When Crohn’s Disease Causes Joint Pain

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.

Additional reporting by Colleen de Bellefonds