Inflammatory Bowel Disease.
Last updated Wednesday, December 22, 2004
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Figure 1 - The digestive tract
Figure 2 - The pelvis, location of the sacroiliac joints
Symptoms
Symptoms
Ulcerative colitis
Ulcerative colitis produces inflammation and breakdown along the
lining of the colon (see figure 1). Inflammation usually begins in the
rectum and extends up the colon. Symptoms may include rectal bleeding,
abdominal cramping, weight loss, and fever.
The bowel symptoms often occur before the symptoms of arthritis.
When ulcerative colitis is present, the arthritis is most likely to
occur if there is severe bleeding or if the area around the anus is
inflamed. When only the rectum is involved, the chance of getting
arthritis is less.
Most of the time, the arthritis flares (becomes worse) 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.
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.
People with ulcerative colitis can develop another form of arthritis called ankylosing spondylitis,
which involves inflammation of the spine. It usually begins around the
sacroiliac joints, at the bottom of the back (see figure 2). Symptoms
of spondylitis generally do not accompany bowel symptoms in ulcerative
colitis. If just the sacroiliac joints are inflamed, the symptoms are
fairly mild. When the spine is affected, however, it may be quite
painful and even disabling. This can result in stiffness or rigidity.
Crohn's disease
Crohn's disease usually involves either the colon or the ileum, the
lower small intestine. It may affect both, or any part of the digestive
tract, from the mouth to the rectum. The inflammation involves all
layers of the intestinal wall, and may lead to scarring and narrowing
of the bowel. Fever, weight loss, and loss of appetite are common
symptoms of Crohn's disease.
The arthritis of Crohn's disease can occur before, after, or
at the same time as the bowel symptoms. As with ulcerative colitis, the
large joints such as the knees and ankles are generally affected,
though not necessarily on both sides of the body, and back pain can
result from ankylosing spondylitis.
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