Crohn's and Arthritis

Arthritis is the most common complication outside the intestines for people with Crohn's disease. About 30% of people with Crohn's experience joint pain. When your gut is inflamed, it can trigger inflammation in your joints too. This connection is part of what doctors call "extraintestinal manifestations" -- symptoms outside your digestive tract.

Two main types of arthritis affect people with Crohn's disease: peripheral arthritis (affecting knees, ankles, wrists) and axial arthritis (affecting the spine). Peripheral arthritis often flares up with intestinal symptoms, while axial arthritis, including ankylosing spondylitis, typically follows its own course independent of gut inflammation.

Peripheral arthritis in Crohn's typically causes pain, swelling, and stiffness in large joints like knees, ankles, elbows, and wrists. These symptoms often appear alongside digestive flares and may improve when your Crohn's is under control. Unlike rheumatoid arthritis, this type rarely causes permanent joint damage but can significantly impact your daily life.

Back pain that improves with exercise but worsens with rest is a hallmark of axial arthritis. You might notice stiffness in your lower back, especially in the morning or after inactivity. Unlike peripheral arthritis, these symptoms often develop independently of your Crohn's flares and may continue even when your digestive symptoms are under control.

Ankylosing spondylitis is a serious form of spinal arthritis. Estimates vary, but it is believed to affect between 2% and 6% of people with Crohn's. It causes inflammation where ligaments and tendons attach to bones, particularly in your spine and pelvis. Over time, it can lead to fusion of spinal vertebrae. Early symptoms include ongoing lower back pain, especially at night and in the morning.

If you have Crohn's and joint pain, your doctor may recommend blood tests to check for inflammation markers and imaging tests like X-rays or MRIs. They'll rule out other causes of joint pain and may refer you to a rheumatologist, a doctor who diagnoses and treats arthritis. You can help the doctor by describing when your pain occurs, which joints hurt, and how the pain relates to your digestive symptoms.

Some medications can help both Crohn's and arthritis symptoms. Biologics like TNF inhibitors target inflammation in both the gut and joints. Corticosteroids can provide short-term relief during flares, while immunomodulators help prevent flares. Your doctor will create a treatment plan addressing both conditions while minimizing side effects.

Gentle exercise like swimming or walking can help your joints feel better without stressing your digestive system. Apply heat for stiffness and cold for acute pain. Maintain good posture and consider seeing a physical therapist to get specific exercises for your joints. You can rest during severe flares, but don't be inactive for too long, as this can make you stiffer. Stay at a healthy weight to reduce the stress on your joints.

Let your health care provider know if you develop new joint pain, especially with swelling or limited movement. Seek immediate care for severe, sudden pain or inability to move a joint. Regular checkups help monitor both conditions. Let your doctor know about all your symptoms, even those that don't seem related to digestion, because that can help your doctor make treatment decisions.