Management of joint pain in patients with IBD is not always straightforward, says Dr. Falloon, and may require a multipronged approach. That means working not only with a gastroenterologist but with a rheumatologist as well.
The first step in managing your joint pain is to get control of your Crohn’s disease, says Swaminath. Often, Crohn’s disease flares and joint pain happen simultaneously, so if you can take care of one problem, the other will also improve.
But depending on how painful or frequently the joint pain flares up, your doctor may recommend one or more of the following therapies.
Physical Therapy to Keep You Moving
Working with a physical therapist, who can teach you range of motion and strengthening exercises, can be effective for managing pain, says Falloon.
Exercise helps reduce stiffness, maintain joint mobility, and strengthen the muscles around the joints.
One research review found that doing resistance training, a form of exercise that increases muscle strength, in physical therapy can prevent and limit the development of osteoarthritis, a common form of arthritis that’s associated with IBD.
Consult with your doctor before starting a new exercise program.
Prescription Medications That Control Inflammation
Doctors focus on controlling the inflammation within the digestive tract using anti-inflammatory medications.
“We’re focused on getting the IBD under control, and if we’ve got the drug that does that, chances are that patient is going to do really well from the joint perspective,” says Swaminath.
One of the older drugs that have been around for decades, sulfasalazine, was initially used for people with arthritis, says Swaminath. But the drug is also effective in people with Crohn’s disease, with an anti-inflammatory effect that helps both the gut and joints. Sulfasalazine can decrease the pain and swelling of arthritis and prevent joint damage.
Other options are biologic drugs, which reduce inflammation and can help prevent joint damage, says Falloon. They are also commonly used to treat a number of types of inflammatory arthritis. But ask your doctor which one is right for you, as some biologics aren’t approved for IBD. The Arthritis Foundation has a list of more than two dozen available biologics for arthritis, along with their benefits and risks.
Over-the-Counter Medications, Though Some May Cause Irritation
Several medications are available to manage joint pain, including nonsteroidal anti-inflammatory drugs (NSAIDs), Swaminath says. But for some people, use of NSAIDs, like ibuprofen or naproxen, may cause a flare. That’s why it’s important to discuss pain medication options with your doctor.
But if the pain is unbearable and short-term relief is needed, acetaminophen (Tylenol) is an option.
Corticosteroid Therapy, but Only for the Short-Term
“Steroids are a short-term solution that can often be quite effective for both gut and joint symptoms,” says Swaminath. “We might use steroids to make a patient quickly comfortable.”
Because they can cause significant side effects in both the long and short term, corticosteroids (steroids) are usually taken only for short periods of time to help control joint pain during a Crohn’s disease flare.
Supplements, Though It’s Still Not Clear if They Work
“Supplements are completely unregulated, and the claims that they make can be founded on very little data, so it makes it quite difficult to know if they will help,” says Swaminath.
Some people with joint pain take supplements such as glucosamine with chondroitin sulfate, curcumin, and omega-3 fatty acids such as fish oil. But as Swaminath said, research hasn’t shown consistent results of their efficacy for arthritis.
One research review on the use of probiotics for inflammatory forms of arthritis suggested that supplements may improve symptoms (including in one study on IBD-related arthritis). More randomized controlled trials are still needed to determine their safety, efficacy, and optimal dosing.