Peripheral arthritis in Inflammatory Bowel Disease

This is the most common extra-intestinal manifestation of inflammatory bowel disease and occurs in around 20% of patients.

In ulcerative colitis it tends to be associated with flare-ups of the disease but in Crohn's disease it is usually less severe and can occur independently of the state of the intestine.

It tends to move from one joint to another (migratory) and can affect a single joint or several joints at a time. The larger joints are more commonly affected, i.e. knees, hips and ankles, but wrists and elbows may be affected also.

What are the symptoms?

The joints become inflamed causing:

• effusion (fluid in the joint)
• swelling
• redness
• pain and tenderness over the joint

What is the treatment?

Some treatments for arthritis may make the colitis worse, e.g. Non-Steroidal Anti-inflammatory drugs (Volterol, Ibuprofen, Naproxen etc.) which can cause diarrhoea and erosion of the mucosa. Some treatments which may help include:

1. Simple painkillers such as soluble paracetamol, distalgesics.
2. Local heat or ice packs to the affected joint.
3. Resting the affected joint.
4. Gentle exercises planned by the Physiotherapist.
5. Aspiration of fluid from the joint, relieving pressure and therefore pain
6. Injection of steroids into the joint.

The symptoms usually settle down with control of the underlying inflammatory bowel disease. Other conditions such as uveitis and erythema nodosum may be associated with flare-ups of the arthritis.