Flare update

[Lam123]

A few weeks ago I went to ER with a flare a possible partial blockage. I'm on prednisone, crohns seems to have calm down and my knees were doing ok, until this week I lowered the prednisone and my knees are hurting again. I see the family dr on Monday to get referred for a rheumatologist. In the meantime I am adding ice, I bought tiger balm and might try taking some glucosamine.

Question, in the past, my knees only act up when the crohns flare, as soon as the crohns feels better the knees feel better. But this seems to be different, the knees are still sore and my crohns symptoms are calm, this happen to anyone?

 

[my little penguin]

Tagging Maya142


You can have spondyloarthritis associated with Ibd
Which has two types
Type I runs parallel to GI disease
Type II runs independent of GI disease and is more agressive

Ds has type II and takes higher doses of humira and mtx due to the juvenile spondyloarthritis even though lower doses fixes his Crohns

 

[Lam123]

So, could I have had type one and now have type two? It seems in the past it a
Ways calmed down right with the crohns, this time it's not. Or, is it possible my crohns isn't calm?

 

[my little penguin]

https://www.hindawi.com/journals/jir/2013/631408/

Table 1: Classification and features of articular involvement subsets in inflammatory bowel disease (IBD).

(i) Pauciarticular (less than 5 joints)
(ii) Asymmetric involvement
(iii) Acute, self-limiting attack (<10 weeks)
(iv) Usually coincides with relapse of IBD
(v) Strongly associated with other extra-intestinal manifestations
(vi) Lower limbs more affected
(vii) Associated with HLA DRB1, B35, B27


(i) Polyarticular (5 or more joints)
(ii) Symptoms persist for months or even years
(iii) May be erosive
(iv) Runs a course independent of IBD
(v) Affects both large and small joints
(vi) Strongly associated with uveitis
(vii) Associated with HLA B44

(i) Both axial and peripheral involvement


(i) Asymptomatic
(ii) Usually non progressive disease



(i) Usually precede the onset of IBD
(ii) Runs a course independent of IBD
(iii) Clinical course is similar to idiopathic ankylosing spondylitis
(iv) Disease progression leads to increasing immobility and ankylosing
(v) Associated with uveitis
(vi) Strongly associated with HLA B27



In 1998, Orchard et al. [26] distinguished two subtypes of peripheral arthritis: type 1, the pauciarticular form (involving fewer than 5 joints), acute and self-limited, which may precede the diagnosis of IBD, generally running parallel to the intestinal disease; type 2, the polyarticular form (involving 5 or more joints), with symptoms lasting for months or years, independently from inflammatory bowel disease. More recently, Smale et al. have shown another type of peripheral arthritis (type 3) that includes patients with both axial and peripheral forms [72].

 

[my little penguin]

http://www.arthritis.org/about-arthritis/types/inflammatory-bowel-disease/

Both CD and UC usually involve severe diarrhea, stomach pain, fatigue, and weight loss.

IBD-associated arthritis of the spine begins with subtle low back pain, especially in younger persons, and morning stiffness. It gets worse with prolonged sitting or standing, and improves with moderate activity. It is more common in CD than in UC and is independent of gastrointestinal symptoms.

Enteropathic arthritis that affects joints other than the low back usually doesn’t cause deformities or damage to the joints, and most often occurs at the same time as the bowel disease. There are 2 types. In type 1, fewer than 5 joints (pauciarticular) are affected: typically large joints, such as the knees, hips and shoulders. It usually lasting less than 10 weeks, and the acute attacks are strongly linked with IBD activity, most often with severe UC. Type 2 affects more than 5 joints (polyarticular) and can last months to years. It is usually more symmetric, affecting small joints of the hands, and is independent of bowel disease. Enthesitis (inflammation of the sites where tendons and ligaments attach to bone and muscle) affects the heel, knee, buttocks, and foot.

Lastly, reactive arthritis is an acute, asymmetric oligoarthritis, usually in the knees and/or ankles. It appears up to several weeks after the initial gut infection.

 

[Lam123]

Ok, it's only been a few weeks since the initial symptoms of flare, so I guess it's hard to tell. Think I should still book with a rheumatologist? Or wait it out a few more weeks to see if it calms down?

 

[my little penguin]

Rheumo is best to determine which type and then how to manage it when you flare even if it's type I
Since it tends to happen over and over

Good luck

 

[Lam123]

Yes, it does happen every time I flare. I will keep my appointments.

 

[Maya142]

Since you were just flaring and probably are still inflamed (even if the inflammation is a bit better), it sounds like it's type 1. But I would definitely see a rheumatologist.

My daughter uses Voltaren gel on her knees - it really helps.

 

[Lam123]

Ok, in the meantime I bought some glucosamine to try. I guess it wouldn't hurt. Also been applying ice. I'm also going to be very careful with my diet and make sure it's easier foods to digest, even if I'm not in pain. Hopefully inflammation will go down in my gut and transfer over to my knees.

 

[Lam123]

Thank you for all the support and suggestions, I really appreciate it.

 

[cmack]

Lam,

I hope you feel better soon. Pain sucks!

 

[Lam123]

Thanks! I know it does suck, but I'm trying to stay positive and not get myself down.

 

[cmack]

Lam,

Good thinking, always explore new options and never let this disease beat you! You are strong. Positive thinking goes a long way during times of pain and struggle.

All the very best and then some,

cmack

 

[Ozboz]

I have ankylosing spondylitis 10% of people with crohns get it it is very painfull all my joints hurt and my spine is fused in a few places and my neck is hard to turn to the left