Inflammatory Bowel Disease

Inflammatory Bowel Disease and the effects on your Joints

What is Inflammatory Bowel Disease?

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Inflammatory Bowel Disease (IBD) can be sub-classified into two main conditions: Crohn’s Disease and Ulcerative Collitis (2). Ulcerative Collitis results in continuous inflammation to the innermost lining of the large bowel (colon and rectum)(2). Crohn’s disease is the most common form of IBD and results in chronic (long term), patchy inflammation affecting all bowel layers (2). Crohn’s disease most commonly targets the small intestine, however, any part of the gastrointestinal tract can be affected (1,2).

What causes Crohn’s Disease and who is most at risk of developing the condition?

The specific cause of Crohn’s Disease remains largely unknown, however, the condition is typically classified as an autoimmune disease where the bodies defense system attacks healthy cells (2). Other factors that influence development of the condition can include:

· Infection by bacteria or viruses

· Environmental chemicals

· Stress

· Certain medications

· Changes in diet

· Smoking

· Genetics.(2,3)

Crohn’s disease affects 50 per 100,000 people in Australia, predominantly women aged between 15 and 35 (2,3). The condition is life-long following diagnosis with periods of remission interspaced with acute episodes or ‘flare-ups’ (2,3). Initial diagnosis occurs following full blood count testing for markers of inflammation, imaging such as CT and either endoscopy or colonoscopy with biopsies taken from affected bowel segments (2,3).

What are Crohn’s disease symptoms?

Symptoms typically include intermittent episodes of abdominal pain and diarrhea (2). Mal-absorption resulting in weight loss and vitamin or mineral deficiencies is another key indication of the disease, as the bowel cannot absorb vital nutrients from food through inflamed layers (2). Additional symptoms can include:

· Fever

· Loss of appetite

· Fatigue

· Bloating

What secondary affects can the condition have on my body?

Individuals diagnosed with Crohn’s disease may potentially experience extra-intestinal symptoms affecting other body organs throughout the course of their disease (3,4). Extra-intestinal symptoms can include:

Mouth: Ulcers of the mucous membrane of the oral cavity

Vascular: Increased risk of developing deep vein thrombosis (blood clot formation in the deep veins of the legs), or pulmonary embolism (blood clot formation in the lungs). (3,4)

The most common extra-intestinal symptoms occur in the joints with approximately 25% of patients diagnosed with Crohn’s disease experiencing symptoms associated with joint inflammation or arthritis (3,4). Both the central (axial) spinal joints and peripheral joints can be affected. The knees are most commonly affected followed by ankles, elbows, wrists and shoulders (6,8). Symptoms of joint inflammation include pain, swelling, tenderness, stiffness typically in the morning and reduced range of movement (6,7). These symptoms may limit functional, everyday activities such as walking, climbing stairs and rising from a seated position (7). The severity of arthritic symptoms generally mimic the course of the disease but abate with appropriate pharmacological treatment following acute flare-up (6,8).

Treatment for Crohn’s Disease

Currently, there is no cure for Crohn’s, however, the condition can be managed with a combination of pharmacological and non-pharmacological solutions. Self-management and careful nutritional planning plays a key role in effectively controlling the symptoms.

Treatment for secondary joint inflammation

For the treatment of secondary painful, arthritic joints, the following suggestions can be helpful to minimize discomfort:

Exercise: Adopt a graduated aerobic exercise program aiming for 30minutes per day, three times a week to maintain strength and cardiovascular fitness. Low impact exercises with reduced load on joints including walking, swimming or bike-riding are recommended. A physiotherapist can assist with tailoring an exercise program to your fitness level.

Water Therapy: Undertaking gentle exercise whilst immerged in warm water (hydrotherapy) has been shown to provide multiple benefits for the treatment of joint inflammation including pain relief and improved joint range of movement (5). These improvements are due to the buoyancy and temperature of the water (5). Examples exercises include forward, backwards and sideways walking. A hydrotherapy program can be individually tailored and monitored by your physiotherapist.

Medications: Non-steroidal anti-inflammatory medication (NSAID) may be useful in the treatment of secondary joint inflammation symptoms. However, certain NSAIDs may aggravate the symptoms of Crohn’s Disease (8). It is strongly recommended you seek medical advice from your doctor regarding medication use.

Exercise Prescription: General strengthening of musculature surrounding peripheral joints provides additional joint stability, reducing stress placed on the joint itself. Postural and stretching exercises are beneficial for improving symptoms of axial arthritis. A physiotherapist can complete a thorough assessment and provide individual exercises tailored to suit your symptoms and requirements.

When is the best time to see my physiotherapist?

People suffering from symptoms are encouraged to seek advice from a health professional when pain is more severe or impacts on your ability to complete normal everyday activities.

APMA would like to thank the Fortus Health for permission to reprint this information.

References

1. Queensland Government (2008). Crohn’s Disease. Retrieved from: http://access.health.qld.gov.au/hid/DigestiveHealth/InflammatoryandIrritiableBowelDisorders/crohnsDisease_ap.asp

2. Mr Dr from MIMS (2009). Crohn’s Disease. Retrieved from: http://www.mydr.com.au/gastrointestinal-health/crohn-s-disease

3. Virtual Medical Centre (2011). Crohn’s Disease (Inflammatory Bowel Disease). Retrieved from: http://www.virtualmedicalcentre.com/diseases/crohns-disease-inflammatory-bowel-disease/175

4. Brukner, P., & Khan, K. (2009). Clinical Sports Medicine (3rd Ed.). McGraw-Hill: North Ryde.

5. Hall, J., Skevington, S., Maddison, P., & Chapman, K. (1996). A randomised and controlled trial of hydrotherapy in rheumatoid arthritis. Arthritis and Rheumatism, 9(3).

6. Olszewski, M. Manos, R., Weis, P., & Provencher, M. (2005). Knee pain and swelling due to Crohn Disease: A case report. Journal of Bone and Joint Surgery, 87(8).

7. Marks, R., & Cantin, D. (1997). Symptomatic Osteo-Arthritis of the knee: The efficacy of physiotherapy. Physiotherapy, 83(6).

8. Tresca, A. (2012). Arthritis and Inflammatory Bowel Disease (IBD). Retrieved from: http://ibdcrohns.about.com/cs/relatedconditions/a/arthritisibd.htm

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