Hi again,
I'll share with you some of my experience and what I know about arthropathy in IBD. Arthropathy (arthralgia and arthritis) is the most common extra-intestinal manifestion of IBD. Here is the ONLY quantitative study about peripheral arthritis in IBD. It was published in 1998, by Orchard and al, and to date, its the only source of empiric information on the subject. The difference is also explained between IBD Arthralgia (pain only) and arthritis (pain, swelling -can be minimal just like my case). I suggest you print the article for easier lecture, as it is filled with so much information.
http://gut.bmj.com/content/42/3/387.full.pdf+html
some GIs, even rheumatologists are not aware that there are 2 types of peripheral IBD arthritis, as found by Orchard and al... My first rhuemy had no clue :frown:
Type1 (most well-known): dependant of IBD activity (announcing or during a flare) or
Type 2 Independant, when there can be no IBD activity, so even when in remission
The 2 types can intertwine, but in general, they present as 2 distinct types with different pattern of disease. Type 1 larger joints and moving around, type 2 mimicking rheumatoid arthritis, (another disease of the joints), symmetrical/bilateral joints affected and affecting small joints primarily such as hands. As you will see in graphs of the reaserch, MCP stands for the joints in the middle of the hands., which are the most commonly affected in IBD arthritis type 2.
Here's my story. My arthritic symptoms in both wrists and fingers started in january 2013, right after a CD remission with 50 mg of tapered prednisone and overwork with hands... I did have pain, little swelling and great lack of flexibility (even more in the morning or after lack of activity.) Nowadays, I barely have pain anymore, but only little lack of flexibility. :ysmile: My condition always improuved slowly since it first started, I am lucky. IBD peripheral type 2 (which i am) episodes lasts around 3 years average as you will see in the tables of the article. I seem to fall in this average, luckly and i feel pretty confident the arthritis will be gone within the next year if I continue on this trend.
Arthritis type 1 and arthralgia fallow the course of IBD activity and will usually resume when IBD is treated.
I had a horrible 8 month journey with my first rhuemy and its a chance I finally met this nice surgeon (where the rheumy sent me for operation with wrong diagnosis!!!) because he,s the one who propose I do a BONE SCINTIGRAPHY, he strongly suspected I had arthritis, and not other conditions diagnosed by the rheumy. I cant blame my GI and GP because we thought we could trust that rheumy at first... BS is the most sensitive test to differenciate arthralgia and arthritis. all previous tests (blood, ultra-sound, MRI) were normal. the BS revealed abnormal chronic mild activity around my upper body joints. So finally I was diagnosed properly and prescribed methotrexate instead of my purinethol when I returned to the rhuemy. (I wish i had been proposed sulpha at first wich is less toxic, along with my purinethol, but I was unaware of all possibilities at that point) so i coulnt discuss much my treatment with the doctor and simply accepted what was proposed. I after changed Rheumy when I got thr real diagnostic.happy with the new one!
you can also read further more some of my threads when I first came here in the forum in search for answers :
http://www.crohnsforum.com/showthread.php?t=57693
I tried MANY alternative treatments you can see in my thread, such as even EEN, whicis typically used in CD. The fallowing study shows that EEN has comparative effect to prednisone (cortico-steroids) on reduction of symptoms in rheumatoid arthritis.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805936/
Its the only study about EEN and any arthritic disease. I pushed for it to my doctors and I gave it a try last february, but not much effect unfortunately in my case. Since you have CD and as another poster mentions it, it seems unclear your CD is still a bit active or not, maybe EEN could be a possibility as a whole treatment if your CD is active. This treatment option will most likely never be offered to you since you are in Toronto and over 18 (in North America, only pediatrics are offered EEN, as opposed to other places in the world such as UK or Israel where its very popular also in adult as treatment for CD). So in case of CD or real arthritis, if EEN sounds appealing to you and prefer trying an alternative before medication, you can discuss about it with your doctor. Some people find it very difficult to fallow EEN diet, but for me it was alright.
Till this date, Ive always been in search for alternative help over phamaceutical options, which I want to keep for ultimate resources. Each individual is free of choice, of course. alternatives can be Omega 3 fish oil, curcumine extract, acupuncture, etc... among all the natural things I have tried, curcuminoid extract is the only one which made a clear improuvement. always best to ask your doctor before trying anything.
Several medication can be offered for IBD arthritis, prednisone, salazopyrine(sulpha), methotrexate, and biologics, some people tried LND (low dose naltrexsone). I am currently on methotrexate (not much help, but yes for CD), tried prednisone 15 mg in february 2014 = great help for morning stiffeness, comparative as Curcuminoid extract for me). In May, I tried sulpha for a month, but chose to discontinue it due to possible side effect, so I didnt test truly its efficacy on me.
For arthralgia, my first GI mentionned Cymbalta, an anti-depressant witch has the capacity to block pain signals. The website of Cymbalta is pretty informative on the subject.
Your GI can recommend a rhuematologist. All of this takes a lot of time unfortunately (3 to 6 months) and so do all the testing for diagnosis. If you describe your symptoms as debilitating as you mention sometimes difficulty walking or even holding a glass, if you are treated in a hospital which offer rheumatology, you GI will most likely be able to ask for a emergency appointment in the very near future. They normally keep spots for emergencies and rhuematologists are more available than GI who have to split between endoscopy and clinic. Ive read several posts in the forum of people with joint issues being told by their doctors to ''suck it up'' or were not taken seriously. Makes me so sad. This can happen unfortunately, so dont come out of your appointment without a plan for this pain :ysmile:
