Introduction:
Inflammatory bowel disease (IBD) is a condition of inflammation of all or part of the digestive tract. Rheumatoid arthritis (RA) is an autoimmune disease affecting joints. It was found that there is a link between RA and IBD. Studies have found that arthritis can manifest into IBD. The association between arthritis and IBD was found in 1929. This was further investigated to notice that peripheral arthritis was linked with IBD in 1950. The concept of spondyloarthropathy (SpA) was done in 1960.
What Is IBD?
IBD is a chronic condition that involves inflammation of the gastrointestinal tract. It involves two major types of IBD, which include:
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Crohn’s disease.
Ulcerative colitis affects any part of the large intestine. Crohn's disease affects any part of the gastrointestinal tract (mouth to anus). There is another type of IBD that is characterized by indeterminate colitis inflammatory bowel disease that has both features of Crohn’s disease and ulcerative colitis.
What Are the Causes of IBD?
IBD is an autoimmune disease in which the immune system attacks healthy cells or tissues. There are no details about the triggers of IBD. Studies are being conducted to know about the mechanisms involved and genetic factors, environmental factors, infectious, immune, and other factors, including the gut microbiome.
IBD may affect any race or ethnic group. It was found that a greater risk for IBD was observed among Jewish ancestry. This condition can run in families. It can also develop abruptly without a family history. IBD may be observed in children as well.
What Are the Symptoms of IBD?
IBD may result in various problems in the colon and rectum. The first signs appear when gastric irritation occurs due to medications or infection. The symptoms of IBD include:
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Experience stomach pain.
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Diarrhea, and sometimes it may happen with blood.
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Fecal incontinence or urgency to bowel movements.
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Rectal bleeding may be observed.
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Weight loss can occur.
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Fever, anemia, and malnutrition can be observed.
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Anxiety and depression may be seen.
IBD may sometimes exhibit swelling or masses in the intestine. If the infection is not controlled, it may cause damage to the intestine. IBD causes the following in the intestine to damage the intestine:
Abscesses: These abscesses form pockets and tear the intestinal wall.
Strictures: These are narrowed areas in the bowel.
Fistulas: These are abnormal passageways that connect two organs that are usually not connected. Fistulas are formed when inflammation and pressure break down the tissue of the bowel, causing the leakage of the bowel contents into the bladder, urethra, or vagina.
Long-term inflammation in the colon may increase the risk of colon cancer.
Sometimes, IBD may affect areas outside the intestine. These include:
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Eyes: Redness and inflammation of the eye causing episcleritis (inflammation of the inner eyelid and white part of the eye).
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Mouth: Mouth sores and ulcers may be observed.
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Liver: Fat deposition may be observed.
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Biliary tract: Gallstones, and inflammation of the bile duct may be experienced.
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Kidneys: Kidney stones may develop. Other issues include hydronephrosis which is swollen kidneys due to backup of urine, fistulas, and urinary tract infections.
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Skin: Erythema nodosum, a tender, red bump on the shins, pyoderma gangrenosum, a rare condition causing severe skin ulcers on the legs) may be observed.
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Joints and Spine: Spondylolysis, a stress fracture of the vertebrae may occur. Sacroiliitis (inflammation of the lower spine connecting the pelvis) and arthritis of the limbs may be observed.
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Blood Circulation: Phlebitis (inflammation of blood vessels) may occur.
Adverse effects of the treatment of joint pains with corticosteroids may lead to the development of osteonecrosis. Bacterial infections of sacroiliac or peripheral joints may occur because of fistulization or bacteremia.
What Are the Rare Rheumatic Manifestations of Inflammatory Bowel Disease?
IBD, Crohn’s disease (CD), and ulcerative colitis (UC) are systemic disorders that can create extraintestinal manifestations among 40 percent of people. Rheumatological manifestations include:
Peripheral Arthritis:
Peripheral arthropathy ranges from 17 percent to 20 percent among those with IBD.
Axial involvement. It is more commonly observed among those with Crohn’s disease. Many studies have noticed that peripheral arthropathy is more common among CD patients. It is classified into pauciarticular or polyarticular arthropathy. These types do not have axial involvement.
In pauciarticular form, the symptoms are acute and self-limited. It can affect both large and small joints. Lower limbs are affected more. The episodes may last for six to ten weeks. The relapse tends to occur more frequently. These are observed with IBD relapses. It was observed that the patients exhibited arthropathy three years before they were diagnosed with IBD.
In the polyarticular type, the disease is chronic, independent of IBD exacerbation and other extraintestinal manifestations. Enthesopathy (affects the Achilles tendon and plantar fascia insertion) can be observed. Various studies have found that colon involvement increases the susceptibility to peripheral arthritis.
Ankylosing Spondylitis and Other Forms of Axial Involvement:
Axial involvement is observed in both CD and UC. It is found a little more commonly among those with CD (5 percent -22 percent). It was noted that a prevalence of 10 percent to 20 percent is observed in scroiliitis (SI), and 7 percent to 12 percent is observed in ankylosing spondylitis (AS). Axial symptoms were found to precede gut symptoms.
AS linked with IBD can begin at any age. Axial involvement may range from inflammatory lower back pain with or without radiological evidence of SI to asymptomatic SI and true AS with pain and spine stiffness and radiological features like squaring syndesmophytes (calcifications in the spinal ligament) and bamboo spine (occurs due to vertebral body fusion by marginal syndesmophytes).
Enthesopathy:
Enthesopathy is a pathologic change at an enthesis (a site of insertion of a tendon or ligament into bones). It manifests as ossification of the entheses. In the case of IBD, enteropathies can be observed at the heel (insertion of the Achilles tendon, or the plantar fascia) or the knee (insertion of patellar tendon). Inflammation of the enthesis may lead to erosive lesions resulting in spur formation.
Osteoporosis:
Osteoporosis is a condition in which the bone is fragile. In this condition, the bone mass and architecture change. It may occur due to corticosteroids given in the case of IBD.
HOA: In this condition, there is an excess proliferation of skin and bone. Excess proliferation is observed at the distal parts of the extremities. Its feature is a bulbous deformity of the tips of the digits called clubbing. In the advanced stage, periosteal proliferation of the tubular bones and synovial effusions can be observed.
IBD belongs to SpA, and shares features of other disorders like the asymmetric pattern of peripheral joint involvement, SI and spondylitis, peripheral enthesopathy, the absence of rheumatoid factor, the link with human leukocyte antigen (HLA) B27, as well as extraarticular features, that include uveitis, carditis, skin, and mucus membrane lesions.
Conclusion:
IBD is an autoimmune condition that may have rheumatic manifestations. It was found that almost 62 percent of people affected by IBD exhibit rheumatic manifestations. Along with these manifestations, IBD may cause other issues and complications as well. Hence it becomes important to know about IBD, its causes, symptoms, and rheumatic manifestation. Knowing about these may help in identifying the disease early. Early diagnosis may help in effective treatment. This in turn helps in achieving a good quality of life.
