The Joints are a Jumpin’

 Reprinted with the permission of the author, Dr. Stanley Cohen 

(Adjunct clinical professor of pediatrics, Emory University School of Medicine;
Director of IBD Research, Children's Center for Digestive Health Care;  

Chief of Gastroenterology and Nutrition Clinics, Children's Healthcare of Atlanta at Scottish Rite Hospital in Atlanta, GA) 

When someone asks the cause of Crohn’s and colitis, I often explain these diseases are similar to arthritis.  Patients and parents understand about arthritis. We know that when someone has it, their joints are tender and painful; we often know what makes it worse, and we know some things to make it better. But we don’t know the real cause; at least not entirely,

The similarities and associations go further. As many as 13 to 21 percent of children with Crohn’s and colitis actually suffer from arthritis as well. In fact, over 200 years ago, painful  arthritic joints were found in patients with dysentery.  Obese patients who have undergone ileal bypass surgery may develop severe arthritis also.  The most logical explanation is that bacteria or other molecules that would normally be eliminated by the intestines may be absorbed instead, forming immune comolexes that accumulate in the joints, causing the arthritis.

Actually, there are two basic forms of this joint disease.  Fortunately, peripheral arthritis is more common, most frequently involving the knees and ankles, although the hips, wrists and elbows may also be involved.  We are now learning that the ligaments and tendons may also be affected in what we call “enthesitis.”

Most often, symptoms from this peripheral variety corresponds to IBD activity and treatment of the bowel disease may result in improvement of the joint problems.  Physical therapy may help, and occasionally separate attention is needed for the joint symptoms, though joint damage itself is rare. The second group of conditions occurs along the spine.  The most severe is ankylosing spondylitis, which affects adults more than children, and patients with ulcerative colitis far more than those with Crohn’s.  These patients will often have morning stiffness and low back pain.

Their symptoms do not parallel their IBD problems and they may progress despite surgical removal of the colon.  A milder form involves the sacroiliac joint, and can be identified by careful scans of the joint, but that testing is rarely needed, since most of those patients are free of symptoms. Certainly, patients with Crohn’s and colitis can have osteoporosis also.  This loss of bobe mineral comes from inadequate calcium intake, malnutrition and/or Vitamin D malabsorption. Steroid use can further aggravate that condition, causing, at times, some degree of muscle weakness.

While IBD patients have enough to worry about otherwise, these joint and muscle complaints are often able to be recognized and treated effectively.