Spondyloarthropathy associated with Inflammatory Bowel Disease

What is IBD-related SpA?

This condition occurs in some, though not all, people who have either Crohn’s Disease or Ulcerative Colitis. Sometimes the SpA can precede the IBD by some months or even years.

How is IBD-related SpA diagnosed?

The condition is diagnosed by a Rheumatologist on the basis of a story suggestive of SpA symptoms, examination, blood tests and imaging. Often the diagnosis is suspected by a Gastroenterology Specialist who may then make a referral to a Rheumatologist.

The symptoms of IBD-related SpA

The typical symptoms are those typical to all SpAs:

  • Inflammatory back pain
  • Joint pain and/or swelling
  • Enthesitis

Fatigue is common but this often correlates most with the degree of severity of the underlying IBD, but can also link to the degree of associated anemia. If someone with IBD is HLA B27 positive then the likelihood of having additional aSpA is increased.

Who gets it?

Anybody with, or at risk of, IBD can get IBD-related SpA. The back symptoms tend to be worse in people with IBD who are HLA B27 positive.

This is a long-term condition. What does the future hold?

Often the musculoskeletal symptoms vary in tandem with the activity of the IBD. Successful treatment of the IBD often leads to improvement of the musculoskeletal symptoms.

What treatments are there?

NSAID painkillers are often avoided because they can aggravate the inflammatory bowel symptoms. So the use of steroids is arguably more common than in other SpAs. Of course steroids improve both bowel and musculoskeletal symptoms.

Immunosuppressant drugs are frequently used and the choice on which to use needs to be taken carefully and in discussion with the Gastroenterologist. Sulfasalazine and Methotrexate are used as long-term treatments (see Patient Information on Disease Modifying Drugs).

Because of the effect of IBD, and any steroid treatment, on the skeleton, it’s especially important to assess the skeleton for low bone density with a DXA (‘DEXA’) scan; and as a result sometimes its wise to treat with anti-osteoporosis medications such as Alendronic Acid or Risedronate. Also TNFi (Biologic) drugs are very effective for IBD-related SpA and can be used to treat the IBD too; see Patient Information on Biologic Drugs.

What things can I do if I have IBD-related SpA?

Bowel health is important and advice in terms of what medications can be taken and whether specific dietary changes are going to be helpful should be taken from the Gastroenterology team. Smoking worsens inflammation in the gut and in joints and should be avoided.

See also Patient Information on Spondyloarthritis