As many as 30 percent of people with an inflammatory bowel disease (IBD), such as Crohn’s or ulcerative colitis, experience arthritis — inflammation and pain in the joints — at some point in their lives, according to the Crohn’s and Colitis Foundation.
“If you have Crohn’s disease, you can have joint pain with or without arthritis,” says Sandra M. Quezada, MD, an assistant professor of medicine in the division of gastroenterology and hepatology at the University of Maryland Medical Center in Baltimore. Your achy joints may be red, swollen, and warm, or you might feel joint pain without any of these signs, she says.
Joint pain usually involves large joints, such as the knees or shoulders, but it can sometimes affect the small joints in hands and feet, Dr. Quezada says. Typically, large joints react during a flare, but the small joints may not, she says.
Most of the time, arthritis that accompanies IBD doesn’t do as much long-term damage to your joints as an autoimmune disease such as rheumatoid arthritis, which tends to affect the same joints on both sides of the body, according to the Crohn’s and Colitis Foundation. Here’s what experts know so far.
The Connection Between Crohn’s Disease and Joint Pain
Doctors don’t fully understand the link between the gut and the joints, but they suspect inflammation plays a role, Quezada says. “Somehow, the immune system is overactive and causes inflammatory reactions targeting the joints and the gut,” she says. “It’s not always at the same time or in the same order.”
Joint pain and Crohn’s disease may be associated with the gene marker HLA-B27, which could predispose a person to joint or gut inflammation, says Glenn Parris, MD, a rheumatologist with Gwinnett Medical Center in Lawrenceville, Georgia. Research has shown that many people with IBD are HLA-B27 positive, according to a paper published in April 2018 in The Journal of Rheumatology.
How to Treat Joint Pain From Crohn’s Disease
The first step in managing your joint pain is to take stock of its severity and frequency, Quezada says. Depending on how painful or frequently the joint pain flares up, your doctor may recommend one or more of the following therapies.
- Physical therapy Some people feel better with lifestyle modifications, such as daily stretching, light exercise (to boost agility), and limiting repetitive movements that can worsen pain, she says. Your doctor may refer you to a physical therapist, who can teach you range-of-motion and strengthening exercises and stretches that may help reduce pain.
- Prescription medication Many doctors focus on controlling the inflammation within the colon, sometimes using anti-inflammatory medications. “Properly treating Crohn’s disease itself is key,” says Susan Coe, MD, a gastroenterologist at Gwinnett Medical Center in Lawrenceville, Georgia. Joint pain should improve as other symptoms of Crohn’s disease do. If it doesn’t, it may be a sign of another condition and requires further evaluation by a rheumatologist, Dr. Coe says.
- Over-the-counter medication A number of medications are available to manage joint pain, starting with nonsteroidal anti-inflammatory drugs (NSAIDs), Dr. Parris says. But some people with Crohn’s disease find that NSAIDs, which include aspirin and ibuprofen, irritate the lining of the gastrointestinal tract and increase inflammation, notes the Crohn’s and Colitis Foundation. That’s why it’s important to discuss options for pain medication with your doctor. If you stay within the recommended doses, acetaminophen is a reasonable alternative that is less likely to damage your digestive tract, Quezada says. “If over-the-counter NSAIDs don’t help, prescription medications for joint pain are available,” she says.
- Corticosteroid therapy The occasional use of corticosteroids is also an option, Parris says. These meds may do double duty, because they can improve both arthritis and Crohn’s disease symptoms, according to the Crohn’s and Colitis Foundation. “In other situations, disease-modifying antirheumatic drugs (DMARDs) may be necessary,” he says.
- Supplements, with a doctor’s approval Some people with joint pain take supplements such as glucosamine-chondroitin sulfate, curcumin, and omega-3s/fish oil, Quezada says. “In general, these therapies have minimal side effects and may produce benefits for some,” she says. Although rare, some herbal treatments can lead to serious health problems, so your doctor should be aware of your full medication list, including any herbal supplements.
Still Tired liveing with crohns
When my Crohn’s disease is active, my fatigue can be debilitating. Sometimes I’m forced to stop answering phone calls because I literally don’t have the energy to construct sentences. I don’t allow myself to drive because it doesn’t feel safe. I’m basically unable to do anything except the bare minimum, and when I come out on the other side I feel like I’ve been in the deepest fog.
How can I be so tired?
After experiencing fatigue like this on and off for quite a while, I began to wonder how I could possibly be SO tired. I was ‘sleeping’ ten to twelve hours a night and taking a nap during the day. What more could my body possibly want? I wasn’t working. I wasn’t moving much. In fact, I wasn’t using any more strength than necessary, and yet, it still felt like too much.
Anyone with IBD knows that when you’re sick, it often feels like more than just stool emptying from your bowels. It feels like life is emptying out too.
Fatigue and mental health
I found the fatigue contributed to my anxiety and depression, affecting my mental health too. It seemed like I was trapped in this awful cycle and all I could do is come up for air between episodes.
During that time, I took prescription sleep medication, I worked with a sleep doctor, and underwent multiple normal sleep studies. I even followed suggestions on reducing screen time, creating sleep hygiene and more, but no matter what, I felt exhausted all of the time.
Sleep versus rest
This was when I learned the difference between being asleep, and getting rest. Being in bed, tossing and turning, waking up during the night – they all impact our ability to achieve deep sleep cycles characterized by faster breathing, a faster pulse, and rapid eye movements, or REM. There were times that my body may have been unconscious, but it most certainly wasn’t at rest.
It became clear to me that I had to learn how to dedicate time to conscious rest when I was awake. To be honest, this felt awkward and like something I was embarrassed about. Have you ever sat down to do something like this?
Changes I made
There were three changes I made that over time have significantly impacted my levels of fatigue, and I’d really like to offer them as suggestions to anyone who is struggling.
- Scrolling through social media, even while laying in bed, doesn’t count as resting. When you brain is actively thinking about things you want, need, or are missing out on, it impacts your body’s ability to rest. Schedule in some breaks to put your phone down.
- Guided imagery and meditation are real things that relax your mind AND your body. I rely on the Calm app, but there are others out there as well which offer you these services right from your phone. Quieting your brain quiets your body in a real, lasting way.
- Aromatherapy – certain scents are tied to physical relaxation. Whether you purchase a linen spray, light a candle, burn incense or diffuse essential oils, or take a bath with bubbles or salts or bombs, aromatherapy draws upon the healing powers of the leaves, flowers, stems, bark, roots or petals of plants to stimulate the natural healing action of both your body and your mind.
Tips on Asking for Support During Crohn’s or UC Flares
If you’re living with inflammatory bowel disease, you know that your life, health, abilities, and capabilities can change dramatically in a short period of time. From my experience, no matter how much I plan for the next flare, there are always things I wish I had done, I need but don’t have, or I would really benefit from help.
Asking for help during a Crohn’s or UC flare
I’ve thought a lot about this and about how it feels hard to ask for help. I don’t usually know what to ask for directly so I often keep quiet, and I never know who exactly I should reach out to in the event that I need (or want!) physical things or tangible assistance.
I wanted to share with you some thoughts I’ve put together after a lot of trial and error. To be honest, it’s SO MUCH better for my mental health and my stress levels as my symptoms increase to know that I know how to best ask for support and that I’m not alone in my trials, especially when this disease can feel so isolating.
Things that are helpful when dealing with a flare
In no particular order, here are some things that have worked for me:
- Keep a list in your phone of a few people who are local that you trust, and that might be able to do you a favor when you don’t feel well. Depending on your needs, this might mean stopping at the store, dropping off a cooked meal, picking up a prescription, taking you to a doctors appointment, sitting with you in the ER or visiting you at home or in the hospital.
- Then, add to the bottom of that list, a few people who might not necessarily be nearby, but who understand your heart. People you can call or facetime or text when you want to cry or vent or be distracted. One important note here: don’t leave out your other friends with IBD! I’ve often avoided telling them that I was doing poorly because I knew they had struggles of their own, and in retrospect, they wished they’d been able to be there for me. They understood my plight directly and agreed they’d tell me if whatever I was telling them or asking them in terms of support felt like too much at any given time.
- Think about your necessities during a flare: what foods or meal replacements you can tolerate, what clothes and basic household items that you both need and that would make you more comfortable, and anything that might cheer you up.
- If you have a roommate, live with family, have a spouse, children or pets, think about if they can help and/or have needs of their own while you are down and out.
- In the event that a friend or family member reaches out and asks what they can do for you, or what they can bring you or send to you, I’ve found politely declining over and over is a loss for both myself and the other person. They genuinely want to help, and I honestly could use it. I have found it to be easiest to have direct and tangible items I can ask for – such as groceries, prepared meals (or meal delivery), conversation to take my mind off of things or company when I don’t have the energy to talk.
Living with inflammatory bowel disease is hard enough, there’s absolutely no reason to decline help or support simply because you don’t know how to ask, or don’t want to inconvenience someone who has already offered.
Inflammatory Bowel Disease
What is Inflammatory Bowel Disease (IBD)
Inflammatory Bowel Disease is a group of chronic lifelong conditions affecting the digestive tract. It includes both Ulcerative Colitis (UC) and Crohn’s Disease (CD) which are similar but affect different parts of the intestine. UC affects the inner lining of the large intestine while CD can affect any part of the digestive tract from the mouth to the anus. You can read further information on IBD in this patient information leaflet.
Clinical features of Inflammatory Bowel Disease
The main features of IBD are bloody diarrhoea associated with frequency, urgency and abdominal cramps. In severe attacks patients may suffer weight loss and anorexia.
In addition patients may have symptoms from outside the digestive tract including:
• Arthritis (large joints)
• ankylosing spondylitis
• erythema nodosum
• pyoderma gangrenosum
• iritis and episcleritis (inflammation of the eyeball)
• primary sclerosing cholangitis (75% pts have IBD, Geonzon –Gonzales 2006)
How common is IBD?
• 15,000 people in Ireland have IBD
• Incidence in Ireland – 6,000 UC
– 3,000 CD
What causes IBD?
The cause of IBD is unknown but is thought to include: Genetic susceptibility
A familial tendency
Environmental factors -smokingstress
non-steroidal anti-inflammatory drugs
history of appendectomy
history of infection with mycobacteria
activation of the immune system
possibly diet but not proven
• Infective agents
• Seasonal changes
• Stress – implicated in aetiology of disease (Mawdsley & Rampton 2005)
Treatment of IBD
Treatment for IBD is often simple and includes both local and oral medications, often the condition can be managed in the community by the patient’s General Practitioner after consultation with a Specialist. Regular review by a specialist is recommended for complex therapies and disease. Surgery may be required in difficult cases.
Mary Kennedy is the IBD Clinical Nurse Specialist at TUH. The IBD nurse is often your first point of contact if you require any advice regarding your disease. She provides a rapid point of access for IBD patients, in particular she can provide support, advice and information on your inflammatory bowel condition. Also, she will play an active role in disease and drug education and management. Treatments such as Infliximab (Remicade) and Adalimumab (Humira) are administered by the IBD Nurse.
An advice line is run by the IBD Nurse and the contact number is 01 414 3855.
TUH Gut Therapy Programme for IBS
The chronic diarrhoea pathway aims to provide patients with diarrhoea symptoms of Irritable Bowel Syndrome (IBS) with fast access to the most appropriate investigations and management of their condition. Patients aged over 45 with chronic diarrhoea of more than one month duration will be automatically be triaged for a colonoscopy. If this and blood tests are normal they subsequently attend the dietitian led gut therapy clinic.
Patients aged under 45 with chronic diarrhoea of more than one month duration with red flag symptoms such as bleeding, weight loss, anaemia and family history of bowel cancer or IBD will also be automatically be triaged for a colonoscopy. If this and blood tests are normal they subsequently attend the dietitian led gut therapy clinic.
Patients under 45 who do not have red flag features will have blood and stool tests done. If these are normal they attend the dietitian led gut therapy clinic, if an abnormality is detected they have a colonoscopy and are managed as appropriate after that.
Its most notable attribute is its effect on wound management and healing. Manuka honey also has antibacterial, antiviral and anti-inflammatory properties that may help treat numerous ailments, including irritable bowel syndrome, gastric ulcers, periodontal disease and upper respiratory infections.
Honey is well known for its anti-inflammatory and antioxidant capacities, which may be useful for the prevention of chronic inflammatory process like atherosclerosis, diabetes mellitus and cardiovascular diseases. The antibacterial, anti- inflammatory and antioxidant properties of honey
What is the fastest way to get rid of inflammation in the body?Follow these six tips for reducing inflammation in your body:
- Load up on anti-inflammatory foods. …
- Cut back or eliminate inflammatory foods. …
- Control blood sugar. …
- Make time to exercise. …
- Lose weight. …
- Manage stress.
Does b12 reduce inflammation?Vitamin B6, folate (B9), and B12 can lower your levels of homocysteine, an amino acid that’s linked to a greater risk for heart disease and rheumatoid arthritis. But we can’t say for sure that lowering homocysteine will also lower your risk for disease. The same is true for C-reactive protein, a sign of inflammation.
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