Enteropathic Arthritis and IBD
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Enteropathic Arthritis and Inflammatory Bowel Disease (IBD)

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  • Enteropathic arthritis (EA)

    Enteropathic arthritis (EA)

    If you have inflammatory bowel disease (IBD), you may also have EA. Joint inflammation can occur can occur throughout your body if you have EA.

    Inflammatory bowel disease (IBD) can also cause:

    • abdominal pain
    • bloody diarrhea
    • cramps
    • weight loss

    Here’s what you need to know about the connection between IBD and arthritis.

  • The problem starts with IBD

    The problem starts with IBD

    IBD involves chronic inflammation of your digestive tract. The most common forms are ulcerative colitis (UC) and Crohn’s disease (CD). In UC, the lining of your colon is inflamed. In CD, inflammation can occur anywhere in your digestive tract and spread deeper into the tissues.

    High levels of inflammation in IBD may occur due to an overreaction of your immune system to bacteria or viruses. It may also occur due to an autoimmune response, which involves your body attacking its own tissue. Whatever the cause, this inflammation can prevent your digestive system from working properly. It might also lead to immune responses in other areas of your body, such as your:

    • skin
    • nail beds
    • eyes
    • joints
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  • You may get arthritis in your arms and legs

    You may get arthritis in your arms and legs

    The two main forms of EA are peripheral and axial.

    According to researchers in the journal Clinical and Developmental Immunology, 17 to 20 percent of people with IBD have some form of peripheral arthritis. It’s more common in those with CD than UC.

    Peripheral EA involves joints in your arms and legs, most often your lower legs. Multiple joints are often involved. If you have peripheral EA, you’ll likely experience attacks or flares of joint inflammation. These flares usually have a rapid onset and set in within 48 hours. They may disappear within six months, but inflammation can become chronic in some people.

    Your symptoms of peripheral EA may flare with other symptoms of IBD. They may get better or worse, depending on the overall level of inflammation in your body.

  • You may also get arthritis in your spine

    You may also get arthritis in your spine

    Axial arthritis is also more common in patients with CD, report researchers in the journal Clinical and Developmental Immunology. It affects up to 22 percent of people with CD, as well as an estimated 2 to 6 percent of people with UC.

    The axial form of EA can affect your lower spine and joints in your pelvis. In some cases, it can affect your entire spine in a type of arthritic inflammation known as ankylosing spondylitis. Over time, this condition can cause your spinal joints to become increasingly immobile.

    It should be noted that the axial form of EA doesn’t typically get worse when symptoms of IBD are flaring up.

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  • Which comes first?

    Which comes first?

    In the axial form of EA, joint symptoms and damage can occur before intestinal symptoms of IBD become noticeable. As a result, you may be diagnosed with spinal arthritis first and IBD later.

    The symptoms of axial EA include lower back pain, morning stiffness, and pain after extended sitting or standing. Lower back pain is especially common in younger people with axial EA.

    Early symptoms of peripheral EA include joint pain. Unlike osteoarthritis, it won’t cause deformation or erosion of your joints.

  • Risk factors

    Risk factors

    Genetics play a role in the development of EA. If you have a gene that’s linked to the production of the protein HLA-B27, you’re more likely to develop EA. This protein is an antigen that may be found on the outside of your white blood cells. It can cause problems with your immune system. For example, it may lead your immune system to attack healthy cells in your joints.

    Infection with certain bacteria, such as Salmonella or Shigella, can also raise your risk of joint inflammation.

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  • Medications

    Medications

    If you have EA, your doctor will likely prescribe medications to reduce inflammation.

    For example, they may encourage you to take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. They may also prescribe drugs that suppress your immune system to reduce inflammatory responses. For example, they may prescribe corticosteroids, such as prednisone, or anti-rheumatic drugs, such as sulfasalazine and methotrexate.

    Biologics are another class of drugs that suppress parts of your immune system. Examples include:


    They block a chemical in your body that triggers inflammation.

    Taking NSAIDS or immunosuppressive drugs may help relieve the symptoms of EA, but they also carry risks. NSAIDs can have long-term side effects on your stomach and digestive system, which cause problems if you have IBD. Immunosuppressive drugs leave you more vulnerable to infection. 

  • Other treatments

    Other treatments

    Exercise and physical therapy may also help relieve the pain of EA while building and maintaining your muscle strength.

    Some people believe that probiotics can also help treat EA and IBD. The good bacteria in probiotics may help lower the levels of bad bacteria in your gut. Bad bacteria may be partly responsible for your gut and joint inflammation. More research is necessary to learn if probiotics can help treat these conditions.

    Your doctor may also recommend treatments to manage other symptoms and potential complications of IBD. For example, if you have IBD, you’re at increased risk of cardiovascular problems. Your doctor may recommend lifestyle changes, medication, surgery, or other treatments to help protect the health of your heart.

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References:

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