When Crohn’s Disease Causes Joint Pain: Here’s What You Need to Know

As many as 30 percent of people with 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.

“The connective tissue that connects the bones and muscles becomes inflamed, sort of like [other types of] arthritis,” says Arun Swaminath, MD, director of the Inflammatory Bowel Diseases Program at Lenox Hill Hospital in New York City.

Unlike other forms of arthritis, IBD-related joint pain does not typically damage the body and will not show up in X-rays, says Dr. Swaminath. But there still may be issues, including limited mobility and pain. Typically, joints in your hands, feet, wrist, hips, shoulders, and knees are affected and can occur on either one or both sides of the body.

But what does a disease that comes from the gut have to do with joint pain? Here’s what the experts say about the connection.

The Connection Between Crohn’s Disease and Joint Pain

The connection between the gut and the joints that causes this pain is not yet fully understood, according to Katherine Falloon, MD, an inflammatory bowel disease fellow at the Cleveland Clinic, but “a genetic predisposition, overactive inflammatory cells, and the make-up of the microbiome have all been explored as potential causes.”

The other is the inflammation that occurs in Crohn’s disease may cause the gut bacteria to cross from the intestines into the body. While not fully worked out, when the body revs up its immune system to fight these bacteria, inflammatory cells (a type of T cell) produce products that unintentionally attack the joints as well.

“If the bacteria from the gut cross into where they do not belong, the immune system’s job is to create inflammation to stop an attack, and the joints are collateral damage,” says Swaminath.

How to Treat Joint Pain From Crohn’s Disease

Management of joint pain in patients with IBD is not always straightforward, says Dr. Falloon, and may require multi-pronged approach. That means working not only with a gastroenterologist but with a rheumatologist as well.

The first step in managing your joint pain is to get control of your Crohn’s disease, says Swaminath. Typically, Crohn’s disease flare-ups and joint pain happen simultaneously, so if you can take care of one problem, the other will follow suit.

But depending on how painful or frequently the joint pain flares up, your doctor may recommend one or more of the following therapies.

Physical Therapy to Keep You Moving

Working with a physical therapist, who can teach you range of motion and strengthening exercises, can be effective for managing pain, notes Fallon.

Exercise helps reduce stiffness, maintain joint motion, and strengthen the muscles around the joints for people with IBD, according to the University of Washington Department of Orthopaedics and Sports Medicine.

A December 2019 review in the journal Rheumatology and Therapy found that physical therapy benefits patients with spondyloarthritis, a type of arthritis that specifically affects the spine and can be associated with Crohn’s disease. This includes regular exercise, which has been shown to improve range of motion and strength, but more research must be done to determine its effectiveness.

Consult with your doctor before starting a new exercise program.

Prescription Medications That Control Inflammation

Many doctors focus on controlling the inflammation within the colon, sometimes using anti-inflammatory medications.

“We're focused on getting the IBD under control, and if we've got the drug that does that, chances are that patient is going to do really well from the joint perspective,” says Swaminath.

One of the older drugs that have been around for decades, sulfasalazine, was initially used for people with arthritis, says Swaminath. But the drug is also effective in people with Crohn’s disease, having an anti-inflammatory effect that helps the gut and joints. The American College of Rheumatology cites sulfasalazine as a treatment for IBD, noting how it can decrease the pain and swelling of arthritis and prevent joint damage.

Another option is biologic drugs like adalimumab, certolizumab pegol, infliximab, natalizumab, risankizumab-rzaa, ustekinumab, or vedolizumab, which reduce inflammation quickly and can help prevent joint damage, says Falloon. They are also commonly used to treat a variety of inflammatory arthritis. But ask your doctor which one is right for you, as some biologics have less certain outcomes for IBD. The Arthritis Foundation has a list of nearly two dozen available biologics for arthritis and their benefits and risks.

Over-the-Counter Medications, Though Some May Cause Irritation

Several medications are available to manage joint pain, starting with nonsteroidal anti-inflammatory drugs (NSAIDs), Swaminath says. But use NSAIDs, like aspirin and ibuprofen, may cause a flare, notes the Crohn’s and Colitis Foundation. That’s why it’s important to discuss pain medication options with your doctor. However, if the pain is unbearable and short-term relief is needed, the Crohn’s and Colitis Foundation recommends acetaminophen as long as you stay within the 3,000 milligrams daily dose.

Corticosteroid Therapy, But Only for the Short-Term

“Steroids are a short-term solution that can often be quite effective for both gut and joint symptoms,” says Swaminath. “We might use steroids to make a patient quickly comfortable.”

Because they can cause significant side effects for both the long and short term, steroids are usually taken only for short periods of time to help control a Crohn’s disease flare, according to the Crohn’s and Colitis Foundation.

Supplements, Though It’s Still Not Clear If They Work

“Supplements are completely unregulated, and the claims that they make can be founded on very little data, so it makes it quite difficult to know if they will help,” says Swaminath.

But some people with joint pain take supplements such as glucosamine-chondroitin sulfate, curcumin, and omega-3s/fish oil, but like Swaminath said, experts are divided on efficacy.

A July 2020 study published in Nutrients also found that some probiotics may produce fatty acids that have anti-inflammatory properties. Researchers examined data on probiotics, prebiotics, and other dietary supplements for IBD, rheumatoid arthritis, and psoriatic disease, and acknowledged that probiotic use for the maintenance of Crohn’s disease has been limited and mixed. What’s known about anti-inflammatory supplements remains unclear and much more research is needed.

Additional reporting by Zachary Smith.