Symptoms of arthritis (such as pain and swelling of joints) occur in about one fourth of all people with IBD. Both men and women are affected equally. The arthritis of IBD can appear at any age, but is most common between the ages of 25 and 45. Joint inflammation begins most often when the colon (the large intestine) is involved in the disease process. In adults, the arthritis is usually most active when the bowel disease is active. Indeed, the amount of bowel disease usually influences the severity of the arthritis. In children, the arthritis is not as often associated with increased bowel disease activity.
Ulcerative colitis produces inflammation and breakdown along the lining of the colon. Inflammation usually begins in the ankylosing spondylitis, which involves inflammation of the spine. It usually begins around the exercises for you to follow every day. Proper exercise helps to reduce stiffness, maintain joint motion, and strengthen the muscles around the joints. Maintaining the range of motion of affected joints is important in order to prevent or reduce deformity caused by lack of use. If you have ankylosing spondylitis, range of motion exercises of the spine are of benefit. Deep breathing exercises are emphasized, because motion of the ribs may eventually be restricted as the disease moves up the spine. If you smoke, you should stop in order to help prevent breathing complications.
If you find exercising to be painful, take a warm shower or bath before you exercise. This should lessen the pain and stiffness. Begin the exercises slowly and plan them for the times of the day when you have the least pain.
Good posture is essential for the person with ankylosing spondylitis and IBD. The spine should be kept as straight as possible at all times. Avoid sitting for prolonged periods of time. Sleep on your stomach or back on a firm mattress. If you need to use a pillow under your head, only use a thin one or one that fits the hollow of your neck. Avoid pillows under your knees. Keep your body as straight as you can. Avoid lying in a curled position.
Surgery
Surgical removal of the diseased bowel is usually a permanent cure for ulcerative colitis. This surgery also puts an end to any arthritis that may be present, unless the arthritis involves the spine. Ankylosing spondylitis may last even after removal of the diseased colon.
Crohn's disease does not respond as well to surgery. Surgical removal of the diseased bowel may be necessary, but it does not cure Crohn's disease. Thus, symptoms of arthritis may recur when and if bowel symptoms reappear.
Diet
Your doctor may give you a special diet to help control your bowel disease. If so, follow it carefully. Control of your bowel disease may also help your arthritis. Many diets are advertised as arthritis "cures." There is no known diet that can cure arthritis caused by IBD.
Living with arthritis and IBD can be very difficult at times. In addition to pain and discomfort, you may have to deal with changes in your appearance or in your leisure time activities. These changes may leave you sad, depressed, or angry. Relaxation techniques are coping skills that can help you relieve pain and stress and adjust to the changes in your life.
It helps to talk about your feelings with family members, friends, or someone else who has arthritis and IBD. Most chapters of the Arthritis Foundation offer. educational programs, materials, and support groups for people who have arthritis, as well as their families. If you are not already a member, you may want to become one. To locate the chapter nearest you, write to the address on the back cover of this pamphlet.
Another source of help is the Crohn's and Colitis Foundation of America, Inc. (CCFA). It provides educational materials and programs for people who have IBD. To locate the chapter nearest you, contact the CCFA at 444 Park Avenue South, New York, NY 10016. Their toll free number is 1-800-932-2423. In the greater New York area, please call 212/685-3440.
Adapted from the pamphlet originally prepared for the Arthritis Foundation
by Barbara J. Bodzin, R.N, MSN, Peter D. Utsinger, M.D., and Robert Inman,
M.D. This material is protected by copyright.
 when the bowel symptoms flare. An exception is during the first episode of arthritis, which can come at any time. One or more joints may be affected, and the symptoms often move from joint to joint. The hips, knees, and ankles are involved most often, although any joint may be affected. The joints may be very painful, red, and hot, but these symptoms usually do not result in permanent damage.<p> <p> About one-fourth of people with IBD who develop arthritis have a skin rash on the lower legs, frequently seen when the arthritis flares. One characteristic rash usually consists of small, reddish lumps which are very painful to the touch. This skin condition is called erythema nodosum.<p> <p> People with ulcerative colitis can develop another form of arthritis called <a href=){kind=link}
 is usually the doctor who directs treatment, but an arthritis or skin specialist may be needed as well.<p> <p> Medication<p> Several medications may be helpful in controlling arthritis and IBD. Sulfasalazine is a very useful sulfa drug. The other medications fall into certain groups of drugs: corticosteroids, immunosuppressives, and nonsteroidal anti-inflammatory drugs (NSAIDs).<p> Sulfasalazine (Azulfidine) helps to control both the bowel disease and the symptoms of arthritis. It is usually started at a low dose to lessen possible side effects and then increased if needed. The most common side effects are nausea and headaches. The nausea may be controlled by taking the drug with food, or by using the enteric-coated form of the drug. (This form is specially designed to dissolve in the bowel, not in the stomach.)<p> Sulfasalazine can usually be taken safely for a long time. Some people, however, develop an allergy to sulfasalazine in the form of a rash and fever. Giving the drug in frequent very small doses may enable the person to tolerate the drug without producing a rash or other reaction. When sulfasalazine cannot be taken due to side effects or allergy, olsalazine (Dipentum) or mesalamine (Asacol) may be taken, but these drugs have not been shown to be effective against arthritis.<p> Corticosteroids are similar to cortisone, a hormone produced by the body. They are strong, anti-inflammatory drugs, which can help both the symptoms of the bowel and the joints. They are used only when the symptoms are severe, because they may produce serious side effects when taken for a long time. These side effects include thinning of bones (osteoporosis), cataracts, reduced resistance to infection, diabetes, obesity, and high blood pressure.<p> Be sure to discuss the possible side effects with your doctor before taking corticosteroids. Most of the side effects decrease and eventually go away as the dosage is reduced and stopped. Once you begin taking these drugs, however, never stop or change the dosage on your own.<p> Immunosuppressives, such as azathioprine (Imuran) are used on occasion for arthritis and Crohn's disease. By suppressing the immune system, they reduce inflammation. The most common side effect of these medications is a decrease in white blood cells, which can cause an increased risk of infections. Other side effects of these medications may include fever, rash, vomiting, hair loss, and liver toxicity. Immunosuppressives, therefore, are used with caution.<p> Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are helpful in controlling the pain, swelling, and stiffness of inflamed joints. To work effectively, they must be taken every day during the arthritis episode.<p> NSAIDs may produce nausea, indigestion, and heart burn. In addition, they may cause bleeding from the stomach and make the underlying bowel disease worse, so they are used with caution in IBD. These side effects can usually be decreased if the drug is taken with food, fluid, or an antacid.<p> <p> Exercise and Posture<p> Your doctor or physical therapist will probably design a program of <a href=){kind=link}