About one in five people with inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, also experience joint pain. Enteropathic arthritis (EnA) is a chronic (long-term) type of inflammatory arthritis that can develop in people with IBD, affecting the joints in the arms and legs or spine and lower back. Arthritis symptoms like pain and stiffness tend to worsen during IBD flare-ups.
The exact cause of IBD-related arthritis isn’t fully understood. However, research suggests several factors likely play a role, including:
- An overactive immune system: IBD occurs when the body’s immune system mistakenly attacks the digestive tract, which includes the mouth, throat, esophagus (the tube connecting the throat to the stomach), stomach, small and large intestine, rectum (the end of the large intestine), and anus. This overactive immune response can cause inflammation and mistakenly attack joint tissues, leading to pain, swelling, and stiffness.
- Gut barrier breakdown: When IBD inflames and damages the intestinal lining, it can create a leaky gut, allowing bacteria and other harmful substances to escape into the bloodstream. The immune system reacts to these substances, which may trigger joint inflammation.
- Dysbiosis (gut bacteria imbalance): This condition happens when the balance of helpful and harmful bacteria in your gut is disrupted. In people with IBD, this imbalance may affect how the immune system works, leading to inflammation that can spread beyond the gut and affect the joints.
- Chronic inflammation: Ongoing inflammation in the digestive tract can lead to body-wide (systemic) inflammation that can affect the joints and cause arthritis.
- Infection: Bacterial and parasitic infections can trigger inflammation and contribute to the development of arthritis in some people with IBD.
- Genetics: Some people inherit genes (traits passed down through families) that increase their risk of IBD and arthritis. For example, about 60% of people with IBD-related arthritis carry the HLA-B27 gene, which is a gene that’s commonly connected to inflammatory conditions.
- Smoking: Smoking can worsen gut inflammation, interfere with healing, and may increase the risk of developing arthritis in people with IBD.
Enteropathic arthritis can affect joints throughout the body, most often involving the joints in the lower limbs, such as the knees and ankles. However, it can also affect the elbows, wrists, shoulders, and in some cases, the hips or spine.
Peripheral arthritis (in the arms and legs) often flares up alongside IBD symptoms like diarrhea and abdominal pain. Inflammation in the spine and back pain are not as likely to occur along with IBD flares.
Symptoms of enteropathic arthritis can range from mild discomfort to more severe joint pain, which may make activities such as walking, dressing, or working more challenging. Enteropathic arthritis symptoms can include:
- Joint pain and stiffness, especially in the knees, ankles, wrists, or fingers
- Joint pain that flares during IBD flare-ups, though it can also occur on its own
- Swollen joints that may feel warm or tender
- Stiff joints in the morning that improve with movement
- Lower back pain or stiffness, particularly in the sacroiliac joints (where the spine meets the pelvis)
- Fatigue or low energy, even after resting
- Eye inflammation (uveitis), which can cause redness, pain, or vision changes
- Skin rashes
Not everyone with IBD will develop enteropathic arthritis. However, several factors may increase your risk:
- Type and severity of IBD: People with Crohn’s disease have a higher risk of developing arthritis than those with ulcerative colitis. Joint pain and swelling are also more likely in those with more severe or frequent IBD flare-ups.
- Family history: If you have relatives with IBD or inflammatory arthritis, you may carry genes that increase your risk.
- Age: Enteropathic arthritis can happen at any age, but symptoms usually begin between 15-40 years old.
- Other autoimmune conditions: Having another autoimmune condition, such as psoriasis or ankylosing spondylitis, can increase your risk of developing IBD-associated arthritis.
- Smoking: Tobacco use can trigger or worsen IBD symptoms and may cause inflammation throughout your body, increasing the risk of arthritis.
If you have IBD and begin to experience joint pain, stiffness, or swelling, it’s important to speak with a doctor. They’ll start by reviewing your medical and family history, as well as your current symptoms, and then perform a physical exam to assess joint tenderness, swelling, and range of motion.
Your doctor may order diagnostic tests for a more accurate diagnosis and recommend a treatment plan. These tests may include:
- Stool (poop) test: Your doctor may order a stool sample to rule out infections and confirm an IBD diagnosis.
- Colonoscopy: This test involves inserting a long, flexible tube (colonoscope) into your anus and rectum to examine the inside of your colon (large intestine) and rectum. They may also take a biopsy (a small tissue sample) to help give you a proper diagnosis.
- Blood tests: These types of blood tests, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) tests, check for signs of inflammation in the blood.
- Genetic testing: These are blood tests that can check for specific genes that increase your risk of developing IBD-related arthritis.
- Joint fluid analysis: Your doctor may draw a small sample of synovial fluid from a swollen joint to help rule out conditions like gout or joint infections. Synovial fluid is the fluid found between joints that helps joints move easily.
- X-rays: These are imaging scans that can show signs of joint damage or inflammation, particularly in the spine or larger joints, such as the hips.
IBD and enteropathic arthritis treatment focuses on reducing inflammation to relieve symptoms and protect your joints and digestive tract. Your doctor will work with you to create a personalized treatment plan that may include:
- Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can help ease joint pain and swelling.
- Disease-modifying antirheumatic drugs (DMARDs): These medications help regulate the immune system to reduce inflammation and slow the progression of the disease. They can slow or prevent joint damage and help control IBD symptoms.
- Physical therapy: A physical therapist can teach you stretches and exercises to maintain the flexibility and strength of your joints. They’ll also teach proper posture techniques and body mechanics (how to move and position your body) during daily activities to reduce pain and protect your joints.
- Heat and cold therapy: Applying heat, such as a warm compress or heating pad, can loosen stiff joints and ease pain. Cold therapy, like ice packs, may help reduce swelling and inflammation during a flare.
- Regular exercise: Low-impact activities such as walking, cycling, swimming, or yoga can improve joint mobility (movement) and reduce inflammation. If you’re new to exercise or are experiencing pain, start slowly and take breaks as needed.
- Stress management: Stress can trigger or worsen IBD and arthritis symptoms. Relaxation techniques such as mindfulness meditation, deep breathing, or progressive muscle relaxation may help reduce the frequency and severity of symptom flares.
- A balanced diet: A nutritious, balanced diet that includes anti-inflammatory foods, such as leafy greens, berries, fatty fish, and whole grains, can help combat inflammation. Try to avoid or limit consuming common IBD triggers or foods that can cause inflammation, such as processed foods, added sugars, and high-fat or spicy meals.
Many people with inflammatory bowel disease (IBD) also experience joint pain. This is because the same inflammation that affects the digestive tract in IBD can also affect the joints, leading to pain, stiffness, and swelling.
IBD arthritis, known as enteropathic arthritis, often flares up or worsens when IBD symptoms do. Managing both conditions can feel overwhelming and may affect your emotional well-being, energy levels, and daily routine. With the right treatment plan and supportive lifestyle habits, you can relieve symptoms and continue doing the things that matter most to you.
