Joint Pain and Swelling in Inflammatory Bowel Disease (Crohn's Disease and UC)

What are IBDs?

Inflammatory Bowel Diseases (IBD) encompass Ulcerative Colitis (UC) and Crohn's Disease (CD). These conditions are characterized by inflammation of the gastrointestinal tract lining.

In Crohn's Disease, inflammation can occur anywhere in the gastrointestinal tract—from the mouth to the anus—though it is most commonly found in the intestines.

In Ulcerative Colitis, inflammation is localized to the rectum and colon.

Both conditions exhibit cycles of flare-ups followed by periods of remission. During flare-ups, symptoms often include:

• Abdominal pain,
• Frequent, sometimes bloody, diarrhoea,
• Complications in the anal region (fissures, abscesses).

In 20% of cases, patients with IBD also experience extraintestinal manifestations such as arthritis (joint inflammation), psoriasis (skin inflammation), or uveitis (eye inflammation).

What are the joint manifestations in IBD?

Joint manifestations affect 10 to 20% of patients with Crohn's Disease and 5 to 10% of those with UC, with a higher prevalence in females.

These conditions can affect the spine (neck, back, lumbar area), sacroiliac joints (buttocks), limb joints (elbows, wrists, knees, ankles), and heels.

Symptoms typically appear at the end of the night and can wake patients in the early morning, accompanied by "morning stiffness." Sometimes, joint swelling occurs due to synovial fluid accumulation, which can make walking difficult.

Approximately 5% of IBD patients experience persistent discomfort from their joint symptoms.

The joint manifestations in IBD are similar in both UC and Crohn's Disease and are classified under spondylarthritis. They manifest as either peripheral joint involvement or axial involvement, similar to ankylosing spondylitis.

Peripheral Joint Involvement

Peripheral joint involvement primarily affects limb joints (especially the lower limbs) and evolves parallel to the gastrointestinal disease (UC or CD). The joint flare-up can even precede the digestive flare-up.

Joints return to normal outside of flare-ups.

Axial Joint Involvement

Axial joint involvement affects the spine and sacroiliac joints. If not treated timely, it can lead to joint stiffness and spinal deformity.

These manifestations evolve independently of the gastrointestinal condition (UC or Crohn's) and require monitoring by a rheumatologist, who will prescribe necessary treatment and rehabilitation.

Axial joint involvement is often associated with the HLA B27 antigen.

HLA antigens are tissue group antigens that serve as the "blood group" for the body's cells. There are many HLA antigens, and each individual has a unique set. The HLA B27 antigen is commonly found in individuals with axial rheumatism. However, not everyone with the HLA B27 antigen will develop rheumatism during their lifetime. Testing for this antigen provides valuable insights for medical management.

How are joint manifestations in IBD managed?

Peripheral Joint Involvement

The management of peripheral joint involvement largely coincides with the treatment of the accompanying digestive flare-up. However, significant pain may be managed with paracetamol until it subsides.

Axial Joint Involvement

Axial joint involvement is more difficult to treat. Often, it requires infiltrations, meaning injections designed to reduce inflammation in the affected joint. Rehabilitation of the spine is prescribed to reduce long-term complications.

Additionally, sulfasalazine is prescribed for managing axial joint involvement.

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