What is inflammatory bowel disease? What is joint involvement due to this disease?
Two diseases come to mind when inflammatory bowel disease (IBD) is mentioned; Crohn’s and ulcerative colitis. These two diseases are two separate autoimmune diseases in which the immune system attacks its own digestive system, causing damage to the intestinal wall and ulcerative sores. It presents with abdominal pain, weight loss, chronic (long-term) diarrhea, bloody diarrhea, loss of appetite and anemia (anemia). Joint complaints occur in an average of 1/3 of these patients. These can be inflammation (arthritis) in joints such as knees, ankles, or they can go away with involvement of the spine (ankylosing spondylitis). Joint involvement due to IBD is included in a group of diseases called spondyloarthropathies.
Who gets Inflammatory Bowel Disease and related joint complaints?
Inflammatory bowel disease (ulcerative colitis and Crohn’s disease) occurs at a rate of 0.05-0.1%. Musculoskeletal involvement develops in 30% of patients with IBD. It is included in spondyloarthropathies. Joint involvement is usually in two forms: peripheral (wrist, knee, ankle, elbow, shoulder, hand and toe joints) arthritis (joint inflammation) and ankylosing spondylitis (inflammatory spinal rheumatism). Joint complaints may occur immediately after the diagnosis of IBD or may develop years later. In fact, there are publications stating that the frequency of joint complaints increases as the duration of the disease increases. Patients may have findings such as arthritis, low back pain and morning stiffness, erythema nodosum, dactylitis. Peripheral arthritis, dactylitis, and erythema nodosum usually occur when intestinal signs are also active. It was observed that joint involvement disappeared in those who underwent total colectomy (removal of the entire large intestine). However, spinal involvement (ankylosing spondylitis) is different; It causes intense complaints during periods when there are no intestinal symptoms. Even in patients who have had the entire large intestine removed; Joint complaints such as low back pain and stiffness continue.
There is a familial predisposition to both ulcerative colitis and Crohn’s disease; In Crohn’s it is a little more. HLA-B27 gene; While it is found in 70% of cases in ankylosing type involvement, it is present in peripheral arthritis type involvement only in 15% of cases. Half of Crohn’s patients have the NOD2/CARD15 gene mutation on chromosome 16.
What are the signs of the disease?
ankylosing type involvement due to IBD; indistinguishable from ankylosing spondylitis that develops alone (see Ankylosing spondylitis). There are complaints of pain and stiffness in the lower lumbar region, neck-back and lower back, alternating hip pain, and heel pain that develop at rest. With movement, waist-neck and back pains are reduced. Unlike ankylosing, it can also develop after the age of 40. Peripheral joint involvements; It is usually simultaneous with intestinal complaints. It starts suddenly; knees, ankles, and less commonly wrists and elbows are frequently involved. Usually 1-4 joints are involved. Sometimes it can be self-limited or go into a chronic (more than 6 weeks) process. It usually does not leave sequelae (damage) in the involved joint. However, when the metatarsophalangeal or hip joint is involved, joint damage may occur. ‘dactylitis’ may occur if one of the fingers or toes swells along the entire length (like a sausage). Sometimes, painful and reddened hazelnut or walnut-sized, painful swellings ‘erythema nodosum’ may develop on the anterior leg. Aphthae or sores in the mouth are common in these patients. Inflammation may develop in a layer of the eye called uveitis.
How is it diagnosed?
When diarrhea and joint complaints coexist, the disease should be considered. The diagnosis of inflammatory bowel disease is usually made by the endoscopic examination of the intestines and biopsy results by a gastroenterologist. Stool examination (such as amoeba) can be performed for other diarrheal and bloody diarrhea-causing diseases that may be confused. HLA-B27 gene testing may be ordered.
How is arthritis due to inflammatory bowel disease treated?
When ankylosing-type involvement develops (common in Crohn), adalimumab or infliximab from biologic treatments called anti-tumor necrosis factor (anti-TNF) can be used. These drugs will be effective on both joint involvement and intestinal complaints. In patients with IBD with peripheral joint involvement; sulfasalazine, systemic steroids can be used. If necessary, methotreaxate and azathioprine can be added to the treatment.
Use of non-steroidal anti-inflammatory drugs (NSAIDs; such as naprosyn, diclofenac, indomethacin) in joint involvement due to IBD,
