Inflammatory Bowel Disease.
Last updated Wednesday, December 22, 2004
Management and treatmentTreatment Usually these conditions are treated with medication, exercise, and sometimes, surgery.Health care team A gastroenterologist (specialist in diseases of the digestive tract) is
usually the doctor who directs treatment, but an arthritis or skin
specialist may be needed as well.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.
Exercise and therapy
Your doctor or physical therapist will probably design a program of 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.
Medications
Several medications
may be helpful in controlling arthritis and IBD. Sulfasalazine is a
very useful sulfa drug. The other medications fall into certain groups
of drugs: corticosteroids, immunosuppressives, and nonsteroidal anti-inflammatory drugs (NSAIDs).
Sulfasalazine (Azulfidine) helps to control both the bowel disease and
the symptoms of arthritis. It is usually started at a low dose to
lessen possible side effects and then increased if needed. The most
common side effects are nausea and headaches. The nausea may be
controlled by taking the drug with food, or by using the enteric-coated
form of the drug. (This form is specially designed to dissolve in the
bowel, not in the stomach.)
Sulfasalazine can usually be taken safely for a long time.
Some people, however, develop an allergy to sulfasalazine in the form
of a rash and fever. Giving the drug in frequent very small doses may
enable the person to tolerate the drug without producing a rash or
other reaction. When sulfasalazine cannot be taken due to side effects
or allergy, olsalazine (Dipentum) or mesalamine (Asacol) may be taken,
but these drugs have not been shown to be effective against arthritis.
Corticosteroids
are similar to cortisone, a hormone produced by the body. They are
strong, anti-inflammatory drugs, which can help both the symptoms of
the bowel and the joints. They are used only when the symptoms are
severe, because they may produce serious side effects when taken for a
long time. These side effects include thinning of bones (osteoporosis), cataracts, reduced resistance to infection, diabetes, obesity, and high blood pressure.
Be sure to discuss the possible side effects with your doctor before
taking corticosteroids. Most of the side effects decrease and
eventually go away as the dosage is reduced and stopped. Once you begin
taking these drugs, however, never stop or change the dosage on your
own.
Immunosuppressives, such as azathioprine (Imuran) are used on
occasion for arthritis and Crohn's disease. By suppressing the immune
system, they reduce inflammation. The most common side effect of these
medications is a decrease in white blood cells, which can cause an
increased risk of infections. Other side effects of these medications
may include fever, rash, vomiting, hair loss, and liver toxicity.
Immunosuppressives, therefore, are used with caution.
Nonsteroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofen, are helpful in controlling the pain, swelling, and
stiffness of inflamed joints. To work effectively, they must be taken
every day during the arthritis episode.
NSAIDs may produce nausea, indigestion, and heart burn. In
addition, they may cause bleeding from the stomach and make the
underlying bowel disease worse, so they are used with caution in IBD.
These side effects can usually be decreased if the drug is taken with
food, fluid, or an antacid.
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.
How useful was this page or article?
|
|