Ulcerative Colitis and Joint Pain

The exact cause of non-GI complications like joint pain in UC isn’t fully understood.

However, research suggests that gut inflammation associated with UC may trigger an immune response, which could lead to inflammation elsewhere in your body. This is sometimes referred to as the gut-brain axis.

Two types of conditions may affect your joints if you’ve received a diagnosis of UC:

• Arthritis: This is the most common non-GI complication of IBD. Arthritis is an inflammatory condition that may cause swelling, stiffness, and pain in your joints.
• Arthralgia: This is a pain in the joints without any inflammation.

Arthritis is more common as you age. However, arthritis associated with UC typically starts at a younger age, according to the Crohn’s and Colitis Foundation.

The following types of arthritis are more likely to affect people with UC:

Peripheral spondyloarthritis

Peripheral spondyloarthritis is a type of spondyloarthritis (SpA), which refers to a group of inflammatory conditions that affect the spine and other joints.

Peripheral spondyloarthritis affects large joints in your arms and legs, such as your:

• knees
• ankles
• wrists
• shoulders
• elbows

Research suggests that up to 13% of people with IBD may also have peripheral spondyloarthritis.

The level of pain tends to mirror your UC symptoms. The more severe your UC, the more severe your arthritis symptoms will be. Once your bowel symptoms go away, your joint pain and swelling should go away, too.

Axial spondyloarthritis (axSpA)

Axial spondyloarthritis (axSpA) is a type of SpA that affects the lower spine and sacroiliac joints in the pelvis.

A 2024 study of 73 participants with UC found that 19.3% had axSpA. The high prevalence of axSpA in people with UC may be due to having more of the gut bacteria Escherichia Shigella.

Symptoms of axSpA may develop gradually and cause the bones of your spine to fuse and limit your movement, according to the Arthritis Foundation.

Ankylosing spondylitis (AS)

Ankylosing spondylitis (AS) is a more severe form of axSpA.

A 2023 review found that people with UC are more likely to develop UC than those without UC. The authors note that having UC and a positive HLA-B27 blood test is associated with a greater risk of developing AS.

According to the Arthritis Foundation, HLA-B27 is a gene strongly associated with spondyloarthropathies, especially AS. The gene may affect your gut microbiome, which could potentially lead to more inflammation.

AS may affect your flexibility by making your back stiff and forcing you into a bent-over posture. This type of arthritis doesn’t improve when you treat UC symptoms.

Treatment for joint pain related to UC will depend on several factors, such as the underlying cause and severity of your symptoms.

Your treatment plan may include a combination of medications and at-home remedies.

Medications

Some medications that help treat arthritis may irritate your intestines and worsen inflammation. These may include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen.

Instead, a doctor may prescribe a UC drug to help bring down inflammation in both the joints and intestines. According to the Arthritis Foundation, these may include:

• corticosteroids, such as prednisone
• immunomodulators, such as sulfasalazine (Azulfidine) and methotrexate
• aminosalicylates, such as sulfasalazine, balsalazide, and mesalamine
• injectable biologics, such as adalimumab (Humira), golimumab (Simponi), and infliximab (Remicade)

A medication called Janus kinase (JAK) inhibitors may also help reduce inflammation in certain types of arthritis.

Speak with a healthcare professional about your treatment options, as some medications for UC may worsen arthritis.

For example, a 2023 study found that the IBD biologic medication vedolizumab increased the chance of developing new or recurring symptoms of arthralgia.

A healthcare professional could help develop the best treatment plan for you.

Home remedies

Several home remedies may also help you manage your joint pain, including:

• applying a warm compress or heating pad to achy joints
• stretching the affected joints and doing range-of-motion exercises
• icing and elevating the inflamed or swollen joint
• trying alternative therapies, such as acupuncture, massage, and psychotherapy

A physical therapist could help develop a movement plan to manage your arthritis symptoms.

You’ll likely need the help of a rheumatologist to treat your joint pain. A rheumatologist is an arthritis specialist. They will ask questions about your pain, such as:

• When did the joint pain start?
• What does it feel like?
• What makes it better or worse?
• Do you have swelling in the joints?

Keep a journal of your pain for 2 weeks ahead of time. This can help you prepare for your appointment. Also, create a list of questions you’d like to ask your doctor.

The doctor may perform tests to find out whether you have arthritis or another condition that affects your joints. These tests can include:

• blood tests for markers of inflammation or genes that are common in people with IBD and arthritis
• joint fluid analysis
• MRI scan
• X-rays

Here are some things you can do to help prevent joint pain:

• Take your medications exactly as your doctor prescribed, and don’t skip doses.
• Eat a well-balanced, anti-inflammatory diet. A doctor can provide guidelines if you need help planning meals.
• Avoid foods that worsen your UC symptoms. This may include spicy, high fiber, high fat, or dairy foods.
• Practice relaxation techniques such as deep breathing to reduce your stress, which can trigger UC flare-ups.

Can ulcerative colitis cause severe joint pain?

Ulcerative colitis is linked to conditions that may cause severe joint pain, such as arthritis and arthralgia.

What does ulcerative colitis pain feel like?

The most common symptoms of ulcerative colitis are gastrointestinal, which may include diarrhea, stomach pain, and frequent stools, among others.

What are the 3 stages of ulcerative colitis?

There are three stages of ulcerative colitis (UC), which are classified based on your daily bowel movements and associated symptoms. Mild UC is less than four bowel movements with no symptoms. Moderate UC is more than four bowel movements and sometimes having bloody stools. Severe UC is more than six bowel movements with systemic symptoms and bloody stools.

What is the end stage of ulcerative colitis?

The most severe stage of ulcerative colitis is fulminant colitis, which is when you experience more than 10 bloody stools per day. It’s important to get immediate medical attention if you experience this.

UC is a chronic condition that causes inflammation in your GI tract. Sometimes, UC may lead to joint pain and conditions like arthritis.

Speak with a healthcare professional if you experience joint pain and you’re living with UC. They could provide a proper diagnosis and develop a treatment plan that’s right for you.

Read this article in Spanish.