Up until now, we have been discussing the problems that arise from inflammation in the intestines. In addition to those, people with IBD sometimes suffer from “extra-intestinal manifestations” or conditions that affect areas outside of the intestines. These include the eyes, mouth, blood, joints, bones, skin and liver.
Flare-ups of extra-intestinal manifestations do not necessarily correlate to flare-ups of IBD. Sometimes they appear when intestinal problems are in remission; other times they can be in remission when the gut problems are active. There is also no guarantee that someone with IBD will experience these problems; some people may never have extra-intestinal manifestations.
Some people with IBD have an increased tendency to develop blood clots. For a variety of different reasons, those with IBD are predisposed to forming clots in their veins, particularly during periods of inactivity. It is very important during periods of bed rest, to “pump” the feet and move the legs to prevent clots forming in the calves. In addition, it is a good idea to get up out of bed and move around a little, even though the desire to stay hunkered down in the sheets is a strong one.
Occasionally people with IBD experience inflammation in their eyes. The inflammation can affect different parts of the eye, resulting in mild symptoms such as redness, some burning sensation and tearing, to more severe symptoms such as blurred vision, headache and eye pain. If any of these symptoms appear, it is best to see your physician.
When joints become inflamed and painful due to intestinal complications, the medical term used is “enteropathic arthropathy” or EA. “Entero” means “intestinal”; “enteropathic” means disease caused by, or related to, the intestines.” “Arthropathy” means a disease of the joints.
Like non-enteropathic arthropathy, joint inflammation is experienced by redness, heat, pain, swelling and stiffness of the joints. Sounds like arthritis, doesn’t it? In fact many patients describe it as arthritis to their doctors, and if it weren’t for their IBD, their physicians would have diagnosed it as such.
The big difference with EA as opposed to arthritis is that it is non-destructive, and the swelling and pain are usually temporary with no damage to joints after a flare-up. Oddly enough, arthralgia (joint pain) can occur separate from flare-ups of IBD; the patterns are quite variant and inconsistent.
EA often affects the large joints such as the hips and knees, but can sometimes attack the small joints of the fingers and toes.
Up to 5% of IBD patients develop primary sclerosing cholangitis (PSC). PSC is more typically associated with ulcerative colitis than Crohn’s disease. This serious liver disease results from inflammation of the small vessels that transport bile from the liver to the small bowel. If the condition becomes severe, it can cause damage to the liver and potentially, liver failure. If you have IBD and you develop a fever and yellowing of your skin (jaundice), you should be seen immediately by your physician.
Osteoporosis, or weakening of the bones, is due to the reduction of minerals, notably calcium, in the bones. This softening of the bones could be due to malnutrition, malabsorption of nutrients from the small bowel or medications that interfere with calcium and vitamin D absorption (such as steroids). Regardless of the cause, people with IBD are at higher risk of developing osteoporosis than the average population.
Those with osteoporosis have a higher risk of fractures so it is prudent to have a Bone Mineral Density (BMD) scan every year to enable early detection and treatment.
Erythema nodosum (EN), pyoderma gangrenosum (PG) and psoriasis are three skin conditions sometimes associated with IBD.
EN appears as dark coloured (red or purple), painful bumps on the skin, usually on the shins. These lesions (bumps) tend to appear when bowel troubles are active, and go away when the bowel flare-ups subside.
PG lesions also typically appear on the legs, but can also be located close to an ileostomy site. They start off looking red and tender, gradually becoming more like a blister in appearance. They eventually do “ulcerate” or break open, seeping fluid from the sore. If large and “weepy”, PG lesions may require dressings.
People with Crohn’s disease appear to have a greater chance of developing psoriasis than the average person. Psoriasis is characterized by itchy, red patches covered with scales. Lesions can occur on the scalp, ears, elbows, knees, navel, genitalia or buttocks.
Ankylosing Spondylitis (AS) is a severe form of arthritis that is more commonly associated with ulcerative colitis (UC) than with Crohn’s disease (CD), although it can manifest with either. It may precede the onset of bowel symptoms by many years and at first, appears unrelated to IBD.
AS symptoms of pain and stiffness of the sacroiliac joints of the lower back do not coincide with flare-ups of bowel problems, and often appear independent of any GI disease. Surgery to remove the colon does not seem to relieve or cure AS. If the disease spreads up the spine, the bones may fuse together, causing permanent stiffness and lack of mobility.
A less severe form of arthritis of the sacroiliac joints is known as sacroiliitis. In this case, pain and stiffness develop in the lower back and possibly the hips. Fusion of the bones of the back does not occur as it does with ankylosing spondylitis.
Sores in the Mouth
Cankerous sores in the mouth can also afflict those with IBD. When related to intestinal disease, these sores appear in clusters, can be quite large and painful, are present for a few weeks and usually coincide with a flare-up of IBD.
This educational content was originally published by The Crohn’s and Colitis Foundation of Canada (CCFC) is a national not-for-profit voluntary medical research Foundation. Its mission is to find the cure for inflammatory bowel disease. Please join with us in our mission to “Find the Cure” by clicking on our online donations and giving what you can.