What’s the Connection Between Crohn's Disease and Arthritis?

If you have Crohn's disease, you may also experience enteropathic arthritis. This type of arthritis is an extraintestinal symptom of Crohn's, meaning it's a symptom that occurs outside the gut.

Learn more about the link between Crohn's disease and arthritis and how to manage it.

The exact reason for enteropathic arthritis remains unclear, but it likely results from a combination or interaction of several factors.

Both Crohn's — a type of inflammatory bowel disease (IBD) — and arthritis involve inflammation. Crohn's may increase the risk of inflammation in other parts of your body through various mechanisms.

"Although primarily a disease of the gastrointestinal tract, Crohn's can affect multiple organs," says Jane Onken, MD, a professor of medicine specializing in gastroenterology at Duke University School of Medicine in Durham, North Carolina. Extraintestinal manifestations include oral ulcers, inflammatory conditions of the eye, certain skin lesions, and joint aches.

Genetic Predisposition

People with Crohn's who develop arthritis often have changes in certain genes.

Luminal Microbiota

The luminal microbiota is the community of bacteria and other microorganisms that live within the gut. A balanced gut microbiome helps you digest food and keeps the gut healthy.

Leaky Gut

Immune System Dysfunction

Medication Use

Some Crohn's medications can cause joint pain that's not necessarily arthritis.

• infliximab
• azathioprine, in some people
• steroids, when used for too long or stopped too quickly

Dr. Onken says that doctors often prescribe prednisone, a steroid, to treat both gut and arthritis symptoms in Crohn's. "A potentially debilitating side effect of prolonged or frequent prednisone use is bone loss that can lead to osteoporosis, compression fractures of the spine, and more."

For this reason, she says, "It's important to try to minimize the use of prednisone whenever possible."

People who use prednisone for a long time need close monitoring of bone density.

"Some Crohn's patients are also at risk for bone loss due to vitamin D deficiency, so levels should be checked and replaced when necessary," Onken says.

About 6 to 46 percent of people with IBD — either ulcerative colitis or Crohn's — develop musculoskeletal problems, such as joint pain and arthritis. This makes arthritis the most common extraintestinal complication of Crohn's.

Peripheral Arthritis

Common features include:

• Asymmetric symptoms, occurring on one side only
• Symptoms in the lower limbs
• Enthesitis, a swelling of tissues where tendons attach to the bone
• Dactylitis, a swelling of the fingers and toes

While painful, it doesn't usually lead to bone erosion or joint deformity.

Axial Arthritis

Axial arthritis affects your:

• Lower spine
• Joints at the bottom of your back
• Hips

It may start before you notice any signs of Crohn's.

Ankylosing Spondylitis

Symptoms include:

• Persistent back pain
• Spinal stiffness
• Buttock and hip pain
• Swollen fingers and toes
• Changes in posture
• Pain in the peripheral joints, such as the limbs

Signs of ankylosing spondylitis tend to appear before intestinal symptoms.

Symmetrical Polyarthritis

Other Arthritis Links

"Although patients with Crohn's can also be diagnosed with other autoimmune conditions that involve joints, such as psoriatic arthritis and rheumatoid arthritis, these conditions meet their own diagnostic criteria and do not involve the GI tract, so are not considered enteropathic arthropathies," says Onken.

Crohn's-related arthritis can differ from arthritis that's not linked to Crohn's in the following ways:

• Crohn's is linked to specific types of arthritis, such as peripheral, axial, and spondyloarthritis.
• Depending on the type, Crohn's-related arthritis symptoms may worsen during an intestinal flare.
• Intestinal symptoms often appear first, but not always.
• In some cases, surgery to resolve Crohn's may also resolve joint pain.
• Flares tend to be self-limiting and usually disappear after around six weeks.

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Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), can help relieve pain but may worsen the symptoms of Crohn's. But the NSAIDs naproxen (Aleve) and celecoxib (Celebrex) may help under certain circumstances.

Here are some other options:

• Disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine (Azulfidine)
• Tumor necrosis factor (TNF) inhibitors, such as infliximab (Remicade)
• Interleukin inhibitors, such as ustekinumab (Stelara)
• Steroids to manage flares, such as methylprednisolone (Medrol), although long-term use can have side effects, such as bone damage

Your team should include both a gastroenterologist and a rheumatologist. They will work with you to find a treatment that addresses both your Crohn's symptoms and your arthritis in a way that best suits your needs.

Alongside medical treatment, various home remedies can help you manage arthritis with Crohn's.

• Physical therapy to maintain mobility and range of motion
• An exercise plan that includes stretching, strength training, and low-impact aerobic exercise, such as stationary cycling and pool exercises
• An anti-inflammatory diet, such as an easy-to-digest version of a Mediterranean diet, which may help with both Crohn's and arthritis

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• Heating pads to relieve pain
• The RICE method (rest, ice, compression, elevation)
• Relaxation techniques, such as breathing exercises and guided imagery

Discuss any dietary changes or exercise program with your doctor or physical therapist. They will help you make an individual plan.

Managing Seasonal Changes

Some people say their arthritis gets worse in the winter — possibly due to changes in atmospheric pressure, according to Neilanjan Nandi, MD, a gastroenterologist and an associate professor at Penn Medicine in Philadelphia.

Dressing warmly and exercising to maintain flexibility is key to keeping symptoms under control during the colder months, Dr. Nandi says.

• People with Crohn's disease may develop enteropathic arthritis, or joint pain due to Crohn's. Experts don't know precisely why it happens, but it likely stems from a combination of genetic, environmental, and other factors.
• Types of arthritis linked to Crohn's include peripheral, axial, spondyloarthritis, and symmetrical polyarthritis.
• Home remedies for Crohn's-related arthritis include gentle exercise, a modified anti-inflammatory diet, and heat and cold treatment.
• The outlook will depend on the type of arthritis, but Crohn's-related arthritis does not usually lead to bone erosion.