Crohn’s disease and joint pain may seem like two separate conditions, but they can be linked.
“Crohn's is an autoimmune condition. The same inflammation targeting the digestive tract can also trigger inflammation in the joints,” says Vikas Taneja, MD, a gastroenterologist at Hackensack Meridian Jersey Shore University Medical Center in Neptune, New Jersey.
Here’s what you need to know to manage both conditions.
How Is Crohn’s Disease Connected to Joint Pain?
Joint pain, or what doctors call arthralgia, affects about 20%-30% of people with Crohn's disease. It’s one of the most common symptoms you can have outside your gut.
“The pain is often described as aching or throbbing pain with stiffness that's typically worse after rest and improves with movement,” Taneja says.
Your age doesn’t matter. You can be young and be affected.
Joint pain can happen with Crohn’s for a few different reasons.
Widespread inflammation
Crohn’s disease triggers the release of cytokines, special proteins that set off inflammation throughout your body. Because there’s no real threat to fight off, the cytokines can go after healthy tissues of your body instead, including in your joints.
The health of your gut
The gut-joint axis is what doctors call the relationship between your microbiome — the trillions of bacteria, fungi, and germs that naturally live in your digestive tract — and your joints.
When your microbiome gets out of balance, it can trigger inflammation throughout your body, including in the sensitive spaces where two bones meet.
New research is looking into other ways your gut can affect your joints. For instance, when your intestinal lining is severely inflamed, it becomes damaged over time. That may allow tiny amounts of food and bacteria to get into your bloodstream, which could also start an immune system response that you can feel in your joints.
“Our understanding is still evolving,” Taneja says. “Researchers are investigating why only some patients develop joint problems, why specific joints are affected, and whether earlier, more aggressive Crohn’s treatment could prevent arthritis before it starts.”
Medication side effects
Sometimes, joint pain can also be a side effect of the medicine that you take to manage Crohn’s disease. The treatment that’s supposed to help your gut could make you achy as a result.
Medications that can sometimes do this include:
- Azathioprine
- Infliximab
- Steroids, if they’re stopped too quickly
Once your medication is adjusted, your joint pain may improve. But it’s important to not stop taking it without first speaking to your doctor.
Where Can You Feel Joint and Tendon Pain From Crohn’s Disease?
You might feel joint and tendon pain in your:
- Back, especially in your spine and lower back
- Hips
- Hands
- Feet
- Arms, especially your elbows
- Legs, such as in your knees and ankles
Can the Joint Pain Be Arthritis?
In Crohn’s disease, joint problems happen on a spectrum, Taneja says. They range from mild, temporary joint pain to enteropathic arthritis, a chronic condition that affects your joints or spine.
You might also hear this called Crohn’s disease arthritis or inflammatory bowel disease (IBD) arthritis.
“Arthritis specifically means inflammation inside a joint, often with visible swelling, warmth, and reduced motion,” Taneja says.
Crohn’s-related joint issues, on the other hand, usually cause pain and stiffness that come and go. Your symptoms may worsen during Crohn’s flares.
To figure out why your joints are sore and achy, your doctor will likely need to run some tests.
How Is Joint Pain Diagnosed?
There isn’t one specific test that can confirm if your joint pain is due to Crohn’s disease.
Your doctor will ask questions about where your pain is, when it started, and what makes it feel better or worse. They'll do a physical exam to check for symptoms like:
- Warm skin
- Swelling
- Soreness
- Range of motion (how far you can move the joint in different directions)
You could also have:
- Blood tests, including one to check for rheumatoid arthritis
- Imaging tests, like X-rays or magnetic resonance imaging (MRI), to get images of your joints
- Aspiration, in which a small sample of fluid is removed from your joint and analyzed at a lab
What Can Help With Crohn’s Disease Joint Pain?
Many different things can help make you more comfortable.
Medications
When your Crohn’s is well-controlled, your joint pain will probably improve as well. Your doctor may prescribe:
- Corticosteroids, like prednisone
- 5-aminosalicylates, like sulfasalazine
- Immunomodulators, like azathioprine, methotrexate, and 6-mercaptopurin
- Biologics, like adalimumab, certolizumab, and infliximab
Some of these are taken by mouth. Others may be injected (given by shot) into your joint.
If your joint pain is mild, acetaminophen may help. Unlike nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen sodium, it won’t irritate your gut. Check with your doctor before you take any over-the-counter medicines or supplements.
At-home remedies
Plenty of small things you do at home can help you feel better. Your home care could include:
Rest. When your joints hurt, give them a break. Don’t “power through” the pain.
Low-impact workouts. Gentle activities like walking, yoga, tai chi, swimming, water aerobics, and biking can improve how well your joints move.
Ice or heat. Placing an ice pack on your joint for 20 minutes causes the blood vessels around it to narrow. That helps reduce pain and swelling.
On the other hand, moist heat, like a warm bath or heated compress, sends more blood to the area. That can help with stiff, sore joints.
If you’re not sure whether to use ice, heat, or switch between both, ask your doctor.
Probiotics. These live microorganisms help restore a balance of “good” germs in your gut. You can find them in foods like yogurt, kefir, miso, and tempeh. Some studies show that they can help lower inflammation.
Ask your doctor if probiotics could help improve your joint pain. If they suggest a probiotic supplement, get the name of a brand that they trust. Like all supplements, probiotics aren’t well-regulated, which means that you can’t always be sure what’s in them.
Complementary therapies. Massage, acupuncture, meditation, and guided imagery may help improve your sore joints. Check with your doctor to make sure it’s safe for you to try them.
Lifestyle changes
Taking care of yourself is good not just for your joints, but for your overall health. To do that:
Try to get to a healthy weight. That can help reduce strain on your joints.
Strengthen your joints and muscles. Practice good posture, make exercise a part of your daily routine, and don’t forget to regularly stretch. A physical therapist can help you get started.
Support your sore joints. Your doctor may suggest that you wear a splint, brace, or shoe inserts to reduce pressure on the joint and make you more comfortable.
Choose anti-inflammatory foods. The Mediterranean diet is an eating plan that focuses on fruits, vegetables, whole grains, beans, nuts, and seeds. It’s been shown to help balance your gut microbiome and decrease inflammation.
Quit tobacco. Smoking can worsen your joint pain and has been linked to arthritis.
Follow your Crohn’s treatment plan. Having less inflammation in your gut can improve your joint pain. Remember to take your daily medication, even when you feel well. Doing so can also help reduce your risk of a flare.
Track your symptoms. “Keep a simple diary noting both bowel and joint symptoms,” Taneja says. “This helps your doctor identify patterns and tailor treatment.”
When Should You See a Doctor?
Call your doctor if your joint pain:
- Lasts more than three days or has come and gone several times within a month
- Involves more than one joint
- Includes swelling, warmth, redness, morning stiffness that lasts over 30 minutes, or any of these that get in the way of your daily activities
See a doctor right away if you can’t move the joint or have:
- Sudden severe pain
- Joint redness
- Fever
“These may signal an infection or another urgent condition,” Taneja says.
Your gastroenterologist is a good place to start. “They understand the link between intestinal and joint inflammation and can adjust your Crohn’s treatment, which may improve joint symptoms,” Taneja says.
They can also refer you to a rheumatologist, a doctor who specializes in joint and autoimmune disorders.
“The bottom line is, you don’t have to live with chronic joint pain,” Taneja says. “With the right treatment plan and daily adjustments, most people achieve excellent control of both Crohn’s and joint symptoms and maintain a strong quality of life.”
