Crohn’s Disease and Joint Pain: What’s the Link?

Up to a third of people with Crohn’s disease experience arthritis. Researchers believe genetic and microbiome factors play a role.

The first thing you think of with Crohn’s disease is probably not joint pain. After all, many people associate Crohn’s disease and other forms of inflammatory bowel disease (IBD) with abdominal pain, diarrhea, and other gastrointestinal (GI) symptoms.

But IBD causes a host of symptoms outside your gut, and joint pain is one of the more common ones. In fact, Crohn’s disease can increase your risk of a few different types of arthritis that can cause joint pain and stiffness.

Crohn’s disease and arthritis may also share a genetic connection.

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The connection between Crohn’s disease and joint pain

When Crohn’s disease causes complications outside of the digestive tract, they’re known as extraintestinal manifestations (EIMs).

Joint pain occurs due to arthritis, one type of EIM that affects as many as 40% of people living with either Crohn’s disease or ulcerative colitis (UC), another common form of IBD.

When arthritis develops due to GI-related immune conditions, it’s known as enteropathic arthritis. This type of EIM may even show up before the development of GI symptoms in IBD.

Experts believe that this kind of arthritis shares several similarities with IBD, including genetic, environmental, and immune factors that influence each disease’s course.

One theory suggests that arthritis occurs in people with IBD due to a combination of two factors:

• an inflamed, leaky gut that allows bacteria or other pathogens to get through and cause an immune response
• changes to a certain gene (known as the HLA-B27 gene) that can make people with IBD susceptible to certain bacteria

The theory suggests that this gene — and possibly others — causes an inflammatory response that targets the joints.

A 2021 review noted that future research is needed to fill in many gaps in scientific understanding of how Crohn’s disease and gut health affect the development of arthritis.

Types of arthritic joint pain in Crohn’s disease

People with Crohn’s disease or UC often develop arthritis symptoms at a much earlier age than people without IBD. Peripheral arthritis and axial arthritis are two types of arthritis commonly associated with Crohn’s disease.

Peripheral arthritis

Peripheral arthritis is the most common cause of joint pain with Crohn’s disease, occurring in about 10% to 20% of people with Crohn’s. It’s more common in Crohn’s disease that affects the colon.

When it develops, it typically affects fewer than five joints. The most commonly affected joints include the ankles, knees, wrists, hips, and elbows.

Pain and stiffness may move from one joint to another. Often, the pain and stiffness coincide with the level of inflammation you’re experiencing. In other words, if your Crohn’s symptoms flare, you may notice worsening stiff and painful joints.

This type of arthritis is not likely to cause any damage or structural changes to the joints. Flares usually last less than 10 weeks.

Some people may develop symmetrical peripheral arthritis, which means the same joints on either side of the body’s center line are affected. This may affect more than five joints, and it often occurs in the small joints of the hands. This type of joint pain can worsen even when your Crohn’s symptoms don’t.

No single test confirms peripheral arthritis. Instead, doctors use several tests, including analysis of joint fluid, blood tests, and X-rays, to rule out other possible causes.

Axial arthritis

This form of arthritis often causes pain and stiffness in the joints of your lower back and sacroiliac joints. Healthcare professionals may also refer to it as spondylitis or spondyloarthropathy.

This combination of Crohn’s disease and joint pain may start months or even years before you develop symptoms typically associated with Crohn’s.

Axial arthritis can cause damage to the joints in your back, causing them to fuse together. This can cause further pain and discomfort as well as limit your mobility.

This condition, known as ankylosing spondylitis, affects about 3% of people living with Crohn’s disease.

When it affects the ribs, it can make it more difficult to take a deep breath.

Often, active axial arthritis stops around age 40.

Similar to peripheral arthritis, there is no single test used to diagnose axial arthritis. Healthcare professionals typically perform several tests that may include:

• review of medical history
• physical exam
• imaging tests
• blood tests, which look for the HLA-B27 gene

Management strategies for joint pain in Crohn’s disease

Healthcare professionals often suggest several different types of therapy, including medications, supplements, and lifestyle changes to address both Crohn’s disease and joint pain.

Medications

Treating joint pain with Crohn’s disease can be challenging. Doctors often suggest using nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, or naproxen, for arthritis pain.

These medications, however, can irritate your digestive tract, making them a less appealing option for some people living with Crohn’s disease. Not everyone with Crohn’s will experience discomfort using NSAIDs, but it’s a good idea to talk with your doctor before using them.

In most cases, doctors will manage peripheral arthritis by managing the inflammation associated with Crohn’s disease. They may do this with medications such as prednisone or sulfasalazine.

Axial arthritis often does not clear or go away when treating Crohn’s disease. This type of arthritis often responds to biologics, such as infliximab (Remicade), adalimumab (Humira), or certolizumab (Cimzia).

Biologics may also help prevent joint damage.

Supplements

Certain dietary supplements may help with joint pain associated with arthritis.

The Arthritis Foundation acknowledges that the following supplements are popular, but study results on their efficacy have been mixed. What’s more, they have not been researched in IBD-related arthritis, so it’s unclear how helpful they may be in relieving joint pain in Crohn’s disease.

• curcumin
• S-adenosyl-methionine (SAM-e)
• glucosamine and chondroitin
• vitamins A, C, and E
• vitamins D and K combined

Supplements are not meant as a substitute for medications or other treatments.

Be sure to check with a doctor before starting new supplements, as they may cause interactions with your current medications.

Diet and other lifestyle modifications

Certain foods may increase your risk of inflammation, while others may help lower inflammation.

Some foods that may increase inflammation over time include:

• red meats
• processed meats
• coconut oil

On the other hand, the following foods may reduce inflammation when eaten for a long period of time:

• cooked vegetables
• fruits
• cooked starches, such as potatoes
• leafy green vegetables
• foods rich in omega-3 fatty acids, such as salmon and flaxseed oil

To address arthritis pain, a healthcare professional may make several recommendations, such as:

• resting the affected joint
• working with a physical or occupational therapist on a range of motion exercises
• applying moist heat to the affected joint

The takeaway

Joint pain in Crohn’s disease may be due in part to a genetic link. Changes to the gut microbiome may also play a role.

The most common type of arthritis that occurs in Crohn’s disease often affects only a few larger joints and worsens during flares. It usually doesn’t cause long-term damage.

You may be able to reduce the pain and inflammation of joint pain associated with Crohn’s disease by taking medications as prescribed, making changes to your diet, and performing certain exercises to improve joint mobility.