at higher risk of developing IBD.
- Age: Even though IBD can occur at any age, it mostly affects people under the age of 35.
Signs and Symptoms of Inflammatory Bowel Disease-Related Arthritis
Signs and symptoms of inflammatory bowel disease-related arthritis include:
- Joint pain
- Swelling
- Stiffness
- Reduced range of motion
- Joint tenderness
- Various gastrointestinal symptoms such as bloody stools, abdominal pain/cramping, diarrhea, low appetite, fatigue, and unintended weight loss
Diagnosis of Inflammatory Bowel Disease-Related Arthritis
It is not always easy to establish if arthritis is connected to inflammatory bowel disease. Typically, arthritis that complicates inflammatory bowel disease is not as severe as rheumatoid arthritis. The joints do not normally undergo devastating changes, and joint involvement is not symmetric (impacting the same joints on both sides of the body). Other than ankylosing spondylitis, arthritis associated with inflammatory bowel disease typically improves as symptoms of IBD improve.
In general, your physician will review symptoms and medical history and perform a physical examination. Two procedures are normally performed: colonoscopy (for ulcerative colitis) and endoscopy (for Crohn’s disease). Imaging tests may also be performed, such as computed tomography (CT) scan, magnetic resonance imaging (MRI), or contrast radiography. Certain blood tests are employed such as HLA-B27 antigen and sedimentation rate, which is a marker of inflammation throughout the body. In some instances, stool samples or blood tests are done to rule out other conditions.
Treatment for Inflammatory Bowel Disease-Related Arthritis
Treatment for inflammatory bowel disease-related arthritis mainly focuses on treating the underlying condition, which is IBD, thereby relieving arthritic symptoms and preventing further deterioration of the disease. Based on the severity of the condition, treatment may include:
- Diet: You will be instructed to follow a balanced diet containing fruits and vegetables, proteins, nutrients, and vitamins.
- Medications: Your doctor will prescribe certain types of medications that include:
- Anti-inflammatory medication: To reduce inflammation and control symptoms corticosteroids are prescribed in case nonsteroidal anti-inflammatory drugs are found to be ineffective, but these are only prescribed for a short duration until symptoms are controlled.
- Antibiotics: These medications treat bacterial infections and heal the sores.
- Immunomodulatory drugs: These medications suppress the immune response and prevent inflammation.
- Biologics: These are made from the proteins present in living cells and include antitumor necrosis agents that help control inflammation mediated by the immune system. This is mainly used in patients with severe ulcerative colitis.
- Anti-diarrheal medications are used to treat diarrhea.
- Vitamins and iron supplements are recommended to address malnutrition and anemia.
- Surgery: If medications are found to be ineffective, surgery is recommended that may include:
- Colectomy: The entire colon or a part of it is surgically removed.
- Proctocolectomy: The entire colon and rectum are excised.
- Ileostomy: Your surgeon will make a small incision in the abdomen and the end of the small intestine is connected to a pouch that collects intestinal waste.
- Ileal pouch-anal anastomosis: An opening will be created at the end of the small intestine that is attached to the anus to collect stool.
- Surgery for Crohn's disease: This involves removal of the damaged portion of the digestive tract and reconnecting the healthy sections. Surgery may also be needed to drain abscesses and close fistulas.
