Joint Inflammation and Arthritis

Joint pain and discomfort

Joint pain is also called arthralgia. Arthralgia occurs in about half of patients with IBD. In addition to join pain, people with arthralgia report joint stiffness and swelling. 

Arthralgia can happen in different joints in the body including the hands, knees, and ankles.

Symptoms of arthraliga overlap with symptoms of arthritis. Arthritis is also common in people with IBD and means that a joint is not only painful but also inflamed. In arthralgia, there is no inflammation of the joints. 

Speak to your healthcare provider if you're experiencing joint pain. You may need to undergo some tests to help determine the cause of your joint pain including arthritis. 


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What is arthritis?

Arthritis is inflammation and pain of the joints. Arthritis affects roughly 20% of patients with Crohn’s disease, and about 10% with ulcerative colitis. 

The arthritis that occurs in IBD is different from rheumatoid arthritis. People with rheumatoid arthritis have arthritis that destroys the joints over time. People with arthritis associated with IBD have arthritis that does not destroy or degrade the joints.

Symptoms of arthritis include:

  • joint pain (sometimes described as aching, burning or hot)

  • swelling

  • stiffness and reduced ability to move joints (range of motion)

The pain and swelling in arthritis can migrate from joint to joint. The joints affected by inflammation may depend on the type of arthritis. 


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Types of arthritis in IBD

There are two types of arthritis that affect people with Crohn's or colitis:

Peripheral arthritis

This type of arthritis affects the large joints, such as the hands, knees, and elbows. Usually less than five joints are affected. It affects 60% to 70% of IBD patients. Flare-ups of this type of arthritis tend to go hand in hand with flare-ups of intestinal inflammation.

Symmetrical polyarthritis

In this type of arthritis, patients typically have arthritis in the small joints of their hands. It is not as common as peripheral arthritis. It can persist for a long time. People with arthritis in their small joints have flares in their joints that do not seem to correlate with the inflammation of their IBD.


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Management of arthritis

Medications

When possible, your doctor should try to use medications that reduce inflammation of both your IBD and your arthritis. 

Avoid NSAIDs and DMARDs

Although nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat arthritis, they should be avoided in people who have IBD because they can trigger an IBD flare.

An exception to this is celecoxib, which has less negative effects on the gut. Some doctors also use sulphasalazine, a disease-modifying anti-rheumatic drug (DMARD), to help treat arthritis associated with IBD.

Peripheral arthritis 

For peripheral arthritis, steroids can help reduce inflammation in the peripheral joints but they have long-term side effects, so their use should be minimized.

Some biologics, such as infliximab (Remicade) and adalimumab (Humira), are very effective for these symptoms. Peripheral arthritis responds well to treatment of the inflammation associated with IBD flares.

Symmertical polyarthritis 

For small joint arthritis, it may be helpful to add an immunosuppressant drug to your treatment plan, such as methotrexate or azathioprine. If your IBD is active also, your doctor may want to consider a biologic.

Exercise and Rest

It is important to rest the affected joint when you're experiencing pain. Try icing and elevating your joint to manage inflammation and pain.

Exercise and regular physical activity can improve movement of the joints (range of motion), and to help manage stress, anxiety and depression.

It is recommended for people with arthritis to do gentle or low-impact exercises such as:

  • swimming and water aerobics
  • biking
  • yoga
  • tai chi

Try different exercises especially at different times of day, for example sometimes getting up in the morning when you can sometimes feel the stiffest. It can be a bit of trial and error as you find what works best for you.

Additional resources

Speak to your doctor to learn more about your treatment options and about getting a referral to a physical or occupational therapist to get a safe and effective exercise routine that meets your needs. 

If you are experiencing pain due to arthralgia and/or arthritis, visit our Pain section for strategies to help you manage your pain.


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