When many of us think about inflammatory bowel disease (IBD), symptoms like abdominal pain, diarrhoea, and bloating come to mind. But for many, IBD doesn’t just affect the gut, it also affects other areas of the body as well—including joints. In fact, arthritis is one of the most common extraintestinal (outside the gut) complications related to IBD.
If you’re living with IBD, it’s important to know how arthritis associated with IBD can show up, what symptoms to watch for, and how it can be managed.
What is Enteropathic Arthritis?
Arthritis simply means inflammation of the joints, but when it’s linked with IBD, doctors call it enteropathic arthritis. It’s also known as enteropathic arthropathy or IBD-related arthropathy.
It’s a type of chronic joint disease called spondyloarthropathy, and causes pain and stiffness often in the lower back.
Symptoms to Watch For
Usually the GI symptoms of IBD appear before the arthritis develops, but in some cases arthritis appears first.
If you have IBD (Ulcerative colitis or Crohn’s disease), other than the symptoms in the GI tract like bloody diarrhoea and crampy abdominal pain, keep an eye on symptoms that point towards arthritis associated with IBD. These include:
- Swelling, warmth, and tenderness in arms, legs, or spine
- Joint deformity (such as bumpy or bent fingers)
- Stiffness in the affected joints (particularly in the morning)
- Limited range of motion in the affected joint
- Lower back pain that improves after exercise
Sometimes the joint symptoms can correlate with the digestive symptoms. This means joints become more painful and swollen when GI symptoms are worse.
What Causes Enteropathic Arthritis?
The exact reason isn’t fully understood yet. But researchers believe that immune system activity and genetics play a role.
In IBD, the immune system mistakenly attacks the digestive tract, and the same immune overactivity can also cause inflammation of the joints.
The HLA-B27 protein present outside the WBCs may cause it. This protein can make your immune system attack the healthy cells in your joints.
But this protein isn’t specific to enteropathic arthritis. This means it can also be positive in people who don’t have this condition.
How Enteropathic Arthritis is Diagnosed?
As joint pain can have many causes, it’s important to have a proper diagnosis.
To make a diagnosis, your doctor will ask you questions about your joint and GI symptoms and take a full medical history. Then they’ll do a physical exam.
They may also order blood tests for inflammatory markers (like ESR and C-reactive protein) and HLA-B27.
Imaging tests like X-ray or MRI of the affected joints and other tests like colonoscopy and biopsy may also be recommended.
Management and Treatment
The good news is, arthritis associated with IBD can usually be managed effectively, especially when diagnosed and treated early.
The treatment mainly focuses on relieving the inflammation in your gut and joints.
Different treatment options include:
Medications
- Corticosteroid injections to help relieve pain and swelling
- Disease-modifying antirheumatic drugs (DMARDs) like methotrexate and sulfasalazine, that can alter the immune system and slow down the disease
- Tumor necrosis factor (TNF)-alpha inhibitors like infliximab
Lifestyle Measures
- Exercise and stretching—low impact activities like walking, swimming, yoga, and stretching can reduce joint stiffness and improve mobility
- Physical therapy also helps improve joint flexibility and mobility
- Healthy diet—it can help improve your overall health. Try to add anti-inflammatory foods and drinks in your diet to help reduce joint inflammation
- Stress management—as stress can worsen the symptoms of both IBD and arthritis
- Maintain a good posture while sitting and standing
- Stop smoking and using any other tobacco containing products
- Join support groups to connect with people who have IBD, arthritis, or both
Surgery
In severe cases, surgery may also be required to correct spine
Prognosis
The course of enteropathic arthritis can vary widely. The symptoms can be persistent or come and go. There can be flare-ups ranging from mild to debilitating.
But the majority of people with enteropathic arthritis are able to live productive lives with normal life expectancy.
Living with IBD and Arthritis
Managing two chronic conditions at once can feel overwhelming. But understanding the connection between them can help you feel in control.
Regular check-ups with your gastroenterologist and rheumatologist are important.
With the right treatment plan, many people with IBD-associated arthritis are able to stay active and have a good quality of life.
Final Thoughts
Enteropathic arthritis is one of the common complications that can come with irritable bowel disease. Living with these both conditions can be challenging, but with early detection and treatment they can be managed effectively.
If you notice any joint pain or stiffness along with your IBD symptoms, don’t ignore them, bring it up with your doctor. By working closely with your gastroenterologist and rheumatologist, you can take care of your gut and joints and maintain an active life.
