Joints

• Joint problems can include joint pain and swelling in the joints in your back, hands, feet, arms and legs.
• Spondyloarthritis is a group of inflammatory arthritis conditions. This means your immune system has caused damage in your joints. Having Crohn's or Colitis can increase your risk of developing spondyloarthritis.
• Joint problems can come and go. For some people they get worse when your Crohn’s or Colitis is worse. For others, you may have a flare-up of arthritis symptoms with no gut symptoms.
• If left untreated, some arthritis conditions can lead to permanent damage. Speak to your GP or IBD team if you have pain, swelling or stiffness in your joints.
• Medicine treatments, exercise and physiotherapy can all be helpful in managing joint problems.

Joint pain

Joint pain commonly affects people with Crohn’s or Colitis.

When joint pain happens without arthritis, or inflammation of the joint, it is called arthralgia. Joint pain can be a side effect of taking some medicines such as azathioprine and will usually go away once treatment is stopped.

Speak to your doctor or IBD team if you have joint pain.

Arthritis

Arthritis is the word used to describe pain and swelling in a joint. There are many different types of arthritis.

Most people experience joint problems after their diagnosis of Crohn’s or Colitis. But for some people, joint problems can be a first symptom of Crohn’s or Colitis.

Joint problems are usually diagnosed through different tests and investigations.

Your GP or IBD team may refer you to a rheumatologist to have further testing.

When your doctor is first investigating joint problems, they may:

• Ask for a history of your symptoms.
• Look at your joints and ask you to do some movements such as bending or lifting your feet.
• Do a blood test to look for signs of inflammation.
• Refer you for an X-ray or Magnetic Resonance Imaging (MRI) scan.

X-rays are sometimes used to exclude other forms of arthritis. Ultrasound can also be used to check for inflammation in the peripheral joints even at a very early stage. MRI scanning is useful for detecting early spondyloarthritis or sacroiliitis.

The National Institute for Health and Care Excellence (NICE) has information on questions that your GP or specialist might ask you when diagnosing spondyloarthritis. Find out more on their website if your symptoms are mostly in your back (axial) or if your symptoms are mostly in your hands, feet, arms and legs (peripheral).

If you have Crohn’s or Colitis, your immune system can cause inflammation in the joints and the area around them. This relationship between your joints and your Crohn’s or Colitis is sometimes known as the gut-joint axis. 

It is not fully understood why this happens. Research shows that it may be genetic, meaning it runs in families.

Spondyloarthritis is also more common in people who have a particular gene called HLA-B27. Your doctor may do a blood test to see if you have this gene.

Many people do not realise that there can be a link between joint and gut symptoms. Your GP or IBD team may not always specifically ask about joint problems. This can mean arthritis may not be diagnosed for some time and effective treatment can be delayed.

There are different treatment approaches depending on the type of arthritis you have and if you are having a flare-up of your gut problems. See treatments for more information.

Other causes of joint problems

Not all the joint problems you experience may be related to Crohn’s or Colitis. Side effects of some medicines used to treat Crohn’s or Colitis can affect the joints. Other causes include injury, infection or other types of arthritis, so careful investigation is important.

Medicine side effects

Infliximab

Common side effects can include joint pain, muscle pain and back pain. 

Steroids

Stopping steroids too quickly can cause joint pain. Long term steroid use can also damage the joints (especially the hip joint) – see osteonecrosis.

Azathioprine

Joint pain can happen if your body is sensitive to azathioprine. It usually starts within three months of starting the medicine. Your doctor may recommend that you switch to mercaptopurine.

If you have started a new medicine and have joint pain, check the Patient Information Leaflet that comes with your medicine to see if this could be a side effect. Let your IBD team know.

Osteonecrosis

This is a rare but serious side effect that can produce joint pain. It happens when steroids cause problems with blood supply to a bone, usually in the hip or knee. You may need medicine or surgical treatment.

Injury

Joint pain can be due to injury such as a sprain or strain during exercise. Find out more on the NHS website.

Gout

This is caused when uric acid crystals are deposited in the joints. It causes sudden and painful attacks usually in the joints of the foot, knee, ankle, hand and wrist. It is very common in the big toe.

Find out more about gout on the NHS website.

Infection

Inflammation of a joint can be caused by bacterial infection. This is known as septic arthritis, and is rare but a medical emergency.

Germs can enter a wound and travel through the bloodstream to infect a joint or may infect a joint directly after an injury or during surgery.

Usually a single joint is affected. Symptoms include sudden redness and swelling around a joint and a high temperature.

You are more at risk if you are taking immunosuppressant medication to treat your Crohn’s or Colitis.

Find out more about septic arthritis on the NHS website.

Having joint problems can have a real impact on your life. They can limit mobility, cause pain and fatigue and affect your mental health. This can mean that daily activities including work, exercise and social life are affected.

Pain

Having painful joint problems can make it difficult to do everyday activities. See the section What can I do? for more information on managing your joint problems. Versus Arthritis also have helpful information on managing your pain.

Actively manage Crohn’s or Colitis

Taking medicines and working with your IBD team to actively manage your condition may help to control inflammation in your gut, which may improve your joint problems.

Getting into a routine of taking your medicines can be challenging, but when medicines have an immediate effect on your symptoms, you may find it easy to remember to take your doses exactly as instructed.

Once you feel better and your symptoms are on your mind less, you may forget a dose. Or you may be tempted to stop taking your medicine altogether, thinking you don’t need it now that you feel better.

Continuing to take medication even when you are well can help keep your symptoms under control and reduce the risk of having a flare-up. Find out more in Taking medicines.

Stop smoking

Smoking has been found to be a high-risk factor for arthritis. Smoking can also lead to worse symptoms of axial spondyloarthritis. See our information on Smoking.

Try gentle exercise

Exercise can help joint problems and boost your energy.  You can try different types of exercise and the time of day that you do them such as in the morning after getting up, when stiffness tends to be worst.

It may take some time to find a type of exercise that works for you. Read more about exercising with arthritis on the Versus Arthritis website.

Your doctor may refer you to a physiotherapist who can create an exercise plan to help ease stiffness and pain.

Look after your joints

There are a few ways you can protect your joints by reducing the stresses on them. Here are some ideas:   

• Use the larger joints as levers. Try using your shoulder to open a heavy door.
• Spread the weight of an object – for example use a rucksack on both shoulders rather than a bag on one shoulder.
• Become aware of your body position, it can help to move around.

Get the help you need at work

If you have Crohn’s or Colitis you may be covered by the Equalities Act at work – find out more in our guides for employees and employers. You can work with your employers to make changes including: 

• Starting later if your joint problems are worse in the morning.
• Using a back rest or foot support.
• Using equipment or technology that could make the tasks easier.

Tell your IBD team if you are experiencing pain or swelling in any of your joints. Or talk to your GP, if it is easier to contact them, and ask if they can refer you to a rheumatologist. A rheumatologist specialises in arthritis and related conditions.

Ideally, a team including a rheumatologist, gastroenterologist and physiotherapist will work with you to manage your Crohn’s or Colitis and joint problems.

What is ibuprofen?

Ibuprofen is a type of painkiller called a non-steroidal anti-inflammatory drug or NSAID.

Why should people living with Crohn’s or Colitis avoid ibuprofen?

One of the common side effects of NSAIDs that you take by mouth is gut inflammation.

This can affect the stomach, the small bowel or the large bowel.

Scientists also think that NSAIDs might trigger flare-ups in people with Crohn’s or Colitis. The evidence is not certain, but there does seem to be a link between regular NSAID use and flare-ups in people with Crohn’s. The link is less certain for people with Colitis. Some studies have found a link and others have not.

Because of these risks, the prescribing information for NSAIDs says they should be used ‘with caution’ in people with Crohn’s or Colitis. But if your Crohn’s or Colitis is in remission, you may be able to take a low dose NSAIDs for a short time.

Your IBD team will discuss whether NSAIDs are right for you.

What about ibuprofen gel or cream?

When you take NSAIDs by mouth, they enter your bloodstream and travel all around your body. When you rub NSAIDs into your skin as creams and gels, only a very small amount is absorbed into your blood. So gels and creams have a much lower risk of causing side effects in your gut.

We have not found any clinical trials that looked at NSAID gels or creams in people living with Crohn’s or Colitis. But:

• In people with arthritis, NSAID gels or creams had a lower rate of side effects in the gut than NSAID tablets or capsules.
• In people with pain or arthritis, NSAID gels or creams did not cause any more side effects than dummy gels or creams.

The prescribing information for NSAID gels or creams does not say they need to be used ‘with caution’ in people with Crohn’s or Colitis. But to keep the risk of side effects as low as possible, use the lowest dose you can. Do not use more than the amount stated on the packaging.

If your Crohn’s or Colitis symptoms get worse when you use ibuprofen gel or cream, it is sensible to stop using it. Contact your pharmacist, GP or IBD team if you need advice.