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Arthritis and Bowel Disease


The cause of inflammatory bowel disease is not known. Research suggests that the immune system, the body's natural defense against foreign invaders, is somehow altered in people with these conditions. Researchers believe that the chronic (long-lasting) inflammation present in the intestines of persons with both forms of IBD damages the bowel. This may permit bacteria to enter the damaged bowel wall and circulate through the bloodstream. The body's reaction to this bacteria may then cause problems in other areas of the body. The most common is inflammation of the joints. Other problems include skin sores, inflammation of the eyes, and certain types of liver disease.

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.
 


Edited by Frederick Matsen III MD Chairman, Department of Orthopaedics, University of Washington, Seattle, USA

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